MS@5
The nurse is providing discharge teaching for a client who will be going home with a T-tube following cholecystectomy surgery. Which statement by the client indicates the need for additional teaching?
"I will slowly pull about an inch of the tube out each day until it's out."
In providing an educational session regarding hepatitis, the nurse includes information about which types of viral hepatitis that can be prevented with a vaccination? Select all that apply.
1. Hepatitis A 2. Hepatitis B 4. Hepatitis D
The nurse provides education to a patient who is diagnosed with acute pancreatitis. Which patient statement indicates the need for additional teaching?
"I will increase my intake of protein rich foods."
A patient with an acutely inflamed gallbladder states that the pain has suddenly stopped. The patient wants to go home. What is the nurse's best response?
"I will inform your healthcare provider of the change in your symptoms."
The nurse assesses a patient who is reporting epigastric pain. The patients serum amylase level is 369 units/L. What is the nurses best
Contact the primary health care provider.
A nurse is providing discharge education to a patient who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?
Low-fat foods high in proteins and carbohydrates
Which finding in the patient diagnosed with pancreatic cancer being evaluated for a surgical cure makes the tumor generally unresectable?
Lymph node involvement
Activities the nurse could suggest to a client interested in preventing gallstone formation include which of the following?
Maintain a lowfat diet.
Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless?
Maintain adequate nutrition.
A client just had a paracentesis. Which nursing intervention is a priority for this client?
Maintain bedrest as per protocol.
A client is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which nursing intervention is the priority?
Maintain the client's airway.
A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis?
Maintain the patient in a semi-Fowlers position whenever possible.
The nurse is caring for a client with acute pancreatitis. Which nursing intervention best reduces discomfort for the client?
Maintaining NPO status for the client with IV fluids
The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome?
Maintaining normal respiratory function
A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the patient who has had pancreatic surgery?
Malabsorption and hyperglycemia
What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)?
Mealtime
Which information obtained by the nurse when admitting a patient who is scheduled for an ultrasound of the gallbladder indicates that the ultrasound may need to be rescheduled?
The patient ate a low-fat bagel an hour previously.
A patient who has advanced cirrhosis is receiving lactulose (Cephulac). Which finding by the nurse indicates that the medication is effective?
The patient is alert and oriented.
Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis?
The patient is alert and oriented.
A patient is scheduled for a laparoscopic cholecystectomy. The health care provider has indicated that there is a chance that the procedure may need to be done as an open cholecystectomy. The nurse knows that if the patient has an open procedure, what is more likely?
The patient may have a T-tube that will allow drainage of bile.
A medical patients CA 19-9 levels have become available and they are significantly elevated. How should the nurse best interpret this diagnostic finding?
The patient may have cancer, but other GI disease must be ruled out.
Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done?
The patient reports a one-time use of IV drugs 20 years ago.
Which information from a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?
The patient used IV drugs about 20 years ago.
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?
The patient will take immunosuppressive agents as required.
Which assessment data collected by the nurse after a liver biopsy requires the nurse to immediately notify the healthcare provider?
The patient's blood pressure is 80/50 mm Hg.
The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?
The patient's hands flap back and forth when the arms are extended.
The nurse is planning care for a patient scheduled for paracentesis to treat ascites. Which outcome should the nurse use for this patient's plan of care?
The patient's respiratory effort will be lessened.
Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?
The patient's stools are tan colored.
Which data obtained by the nurse during the assessment of a patient with cirrhosis will be of most concern?
The patients hands flap back and forth when the arms are extended.
Which outcome should receive priority in the care plan for a patient who has had a paracentesis to treat ascites?
The patients respiratory effort will be lessened.
The nurse would explain to a client that to combat the rising rate of primary hepatocellular cancer in the United States public health measures need to be directed towards decreasing the
increasing prevalence of hepatitis C.
The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. This finding is best reported as:
indication of retroperitoneal hemorrhage.
