MedSurg: NCLEX: Liver/Pancreas/Gallbladder
The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnoses are appropriate? Select all that apply.
- Risk for injury related to altered clotting mechanisms - Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort - Disturbed body image related to changes in appearance, sexual dysfunction, and role function
Which type of jaundice seen in adults is the result of increased destruction of red blood cells?
Hemolytic Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?
Measure abdominal girth according to a set routine.
Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis?
Severe, radiating abdominal pain
A client has worked for a company that produces paint and varnishing compounds for 24 years. She is visiting the clinic with complaints of chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of her skin and sclera. She reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis would the nurse suspect is the cause of the client's symptoms?
a) Postnecrotic cirrhosis
When caring for a client with cirrhosis, which of the following should a nurse notify immediately? Choose all correct options
• Signs of GI bleeding • Change in mental status
A 67-year-old client is returning for a follow-up appointment to the primary care group where you practice nursing. At his last appointment, he received the diagnosis of portal hypertension and the physician instituted interventions to begin treatment of this condition. What is the primary aim of portal hypertension treatment? Choose all correct options.
• Reduce venous pressure • Reduce fluid accumulation
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
• Signs of GI bleeding • Change in mental status
A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?
Ineffective breathing pattern
A young patient with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The patient asks the nurse how long she needs to stay in the hospital. In planning care for the patient, the nurse identifies impaired psychosocial issues and assigns the highest priority to which of the following patient outcomes?
b) Minimizing social isolation
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?
Hepatic encephalopathy The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.
A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate?
Liver disorder
The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase
Rash During the prodromal or preicteric phase, the following signs and symptoms would be noted: urticaria; nausea; vomiting; anorexia; fever; malaise; arthralgia; headache; right upper quadrant (RUQ) discomfort; enlargement of the spleen, liver, and lymph nodes; weight loss; and rash. Jaundice and clay-colored stools would be characteristic of the icteric phase. Liver function tests returning to normal would be noted in the posticteric phase.
A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones?
a) Chenodiol (Chenix)
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor?
a) Elevated alpha-fetoprotein
A patient with end-stage liver disease who is scheduled to undergo a liver transplant tells the nurse, "I am worried that my body will reject the liver." Which of the following statements is the nurse's best response to the patient?
"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs."
A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply.
- Acetaminophen - Ketoconazole - Valproic acid
A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?
Vasopressin (Pitressin) In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Vasopressin (Pitressin) may be the initial mode of therapy in urgent situations, because it produces constriction of the splanchnic arterial bed and decreases portal pressure. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.
The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.
a) Insomnia d) Agitation e) Alterations in mood
A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that which of the following findings will place the client at risk for complications?
a) Low platelet count
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide?
a) Normal activities may be resumed in 1 week.
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply
• Jaundice • Ecchymoses • Petechiae The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema.
Which of the following is a contraindication for a liver transplant? Select all that apply.
Uncontrolled hypertension • Extrahepatic malignancy • Irreversible brain damage • Anatomic difficulties • Multiorgan failure
A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, How long should the nurse withhold food and fluids?
Until the gag reflex returns
A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?
Until the gag reflex returns
The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin-aldosterone and sympathetic nervous system and decreased responsiveness to diuretic therapy?
Upright
Which type of positioning should be utilized for a patient undergoing a paracentesis?
Upright at the edge of the bed
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
anorexia, nausea, and vomiting. Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity?
b) Albumin c) Diuretics
Timothy is a client being treated for hepatitis in the infectious disease office where you practice nursing. He has a history of IV drug use. He presents today with jaundice and arthralgias. Timothy most likely has which type of hepatitis?
b) Hepatitis B
A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction?
b) High-dose corticosteroids
Chronic pancreatitis, commonly described as autodigestion of the pancreas, is often not detected until what percentage of the exocrine and endocrine tissue is destroyed?
80% to 90%
The nurse is educating a patient with cirrhosis about the importance of maintaining a low sodium diet. What food item would be permitted on a low sodium diet?
