MED SURG CH. 41 NCLEX QUESTIONS

A patient with cirrhosis has esophageal varices and hemorrhoids. The nurse understands that varices and hemorrhoids are caused by: 1. Blood vessels weakened by malnutrition 2. Inability to conjugate and excrete bilirubin 3. Elevated pressure in GI blood vessels 4. Fluid retention associated with excess aldosterone

3. Elevated pressure in GI blood vessels Distended, engorged vessels in the esophagus are called esophageal varices. They are fragile and bleed easily, with the potential for fatal hemorrhage. Circumstances that may trigger bleeding in the esophageal varices and hemorrhoids include irritation and increased intraabdominal pressure.

A patient who has hepatitis reports that she is itching and cannot resist scratching. Which measures should help to control the itching? (Select all that apply) 1. Apply lubricating lotion 2. Administer prescribed antihistamine 3. Use tepid water for bathing 4. Vigourously massage affected areas 5. Administer prescribed antibiotics

1. Apply lubricating lotion 2. Administer prescribed antihistamine 3. Use tepid water for bathing Moisturizing lotions protect the skin and can help relieve itching associated with jaundice. The patient should bathe in tepid water, and pat dry. Mild soap is used unless it seems to increase symptoms. Lubricating lotions or topical antipruritics can be applied. Use light strokes in the direction of the heart. Select older, soft sheets. Gently pat the skin instead of scratching to reduce the itching sensation. Vigorous massage can further irritate the skin. If a patient is confused, trim the fingernails as agency policy permits. Mittens may be needed to prevent skin injury. If conservative measures are not effective, consult the physician about ordering an antihistamine. If the event that the patient is having an allergic reaction to antibiotics, contact the physician before continuing the medications.

The nurse knows that which are the functions of bile? Select all that apply. 1. Emulsifies fat 2. Removes some toxins 3. Neutralizes alkalytic chime 4. Helps absorb fat-soluble vitamins 5. Converts urobilinogen to bilirubin 6. Produced in the gallbladder, aids the liver

1. Emulsifies fat 2. Removes some toxins 4. Helps absorb fat-soluble vitamins Bile emulsifies fat, breaking it into small particles that can be absorbed. Bile is responsible for removing some toxins. In addition, bile plays a role in the absorption of fat-soluble vitamins. Bile neutralizes acidic rather than alkalytic chime as it leaves the stomach. In the large intestine, bile is converted to urobilinogen and then stercobilin, not bilirubin. Bile is produced in the liver and stored in the gallbladder.REF: p. 848

A nurse is leading an education class on the various types of hepatitis for newly hired certified nurse assistants (CNAs). Which statement best describes hepatitis A? 1. Infectious hepatitis is the most common type and is rarely fatal. 2. Serum hepatitis is found in body fluids and is of particular concern to health care workers. 3. This type of hepatitis is most likely to result in the person becoming a chronic carrier of the virus. 4. Chronic forms of this type do not exist and are considered to be very rare in the United States.

1. Infectious hepatitis is the most common type and is rarely fatal. Hepatitis A is called infectious or epidemic and is transmitted from one person to another through contaminated food, water, or medical equipment. It is the most common type and is rarely fatal. Serum hepatitis is also known as hepatitis B and is found in body fluids and medical equipment that is contaminated. Persons with hepatitis C are more likely to become chronic carriers of the virus. Hepatitis E is similar to hepatitis A; however, it is rarely seen in the United States.REF: p. 856

A patient returns from surgery for an incisional cholecystectomy with a T-tube. The nurse understands that the purpose of the T-Tube is to: 1. Maintain bile flow in the common bile duct 2. Relieve pressure on the liver 3. Divert intestinal contents from the surgical site 4. Prevent bile leakage into the abdomen

1. Maintain bile flow in the common bile duct A T-tube is placed in the common bile duct to maintain bile flow until swelling in the duct subsides. One part of the tubing is brought through the patient's skin and connected to a closed-gravity drainage receptacle. A T-tube does not relieve pressure on the liver, or divert intestinal contents, or prevent bile from leaking on the abdomen.