A patient with advanced cirrhosis develops esophageal varices as a direct result of portal hypertension. The nurse anticipates that this complication will be addressed by: (Select all that apply.)
insertion of a BlakemoreSengstaken tube. administration of IV vasopressin (Pitressin). lactulose to empty swallowed blood in colon. vasoconstrictors to reduced portal blood flow.
The nurse providing information about the hepatitis B vaccine would include the information that the inoculation
is given by three separate injections over 6 months.
A client with ascites has the nursing diagnosis Activity Intolerance. An appropriate goal for this client would be: the client will
learn to balance activity with rest.
The nurse administering -interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for:
leukopenia.
When combination therapy of a-interferon and ribavirin (Rebetol) is being used to treat chronic hepatitis C, the nurse will plan to monitor for
leukopenia.
A nurse is assessing a client with right upper quadrant pain. The nurse asks questions directly related to the health of the client's
liver
The nurse correlates which organ as the main site for metabolizing medications?
liver
The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n):
liver biopsy.
The home health nurse caring for the patient with tuberculosis who is taking rifampin and isoniazid (INH) will be alert for an indication of a common side effect of these drugs, which is:
liver disorders.
The nurse is caring for a patient with chronic pancreatitis and a serum amylase level of 180 units/L. Which dietary plan should the nurse instruct the patient to follow?
low fat, no alcohol
A patient with end-stage pancreatic cancer is admitted to the nursing unit. The patient is lethargic and jaundiced. What is the priority nursing care for this patient?
manage comfort
What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B?
measures for improving appetite
When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about
measures that will be helpful in improving appetite
The nurse teaches a patient about the functions of the liver. Which patient statement indicates the need for additional teaching?
my liver produces glucagon
A patient with a liver abscess is experiencing nausea and vomiting. Which problem should the nurse identify as a priority for this patient?
not enough fluid
A nurse is providing discharge instructions for a postcholecystectomy client. The nurse would view the goals for teaching had been effective when the client states he/she would
notify the physician of jaundice or itching.
A client with jaundice is experiencing uncomfortable itching of the skin. The nurse would anticipate an order to administer
oral cholestyramine (Questran).
The nurse percussing a patient's abdomen hears a dull thud in the right upper quadrant. This finding indicates that the area being percussed is:
over the liver.
A nurse is promoting increased protein intake to enhance a patients wound healing. The nurse knows that enzymes are essential in the digestion of nutrients such as protein. What is the enzyme that initiates the digestion of protein?
pepsin
When caring for a patient following a needle biopsy of the liver at the bedside, the nurse should
place the patient on the right side with the bed flat.
To palpate the liver, the nurse
places one hand on the patients back and presses upward and inward with the other hand below the patients right costal margin.
The nursing intervention that takes priority for the nursing diagnosis High Risk for Injury related to presence of SengstakenBlakemore tube is
placing a pair of scissors at the bedside.
In caring for a client with severe hepatic abscess, the nurse would assess carefully for the common complication of
pleural effusion.
A client who underwent laparoscopic cholecystectomy asks the nurse how soon he/she can return to work. The nurse would respond that the final decision is up to the surgeon, but that clients can usually resume work after
3 to 4 days.
The nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which statements by the patient indicate teaching has been effective?
3. "I will avoid contact with blood and body fluids." 5."I will use safe sex techniques."
The nurse is teaching a patient about strategies for reducing the risk of hepatitis B transmission. Which statements by the patient indicate understanding of the nurses instruction?
3. I will avoid contact with blood and body fluids. 5. I will use safe sex techniques
A nurse assessing the first 24 hours of drainage from a T tube inserted during surgery for cholelithiasis would record as normal the Ttube output of
300 to 500 ml
The nurse recognizes that which patient is at highest risk of developing cholecystitis?
35-year-old Caucasian female with history of weight loss surgery
In reviewing the physical assessments of several patients, the nurse recognizes that the patient most likely to have gallstones would be the:
50 year old obese Mexican American woman who has type 1 diabetes.
In performing a gastrointestinal assessment, the nurse correlates which measurement as the normal liver span?