A pear
The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet?
A pear
The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase?
rash
The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of :
serum lipase
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
subnormal serum glucose and elevated serum ammonia levels. In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.
Several clinical manifestations are associated with a tumor of the head of the pancreas. Choose all that apply.
- Clay-colored stools - Dark urine - Jaundice
Pain associated with pancreatitis frequently occurs within which time frame?
24 to 48 hours
A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxy-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give?
6 to 12 months
The nurse reviews the laboratory values for a patient being evaluated for alcoholic cirrhosis. The nurse is aware that a diagnostic indicator present in greater than 70% of cases is which of the following?
AST/ALT ratio >3.0
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?
Abdominal paracentesis Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain. Fluid is removed from the lung via a thoracentesis. Fluid cannot be removed with an abdominal CT scan, but it can assist with placement of the needle. Fluid cannot be removed via an upper endoscopy.
A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?
Abstain from drinking alcohol
An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:
Acetaminophen
A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?
Acute pain related to biliary spasms
A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?
Administering morphine I.V. as ordered
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
Albumin
What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?
Albumin infusion
The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
Alpha-interferon
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?
Ammonia
The nurse completing a plan of care for a patient with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which of the following is an appropriate nursing intervention for this problem?
Arrange for a low air loss bed.
Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction?
Asterixis
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?
Asterixis may be seen in stage II encephalopathy
Which of the following is the imaging modality of choice for assessment of both acute and chronic pancreatitis?
CT
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?
Change in the client's handwriting and/or cognitive performance The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?
Clay-colored or whitish
A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?
Relieving abdominal pain
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?
Clay-colored stools Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.
A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?
Reposition the client every 2 hours
A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?
Reserving an antecubital site for a peripherally inserted central catheter (PICC)
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is
b) acute cholecystitis
The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching?
Decrease the amount of protein in the diet.
What is the most appropriate nursing diagnosis for the client with acute pancreatitis?
Deficient fluid volume
A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions?
Hepatic encephalopathy
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?
Liver biopsy A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure. Coagulation studies provide information about liver function but do not definitively confirm the diagnosis of cirrhosis. Magnetic resonance imaging and radioisotope liver scan help to support the diagnosis but do not confirm it. These tests provide information about the liver's enlarged size, nodular configuration, and distorted blood flow.
Which of the following is commonly associated with acute episodes of pancreatitis?
Long-term use of alcohol
Which of the following the are early manifestations of liver cancer? Select all that apply.
Pain Continuous aching in the back Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever and vomiting are not associated manifestations.
Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis?
Pancreatic necrosis
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding.
A nurse educator is teaching a group that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?
The effect of liver problems on medication metabolism
Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses?
Ultrasonography
Louisa Collins, a 52-year-old high school science teacher, is your client on the medical-surgical floor at the hospital where you practice nursing. She is undergoing diagnostics to determine what is causing her liver disorder. As you discuss her condition, Louisa asks questions pertaining to liver physiology and cellular function. Which liver cells perform most of the liver's metabolic functions?
c) Parenchymal cells
A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider?
c) Tachycardia and tachypnea
The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis?
d) Severe midabdominal to upper abdominal pain radiating to both sides and to the back
A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:
phytonadione (Mephyton).
A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review?
Serum bilirubin level greater than 1.0 mg/dL
A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?
Ultrasonography
A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful?
"I might need to have this procedure done again." Persistent portal hypertension allows varices to form again, making it necessary to repeat injection sclerotherapy or variceal banding regularly. Injection sclerotherapy involves passing an endoscope orally to locate the varix.
The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?
"How often do you drink alcohol?"
A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
"Maintain a high-carbohydrate, low-fat diet."
A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?
"You must have the second one in 1 month and the third in 6 months." Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.
When caring for a client with cirrhosis, which of the following should a nurse notify immediately? Choose all correct options.
- Change in mental status - Signs of GI bleeding
A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply.