A patient is having blood drawn for suspected liver disease. The PT is 12, and the INR is 1. The laboratory has called the nurse with the results. What is the nurse's best action? 1. Place the results in the chart. 2. Call the care provider immediately. 3. Prepare for assisting with a liver biopsy. 4. Institute safety precautions because of an increased risk for bleeding.

1. Place the results in the chart. The PT of 11.0 to 12.6 seconds and the INR of 1 to 1.2 are within normal limits, so no further action is needed unless the care provider has specifically instructed to do so. The patient's results are not indicative of a prolonged clotting time or evidence of liver disease, so a liver biopsy may not be done. The results of the PT and INR do not demonstrate increased risk for bleeding.REF: p. 853

The nurse is teaching a health promotion class. The participants should be told that they can reduce the risk of pancreatic cancer by: (select all that apply) 1. Smoking cessation 2. Increased dietary protein 3. Regular exercise 4. Stress reduction activities

1. Smoking cessation 4. Stress reduction activities Among the risk factors for pancreatic cancer are chronic pancreatitis and smoking. Other probable risk factors are a high-fat diet and exposure to certain toxic chemicals. Tumors may develop in the head, body, or tail of the pancreas. Chronic pancreatitis is often related to alcohol abuse, so stress reduction exercises are needed. Nursing care of the patient with pancreatitis addresses anxiety along with acute pain; deficient fluid volume; risk for infection; impaired gas exchange; imbalanced nutrition: less than body requirements; and deficient knowledge. Increased dietary protein is not an intervention needed to reduce one's risk of pancreatic cancer. Regular exercise is not as important as interventions to relieve stress.

The endocrine functions of the pancreas include which of the following? (Select all that apply) 1. Storage and secretion of insulin in response to high blood glucose levels 2. Conversion of excess blood glucose to glycogen for storage 3. Breakdown of excessive fats and carbohydrates in the intestine 4. Production and secretion of digestive enzymes into the duodenum through a duct 5. Manufacture and storage of bile

1. Storage and secretion of insulin in response to high blood glucose levels 2. Conversion of excess blood glucose to glycogen for storage The endocrine function of the pancreas is carried out by clusters of specialized cells scattered throughout the pancreas. These cells are called islets of Langerhans. The islets contain alpha, beta, delta, and PP cells. Alpha cells produce and secrete glucagon. Beta cells produce and secrete insulin. Insulin is secreted when the blood glucose rises, as after a meal. It stimulates the use of glucose by the cells so that a normal blood glucose level is maintained. Glucagon is secreted when the blood glucose level falls. It stimulates the liver to convert glycogen into glucose. Pancreatic fluid is part of the exocrine function of the pancreas. This fluid contains enzymes needed for the digestion of proteins, fats, and carbohydrates. It is secreted into the duodenum through the pancreatic duct. The manufacture and storage of bile is not an endocrine function of the pancreas. Bile is produced in the liver, stored in the gallbladder, and delivered to the intestine, where it is essential for emulsification and digestion of fats. When fats enter the duodenum, the gallbladder contracts and delivers bile to the intestine through the common bile duct.

The nurse is providing instructions for a patient who will be having a percutaneous transhepatic cholangiography in 2 days. Which statement by the patient indicates understanding of this procedure? 1. "I will be able to leave the facility as soon as the procedure is finished." 2. "The nurses will monitor the puncture site and check my blood pressure frequently." 3. "This procedure requires that I be on bed rest for a minimum of 12 hours afterward." 4. "Results of the test will be discussed with my family while I am recovering from the procedure."

