Medsurge II - Chapter 25: Nursing Management: Patients With Hepatic and Biliary Disorders
Serologic testing of a middle-aged woman with a recent history of severe flu-like symptoms has just resulted in a diagnosis of hepatitis A. Which of the following assessment questions should the nurse prioritize when discussing this diagnosis with the patient?
"Which restaurants have you eaten in over the past few weeks?"
A 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."
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."
A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms?
"Apply a heating pad to your shoulder for 15 minutes hourly as needed."
The nurse instructs a client on care at home after a laparoscopic cholecystectomy. Which client statement indicates that teaching has been effective?
"I should wash the site with mild soap and water."
A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client?
"Inflammation is confined to only the pancreas."
A nurse is preparing a client for endoscopic retrograde cholangiopancreatography (ERCP). The client asks what this test is used for. Which statements by the nurse explains how ERCP can determine the difference between pancreatitis and other biliary disorders? Select all that apply.
"It can evaluate the presence and location of ductal stones and aid in stone removal." "It can assess the anatomy of the pancreas and the pancreatic and biliary ducts." "It can detect unhealthy tissues in the pancreas and assess for abscesses and pseudocysts."
A client has a nasogastric (NG) tube for suction and is NPO after a pancreaticoduodenectomy. Which explanation made by the nurse is the major purpose of this treatment?
"The tube allows the gastrointestinal tract to rest."
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has?
Bleeding esophageal varices
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 generally be limited to the equivalent of:
1 drink
A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood glucose level does the nurse recognize as inadequate to sustain normal brain function?
30 mg/dL
Pharmacologic therapy frequently is used to dissolve small gallstones. It takes about how many months of medication with UDCA or CDCA for stones to dissolve?
6 to 12
A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxycholic-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
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?
6 to 12 months
This example of cholesterol gallstones (left side of picture) is the result of decreased bile acid synthesis and increased cholesterol synthesis in the liver, which in turn, form stones. Cholesterol stones account for what percentage of cases of gallbladder disease in the United States?
75%
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 is diagnosed with a disorder that affects pancreatic digestive enzymes, and their typsin levels are elevated. The client has jaudice and verbalizes severe abdominal pain. The nurse most likely anticipates which condition?
Acute pancreatitis
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
The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
Alpha-interferon
Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy?
Assessing the color of the sclera every shift
The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?
Assisting the client to turn, cough, and deep breathe every 2 hours
A patient returns to the floor after a laparoscopic cholecystectomy. The nurse caring for the patient is aware that the most serious potential complication is what?
Bile duct injury
The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired?
Carbohydrate digestion
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 nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report?
Clay-colored or whitish
The nurse is caring for a client recovering from acute pancreatitis. Which menu item should the nurse remove from the client's breakfast tray?
Coffee
The nurse is caring for a client with a history of recurrent episodes of acute pancreatitis. The nurse will anticipate preparing the client for which diagnostic test?
Computed tomography (CT) scan
Which is an age-related change of the hepatobiliary system?
Decreased blood flow
The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition?
ERCP
A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?
Edema and inflammation
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?
Elevated alpha-fetoprotein
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
The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones?
Endoscopic retrograde cholangiopancreatography (ERCP)
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral
Which type of deficiency results in macrocytic anemia?
Folic acid
Which condition in a client with pancreatitis makes it necessary for the nurse to check fluid intake and output, check hourly urine output, and monitor electrolyte levels?
Frequent vomiting, leading to loss of fluid volume
The nurse identifies which type 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
A 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses?
Hepatitis C
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.
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?
High-dose corticosteroids
Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
Hot roast beef sandwich with gravy
The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority?
Ineffective breathing pattern
A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam?
It visualizes the gallbladder and bile duct.
A 59-year-old male patient was diagnosed with cirrhosis several years ago. After years of successful management of his chronic disease, he experienced a constellation of symptoms that eventually resulted in a diagnosis of hepatocellular carcinoma (HCC). What treatment holds the greatest potential for curing this patient's health problem?
Liver transplantation
A client with acute pancreatitis has been started on total parenteral nutrition (TPN). Which action should the nurse perform after administration of the TPN?
Measure blood glucose concentration every 4 to 6 hours
A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome?
Minimizing social isolation
The nurse identifies a potential collaborative problem of electrolyte imbalance for a client with severe acute pancreatitis. Which assessment finding alerts the nurse to an electrolyte imbalance associated with acute pancreatitis?
Muscle twitching and finger numbness
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when the client will be able to resume normal activities. What information should the nurse provide?
Normal activities may be resumed in 1 week.
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?
Octreotide
A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position?
On the right side
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 the diagnosis of acute pancreatitis?
Pain with abdominal distention and hypotension
Which condition is the major cause of morbidity and mortality in clients with acute pancreatitis?
Pancreatic necrosis
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
Pancreatitis
One difference between cholesterol stones (left) and the stones on the right are that the ones on the right account for only 10% to 25% of cases of stones in the United States. What is the name of the stones on the right?
Pigment
The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms?
Place the client in semi-Fowler's position.
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?
Radioisotope liver scan
A client with gallstones is diagnosed with acute pancreatitis and is requesting information about the physiology of the gallbladder. Which information will the nurse include about the function of this organ?
Releases bile in response to cholecystokinin
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 client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?