6 to 12 cm
The nurse recognizes that which patient is at highest risk of developing chronic pancreatitis?
60-year-old African American male with a 50-pack year history of smoking
A nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan?
Administration of diuretics as ordered
What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis?
Cigarette smoking
The nurse monitors for which clinical manifestation in a client with a decreased fecal urobilinogen concentration?
Clay-colored stools
The nurse is caring for a client with cholecystitis. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?
Clay-colored stools and dark amber urine
The nurse is assessing health fair participants for risks for hepatitis. The nurse recognizes which client as being at greatest risk for developing hepatitis B?
College student who has had several sexual partners
The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands. The client states this has not happened before. Which action by the nurse is most appropriate?
Conduct a thorough assessment, then notify the surgeon of the findings.
The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?
Administer prescribed opioids to relieve pain as needed.
Which statement by the patient diagnosed with hepatitis indicates the need for further teaching?
"A vaccine would not have helped me because I have hepatitis A."
A client has been diagnosed with cancer of the gallbladder. Which statement by the client would lead the nurse to feel concern for this client's coping?
"After my chemotherapy is over, I think I will retire and do a lot of traveling.
The nurse is caring for a postoperative client who reports pain in the shoulder blades following laparoscopic cholecystectomy surgery. Which direction does the nurse give to the nursing assistant to help relieve the client's pain?
"Ambulate the client in the hallway."
Which statement from the patient diagnosed with acute pancreatitis indicates the need for further teaching regarding approved therapeutic agents?
"Anticholinergics are used to increase intestinal motility."
The nurse is caring for a client who is being discharged from the hospital after an attack of acute pancreatitis. Which discharge instructions does the nurse provide for the client to help prevent a recurrence? (Select all that apply.)
"Attend local Alcoholics Anonymous (AA) meetings weekly." "Use cooking spray when you cook rather than margarine or butter." "We can talk to your doctor about a prescription for nicotine patches."
A client is diagnosed with hepatitis B. Which information does the nurse include in the teaching plan as a priority?
"Avoid drinking any alcohol until the doctor says you can."
A patient with acute cholecystitis is concerned about having the flu because of an oral temperature of 101.8°F. What should the nurse respond to the patient?
"Bacterial infection is often present in cholelithiasis."
The nurse is reviewing a client's history. Which statement by the client indicates a need for health teaching?
"Because of my arthritis, I take a lot of Tylenol."
The client with obstructive jaundice asks the nurse why his skin is so itchy. Which is the nurse's best response?
"Bile salts accumulate in the skin and cause the itching."
A nurse is teaching a client and spouse about insulin administration. The spouse becomes quite upset, saying "Why are we having to use insulin at home? The diagnosis is pancreatitis! How did you make him a diabetic?" The best response by the nurse is
"I see you are upset. Let me answer your questions before we talk about insulin."
Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis?
"I should eat plenty of fresh fruits and vegetables."
Which statement by the patient about T-tube management for biliary drainage indicates the need for further teaching?
"I should only empty the bag once a day"
Which statement by the patient diagnosed with chronic pancreatitis indicates understanding of this disease process?
"I will avoid coffee and caffeine."
A client is refusing to take lactulose (Heptalac) because of diarrhea. Which is the nurse's best response to this client?
"Diarrhea is expected; that's how your body gets rid of ammonia."
In taking the history of a person with hepatitis A, an appropriate question for the nurse to ask is:
"Do you eat shellfish or oysters often?"
A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate?
"Do you use any over-the-counter drugs?"
The nurse is assessing a client for asterixis. Which instruction to the client is most appropriate?
"Extend your arm, flex your wrist upward, and extend your fingers."
The nurse is caring for a patient being treated for recurrent gallstones. The patient questions the need to have the stones removed, voicing a concern about the condition causing cancer. What statement by the nurse is most correct?
"Gallstones cause an irritation which is linked to an increase in the incidence of cancer."
The nurse is assessing a patient with liver failure and jaundice. Which question should the nurse ask to determine if the cause of the jaundice is hemolytic?