2. "The nurses will monitor the puncture site and check my blood pressure frequently." The percutaneous transhepatic cholangiography is an invasive procedure performed while a needle is inserted into the liver and dye injected. The nurse must closely monitor the puncture site for bleeding and must also monitor vital signs frequently. The patient will be maintained on bed rest for a minimum of 8 hours and will stay at the facility while this is accomplished. The results of the test will be discussed with the patient after the procedure.REF: p. 853

Which factors predispose a patient to disorders of the gallbladder? Select all that apply. 1. Male 2. 40 years of age 3. Obesity 4. Fertile 5. Sedentary 6. Family history

2. 40 years of age 3. Obesity 4. Fertile 5. Sedentary 6. Family history The age of 40 years is one of the five factors used to describe persons at risk for gallbladder disorders. Obesity or being overweight is a factor, as is being fertile. A sedentary lifestyle is also a risk factor. Family history can show a tendency toward gallbladder issues. Being female is a greater risk factor than being male.REF: p. 871

The nurse is providing discharge instructions that include education for a patient who was recently diagnosed with hepatitis B. Which information should be included in the teaching plan for this patient? 1. The diet should be regular with added vitamin and mineral supplements. 2. Activity levels will depend on the patient's signs and symptoms and liver function test results. 3. When the patient has completed an antiviral medication, he or she will no longer be contagious. 4. It is important to take a medication such as diphenhydramine (Benadryl) around the clock to prevent severe itching.

2. Activity levels will depend on the patient's signs and symptoms and liver function test results. Activity levels depend on the individual patient's signs and symptoms. The diet for a patient who has hepatitis should be high-calorie, high-carbohydrate, moderate- to high-protein, and moderate- to low-fat with supplementary vitamins. Antiviral medications may help to lessen symptoms; however, the patient may still be contagious. Benadryl is helpful for itching when it occurs; however, there is no need to take it routinely.REF: p. 858

The nurse is caring for a patient who is returning to the unit after a liver biopsy. Which intervention implemented by the nurse is appropriate during the postintervention care of this patient? 1. Maintain the patient on the left side for at least 2 hours after the procedure. 2. Check vital signs every 15 minutes for the first hour and then according to protocol. 3. Encourage the patient to keep the right arm above the head and to take frequent deep breaths. 4. Change the pressure dressing every 30 minutes for the first 2 hours and assess the puncture site.

2. Check vital signs every 15 minutes for the first hour and then according to protocol. To monitor for potential complications after a liver biopsy, vital signs are checked every 15 minutes for the first hour and then according to protocol. The patient must remain on the right side for at least 2 hours to maintain pressure on the puncture site. The patient is encouraged to keep the right arm above the head and to take frequent deep breaths during the actual procedure, not postprocedure. The pressure dressing should be checked for bleeding every 15 minutes for the first hour and then every 30 minutes during the second hour; however, the dressing should not be removed or changed.REF: p. 855

Which of the following structures comprise the common bile duct? (Select all that apply) 1. Duodenum 2. Cystic duct 3. Hepatic bile ducts 4. Main pancreatic duct 5. Ductus arteriosis

2. Cystic duct 3. Hepatic bile ducts The common hepatic bile duct joins the cystic duct to form the common bile duct. The cystic duct leads to the gallbladder, a saclike organ beneath the liver. Bile flows from the liver to the gallbladder, where it is stored and concentrated. The duodenum, main pancreatic duct, and ductus arteriosus are not components of the common bile duct.

A patient with chronic pancreatitis is taking pancreatic enzyme tablets. To assess the effectiveness of the tablets, the nurse should: 1. Monitor daily weights 2. Examine the stools for steatorrhea 3. Record intake and output 4. Ask whether pain is relieved

2. Examine the stools for steatorrhea The patient with chronic pancreatitis is likely to need to take pancreatic enzymes to digest food. The enzymes can be taken with meals or snacks. The effect of the enzymes can be determined by examining the stools for steatorrhea: a high fat content caused by inadequate enzymes. Monitoring daily weights, recording intake and output, and checking for pain relief are not assessments related to pancreatic enzyme tablets.