Reserving a site for a peripherally inserted central catheter (PICC)
A patient who had surgery for gallbladder disease has just returned to the unit. The nurse caring for this patient knows to immediately report what assessment finding to the primary care provider?
Rigidity of the abdomen
A patient has been admitted to the critical care unit from the subacute medical unit because his signs and symptoms of liver failure have become more pronounced over the past 24 hours. The critical care nurse who is planning this patient's care should prioritize which of the following nursing diagnoses?
Risk for bleeding related to complications of liver failure
A nurse is teaching a client about the cause of acute pancreatitis. The nurse evaluates the teaching as effective when the client correctly identifies which condition as a cause of acute pancreatitis?
Self-digestion of the pancreas by its own proteolytic enzymes
A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?
Serum amylase
A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?
Spironolactone
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone
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
The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?
The client's hands flap back and forth when the arms are extended.
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.
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.
The nurse is planning the care of a patient who has a diagnosis of chronic pancreatitis. As part of this patient's early discharge planning, the nurse is identifying goals for self-care in collaboration with the patient. Which of the following goals is the most likely priority?
The patient will abstain from drinking alcohol.
A patient who has undergone liver transplantation is ready to be discharged home. The nurse is providing discharge teaching. Which topic will the nurse emphasize most related to discharge teaching?
The patient will take immunosuppressive agents as required.
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
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
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?
Use incentive spirometry every hour.
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin
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
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 suspect the patient may be experiencing?
Vitamin K deficiency
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
A client with chronic pancreatitis is treated for uncontrolled pain. Which complication does the nurse recognize is most common in the client with chronic pancreatitis?
Weight loss
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.
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
What is the recommended dietary treatment for a client with chronic cholecystitis?
low-fat diet
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.
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?
tachycardia and tachypnea
A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by 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."
A nurse cares for an older adult client and teaches the client about age-related changes of the biliary tract. What statements will the nurse include when discussing age-related changes that occur in the pancreas of the older adult? Select all that apply.
"The pancreas develops fibrous material with age." "The pancreas develops fatty deposits with age." "The pancreas decreases secretion of enzymes with age." "The pancreas decreases bicarbonate secretion with age."
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?
Clay-colored stools
A student nurse is preparing a plan of care for a client with chronic pancreatitis. What nursing diagnosis related to the care of a client with chronic pancreatitis is the priority?
Impaired nutrition: less than body requirements
A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan?
Increase respiratory effectiveness.
A 60-year-old man is receiving care for cirrhosis on a medical unit. The nurse who is planning his care recognizes the risks of fluid imbalances that accompany this health problem. Scheduled assessments of this patient's fluid balance should include:
Daily weights and abdominal girth measurements
A 70-year-old client is admitted with acute pancreatitis. The nurse understands that the mortality rate associated with acute pancreatitis increases with advanced age and attributes this to which gerontologic consideration associated with the pancreas?
Decreases in the physiologic function of major organs
A man presented to his primary caregiver with complaints of nausea and vomiting and was referred to the emergency department (ED), where he was diagnosed with cholecystitis. The ED nurse should be aware that the preferred intervention for this patient's health problem is:
Dietary changes and pharmacological treatment
A client with alcoholic cirrhosis develops hematemesis. For which intervention will the nurse prepare this client?
Endoscopy
The critical care nurse is caring for a patient with cirrhosis. What is a priority nursing function when caring for a patient with cirrhosis?
Monitoring the patient's mental status
A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client?
"This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort."
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply.
Jaundice Petechiae Ecchymoses
The nurse is administering medications to a client 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
A client with right upper quadrant pain and weight loss is diagnosed with liver cancer. For which treatment will the nurse prepare the client when it is determined that the disease is confined to one lobe of the liver?
Liver resection
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
A 49-year-old man with a history of heavy alcohol use and liver cirrhosis has been admitted to the hospital's medical unit due to an exacerbation of his health problems that has resulted in massive ascites. The nurse should be prepared to implement which of the following interventions in an effort to resolve the patient's ascites?
Low-sodium diet and administration of diuretics
A critical care nurse is caring for a client with acute pancreatitis. One potentially severe complication involves the respiratory system. Which of the following would be an appropriate intervention to prevent complications associated with the respiratory system?
Maintain the client in a semi-Fowler's position.
A 40-year-old woman who had fulminant liver failure received a liver transplant 36 hours ago and is now receiving care in the intensive care unit. Which of the following aspects of nursing care addresses one of the major threats to this patient's health at this time?
Maintaining meticulous hand hygiene and infection control
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.
A nurse admits a woman reporting severe right upper quadrant pain after eating dinner. What client risk factors lead the nurse to suspect gallbladder disease? Select all that apply.
Multiparous Obese Older than 40 years old History of diabetes mellitus
A client has undergone a liver biopsy. Which postprocedure position is appropriate?
On the right side
Over the past 2 years, a 51-year-old man has been admitted to the hospital five times for problems related to alcohol abuse, including falls, acute alcohol withdrawal, and cirrhosis. The man's current admission has been precipitated by signs and symptoms of alcoholic liver disease (ALD). The care team is reasonably pleased with the patient's recovery to this point and discharge planning has begun. When organizing the patient's discharge planning, what psychosocial nursing diagnosis should be prioritized?
Risk for ineffective management of therapeutic regimen