- Encourage bed rest to decrease the client's metabolic rate. - Teach the client about the correlation between alcohol intake and pain. - Withhold oral feedings to limit the release of secretin.
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.)
- Encouraging bed rest to decrease the metabolic rate - Withholding oral feedings to limit the release of secretin - Administering parenteral opioid analgesics as ordered
A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply.
- Infection at school - Suboptimal sanitary habits - Consumption of sewage-contaminated water or shellfish - Sexual activity
The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are
- Multiparous - Obese - Older than 40 years
Which of the following are risk factors for pancreatic cancer? Select all that apply.
- Tobacco - Obesity - Nonhereditary chronic pancreatitis - Diabetes mellitus
A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.
2.5 Jaundice becomes clinically evident when the serum bilirubin level exceeds 2.5 mg/dL (43 fmol/L).
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function?
30 mg/dL
The severity of pancreatitis is directly proportional to the number of indicators present. A patient with five to six signs indicative of pancreatitis would have a __________% chance of mortality.
40%
A nurse is responsible for monitoring the diet of a patient with hepatic encephalopathy. The nurse knows that the 185-pound male should have a daily protein intake between __________.
42 and 126 grams
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?
7 months
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?
Decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.
Which of the following is an age-related change of the hepatobiliary system?
Decreased blood flow Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.
client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention?
Discuss meals that include low-fat high-carbohydrate content. In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for carbohydrates and other energy sources for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein effectively.
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?
Edema and inflammation
A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's:
Electrocardiogram
A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?
Elevated urine amylase levels
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?
Endoscopic retrograde cholangiopancreatography (ERCP)
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.
Enlarged liver size Ascites Hemorrhoids
Which of the following would be most appropriate for a client who is experiencing biliary colic?
Ensure that the client rests.
An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage?
Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation.
Which of the following laboratory test results would the nurse associate with obstructive jaundice?
Increased direct bilirubin
A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?
Excrete bile The liver forms and excretes bile, synthesizes amino acids from the breakdown of proteins, converts ammonia into urea, and synthesizes the factors needed for blood coagulation.
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.
Which type of deficiency results in macrocytic anemia?
Folic acid Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.
Which of the following would be the least important assessment in a patient diagnosed with ascites
Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.
A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the:
Gallbladder
Most pancreatic cancers develop in which area of the pancreas?
Head
The nurse identifies which of the following types of jaundice in an adult experiencing a transfusion reaction?
Hemolytic
A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?
Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
Hepatitis C increases a person's risk for liver cancer.
The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond?
High-carbohydrate, low-protein, low-fat diet
When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor?
History of pancreatitis
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
Hypotension
Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes?
Increased appetite and thirst
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
Irritability and drowsiness Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.
The nurse is administering medications to a patient that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?
Lactulose (Cephulac) Lactulose is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients. Potassium-sparing diuretics such as spironolactone are used to treat ascites. Cholestyramine is a bile acid sequestrant and reduces pruritus. Kanamycin decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.
Which of the following aids in digestion of fats?
Lipase
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?
Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.
A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy?
Low platelet count Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.
Which of the following is the recommended dietary treatment for a client with chronic cholecystitis?
Low-fat diet The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.
A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals?
Maintaining the airway Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.
From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography?
Mark, suspected of having stones in the gallbladder
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?
Metabolism of medications Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.
Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy?
Observe color of sclera
A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?
Octreotide (Sandostatin)
To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement?
Pad the side rails on the bed
The nurse is teaching a patient who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the patient chooses which of the following food choices from the menu?
Pancakes with butter and honey and orange juice
Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?
Pancreatitis
Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid?
Paracentesis
In actively bleeding patients with esophageal varices, the initial drug of therapy is usually:
Pitressin
Which is the most common cause of esophageal varices?
Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.
When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
Positioning the client on the side with the knees flexed
A client has worked for a company that produces paint and varnishing compounds for 24 years. She is visiting the clinic for chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of her skin and sclera. She reports clay-colored stools and frequent nosebleeds. What would the nurse suspect is the cause of the client's symptoms?