"Have you been diagnosed with a disorder of red blood cell destruction?"
To obtain the most helpful information from a client about risk factors related to hepatitis, the nurse would ask
"Have you ever had body piercing or a tattoo?"
A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate?
"Hepatitis A is not transmitted as a result of close contact with an infected individual."
Which statement by a new nurse assigned to the infectious disease clinic regarding the incubation period of hepatitis indicates the need for further teaching?
"Hepatitis B has an incubation period of 30 to 60 days."
A patient has been given instructions about a laparoscopic cholecystectomy. Which patient statement indicates further teaching is needed?
"I am glad I won't need to have an open cholecystectomy."
The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement?
"I can take a shower and walk around the house tomorrow."
A patient who returned from a humanitarian trip to Central America 2 weeks ago is jaundiced and diagnosed with hepatitis A. The patient is the parent of three school-age children. Which patient statement should the nurse follow up with the patient?
"I can't go home and expose my children to this."
A client has liver cancer. Which statement by the client about treatment options demonstrates an accurate understanding?
"I choose hepatic arterial infusion of chemo to limit side effects."
The nurse is caring for a client with end-stage pancreatic cancer. The client asks the nurse, "Why is this happening to me?" Which is the nurse's best response?
"I don't know. I wish I had an answer for you, but I don't."
In evaluating a client for the presence of gallbladder disease, the nurse would recognize that the client's statement most suggestive of this problem is
"I have a terrible pain in my stomach; it is so bad I can feel it in my shoulder."
The nurse is teaching a patient with an acute attack of cholecystitis about nutritional interventions. Which patient statement indicates additional teaching is required?
"I may be prescribed vitamins B and C."
A client has been diagnosed with hepatitis A. The nurse evaluates that teaching regarding the disease is understood when the client makes which statement?
"I may have been exposed when we ate shrimp last weekend."
The nurse provides education to a patient who experiences ascites as a result of cirrhosis. Which patient statement indicates a need for additional teaching?
"I might need to have a banding procedure to stop the bleeding in my stomach."
The nurse is providing discharge teaching for a client who has just undergone laparoscopic cholecystectomy surgery. Which statement by the client indicates understanding of the instructions?
"I need a diet without a lot of fatty foods."
Which statement by a client with alcohol-induced cirrhosis indicates the need for further teaching?
"I need to avoid protein in my diet."
A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS) insertion. The nurse determines that teaching has been effective when the client makes which statement?
"I will be monitored closely for a while after the procedure is over."
In preparing the teaching plan on dietary changes after discharge for a client with chronic pancreatitis, the nurse would know that the statement most indicative of the client's understanding of the information is
"I won't be eating any more French fries or drinking hard liquor."
A client with a T tube following choledochostomy asks the nurse why the tube is being clamped during mealtimes. The most accurate response by the nurse is
"It helps with digestion of fats in the meal."
The patient with acute cholelithiasis asks why a nasogastric tube has to be inserted. What is the nurse's best response?
"Keeping your stomach empty allows your gallbladder to rest, reducing pain."
A thin, cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE). The family expresses distress that the client is receiving so little protein in the diet. Which explanation by the nurse is most appropriate?
"Less protein in the diet will help with the confusion."
The nurse is providing information about hepatitis to a high school health occupations class. The students all volunteer examples of how hepatitis is transmitted. Which statement by one of the students indicates the need for further teaching about hepatitis transmission?
"Mosquito or tick bite"
Which statement by the family member of a patient diagnosed with liver cancer indicates the need for further teaching?
"She needs to drink plenty of fluids to keep her kidneys working."
The nurse is providing discharge teaching for a client who will be receiving pancreatic enzyme replacement at home. Which statement by the client indicates that additional teaching is needed?
"The best time to take the enzymes is immediately after I have a meal or a snack."
The patient in the icteric phase of hepatitis asks the nurse, "Why are my stools no longer brown?" How should the nurse respond?
"The pigment is backing up into your blood and turning your skin yellow."