Nursing students are required to have certain immunizations. Vaccination for which of the following is required because health care providers are often in contact with body fluids? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

2. Hepatitis B Health care providers should be vaccinated against hepatitis B because it can be spread through contact with body fluids. Hepatitis A is also called infectious hepatitis and epidemic hepatitis. It is caused by the hepatitis A virus (HAV), which is transmitted from one person to another by way of water, food, or medical equipment that has been contaminated with infected fecal matter. Hepatitis A is the most common type of viral hepatitis. Fortunately, it is rarely fatal and infected persons do not become asymptomatic carriers. Hepatitis C is transmitted by contact with contaminated blood or medical equipment or by contact with infected body fluids. Like hepatitis B, it can be transmitted from an infected mother to her baby during birth; however, that is rare. Whereas some individuals recover completely from acute hepatitis C, a significant proportion of people with hepatitis C develop chronic infections and become carriers. Many of these will develop cirrhosis or cancer of the liver. Hepatitis D is caused by a virus known as the delta agent, which is a defective ribonucleic acid (RNA) virus that can survive only in the company of hepatitis B virus (HBV). Hepatitis D is transmitted percutaneously (through the skin or mucous membranes) with or following HBV infection. The presence of hepatitis D greatly increases the risk that the patient will progress to chronic hepatitis and possible liver failure.

Which medication would be given to promote elimination of ammonia in fecal matter and to treat hepatic encephalopathy in a patient with cirrhosis? 1. Furosemide (Lasix) 2. Lactulose (Cephulac) 3. Propranolol (Inderal) 4. Spironolactone (Aldactone)

2. Lactulose (Cephulac) Lactulose is used to help eliminate ammonia in feces and to prevent or treat hepatic encephalopathy. Furosemide is used for excretion of excess fluid. Propanolol reduces pressure in veins, decreasing the risk for bleeding. Spironolactone is used to decrease excess fluid.REF: p. 863

The nurse is assigned to observe a patient immediately after a needle biopsy of the liver is performed. Which nursing action would be most appropriate? 1. Monitor vital signs every 15 minutes for 1 hour and then hourly. Position the patient on the left side. 2. Monitor vital signs every 30 minutes for 2 hours and then hourly. Position the patient in the right side-lying position. 3. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. 4. Monitor vital signs every 15 minutes for 1 hour followed by every 30 minutes for the next hour. Position the patient on the left side.

3. Monitor vital signs every 15 minutes four times and then every 30 minutes two times. Position the patient on the right side. Vital signs should be monitored every 15 minutes for the first hour, then every 30 minutes for the next hour, and then hourly. While assessing vital signs, the pressure dressing should be assessed for bleeding. The patient is placed on the right side for at least 2 hours. The patient would be placed on the right side rather than the left side to maintain pressure on the puncture site.REF: p. 855

A patient comes to the clinic for follow-up 1 month after liver transplantation. Which of the following assessment findings would concern you most? 1. Heartburn 2. Constipation 3. Pale urine 4. Fever

4. Fever The most concerning transplant rejection finding is fever. Fever is sometimes the only sign of rejection. Other assessment findings that would alert the nurse are anorexia, depression, vague abdominal pain, muscle aches, and joint pain. Rejection may be treated with corticosteroids or other immunosuppressant medications. If this treatment is unsuccessful, then retransplantation may be needed. Heartburn, constipation, and pale urine are not complaints or signs that might signal transplant rejection.

Your focused assessment of a patient with hepatitis reveals jaundice, light-colored stools, and dark urine. These findings are typical of which phase of hepatitis?

icteric phase The icteric phase is characterized by jaundice, light- or clay-colored stools, and dark urine typical of impaired bile production and secretion. Bile salts accumulate under the skin and can cause pruritus. Gastrointestinal symptoms from the preicteric phase often persist. The icteric phase lasts 2 to 4 weeks. Hepatitis patients who do not develop jaundice are said to have anicteric hepatitis.