Postnecrotic cirrhosis Postnecrotic cirrhosis results from destruction of liver cells secondary to infection (e.g., hepatitis), metabolic liver disease, or exposure to hepatotoxins or industrial chemicals
An elderly homeless client with a lengthy history of alcohol addiction is visiting the clinic. He has worsening jaundice. The physician returns a diagnosis of cirrhosis. The nurse begins client education about this condition. What would the nurse emphasize as the principal goal of cirrhosis therapy?
Preserving liver function The principal aim of therapy is to prevent further deterioration by abolishing underlying causes and preserving what liver function remains.
Part of preoperative patient preparation for liver transplantation is informing the patient about postoperative complications. The most severe complication is:
Primary graft nonfunction
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
Purpura and petechiae
Connie, a 60-year-old retired financial planner, is recently diagnosed with carcinoma of the pancreas. She has just met with her surgeon and feels overwhelmed by all the information she was given. She tells you that she is having the head of the pancreas removed; additionally, the surgeon is also removing the duodenum and stomach and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is Connie having performed?
Radical pancreatoduodenectomy
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction
Radioisotope liver scan
A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis?
Recent weight loss and temperature elevation
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
Reduce fluid accumulation and venous pressure.
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient?
Respiratory assessment related to increased thoracic pressure
In what location would the nurse palpate for the liver?
Right upper quadrant
Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency?
Scurvy
A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by:
Selective vasodilation of the portal system
The nurse is caring for a patient who has undergone surgery for a liver disorder. The client experiences a risk of fluid loss from drainage. The nurse should monitor which of the following to determine the presence of decreased intravascular volume in the patient?
Serum sodium levels
The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital?
Severe abdominal pain
The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is:
Severe abdominal pain
A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse?
Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.
The nurse is concerned about a potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?
Spironolactone (Aldactone)
The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?
Spironolactone (Aldactone)
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone (Aldactone) Gynecomastia is a common side effect caused by spironolactone. Pitressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.
A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?
Stage 2
During chronic pancreatitis, the patient's stool may become frothy and foul-smelling. This would be documented as which of the following?
Steatorrhea
Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis?
Such clients cannot tolerate high-glucose concentration. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?
Tacrolimus In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used. Chenodiol and ursodiol are agents used to dissolve gallstones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?
The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:
The digestion of dietary and blood proteins. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.
A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient?
The patient has developed peritonitis.
A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?
The physician will use an ultrasound guided paracentesis
A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observes they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?
The physician will use an ultrasound guided paracentesis
The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?
To reduce gastric and pancreatic secretions
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?
Transjugular intrahepatic portosystemic shunting (TIPS)
Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of:
Two 6 oz glasses of wine Intake of 60 g/day for men and 30 g/d for women (10 g of alcohol is equivalent to 1 oz of bourbon, 12 ounces of beer, or 4 ounces of red wine) is sufficient to cause liver injury.
Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin (Pitressin) Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.
During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in:
Vitamin K
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?
Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse expect the patient may be experiencing?
Vitamin K deficiency Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?
Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.
client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
You may have eaten contaminated restaurant food. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which of the following nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply.
a) Alterations in respiratory function b) Potential for infection d) Acute pain and discomfort
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
cirrhosis. Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:
cryoprecipitate and fresh frozen plasma.
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:
level of consciousness (LOC).
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:
perforation of the colon caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region — in this case, the abdomen. This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness
A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
wash her hands after touching the client. To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients
A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
yellow sclerae
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply
• Glucose metabolism • Ammonia conversion • Protein metabolism
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.
• Glucose metabolism • Ammonia conversion • Protein metabolism
A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply.
• Instructing the client to remove salty and salted foods from the diet • Administering prescribed spironolactone (Aldactone) • Assisting with placement of a transjugular intrahepatic portosystemic shunt