A patient scheduled for a laparoscopic cholecystectomy asks the nurse why a surgical consent for a laparotomy must also be completed. How should the nurse respond?
"The surgeon will start the procedure laproscopically but may need to make an incision to complete the procedure."
Which statement by the family member of a patient who has a Sengstaken-Blakemore tube placed to treat complications of liver disease indicates understanding of this treatment modality?
"The tube provides compression to stop esophageal bleeding."
A patient with pancreatitis asks the nurse, "Why are my stools so frothy and smell so bad?" How should the nurse respond?
"This indicates your stools have more fat in them."
A nurse asks a client with cirrhosis to write his/her name on a piece of paper each day. A student asks why the nurse does this. The best response by the nurse is that
"This is an important safety assessment for the client with cirrhosis."
Which statement by the patient scheduled for vagotomy to treat pancreatic cancer indicates that teaching was effective?
"This procedure will result in decreased gastric acid secretion."
The nurse is providing discharge instructions to a client going home with a T tube after an open cholecystectomy. Goals for teaching have been met when the client says
"This tube will stay in for 12 weeks and I should watch for diminishing drainage."
A client being discharged after an episode of acute pancreatitis asks the nurse why items such as coffee/tea, spicy foods, and heavy meals should be avoided. The nurse should reply
"Those things stimulate the pancreas too much and may give you another attack."
The nurse is caring for a client with chronic pancreatitis. Which instruction by the nurse is most appropriate?
"We need to call the dietitian to get help in planning your diet."
A client with cirrhosis is on the transplant list and is now admitted for endstage liver failure. The spouse breaks down crying, stating "I just can't cope any more. I already have to do every thing at home and for the kids, now if he/she dies, I just don't know what I will do!" The best response by the nurse is
"What has helped you handle all the family responsibilities so far?"
A patient scheduled for a laparoscopic cholecystectomy in 4 days asks how pain can be controlled until the surgery. How should the nurse respond?
"You will feel better if you sit in a recliner and drink water and try not to eat anything. Do not eat any fat."
Which information should the nurse provide to a patient who will be receiving the hepatitis A vaccine?
"You will receive one shot with a booster 6 to 12 months later."
Which information should the nurse include in a teaching session for a patient who is to receive the hepatitis B vaccine?
"You will receive three injections over a 6 to 12 month period"
The nurse recognizes that fetor hepaticus is consistent with which assessment finding?
A fruity or musty breath odor
A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patients care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.
1, 2, 3, 4, 5
The nurse has instructed a patient about the possible complications of unresolved cholecystitis. Which patient statements indicate that teaching has been effective?
1. "I could have infected pus stored in my gallbladder." 2. "My gallbladder could rot and cause a big infection in my abdomen." 3. "A hole could form a connection between my gallbladder and intestines."' 4. "My intestines could be blocked with a gallstone."
The nurse is caring for a patient taking chenodiol (Chenix). Which patient statements indicate the need for immediate follow-up by the nurse?
1. "I could see the big gallstone on the x-ray, but this medication doesn't seem to be helping at all. I don't feel better after taking it for 4 months." 2. "My rectal area is tender from all the diarrhea I've been having." 3. "My skin looks yellow." 4. "I can't afford my medication and have been cutting pills in half to make it last longer."
The nurse is teaching a patient about the effects of liver failure. The nurse knows the patient understands when the patient identifies which manifestations as related to liver failure?
1. "My abdomen is becoming very large." 2. "My blood sugar is sometimes too high and sometimes too low." 4. "My menstrual cycle has become very irregular." 5. "My skin appears yellow."
The nurse correlates which factors as associated with an increased risk of developing liver cancer? select all that apply.
1. African American race 3. Alcohol abuse 4. Obesity 5. Diabetes mellitus
The nurse includes which information in the discharge teaching for the patient diagnosed with chronic pancreatitis? Select all that apply.
1. Avoid caffiene 4. Eliminate alcoholic beverages 5. Take pancreatic enzyme replacement therapy (PERT) as directed
The nurse is caring for a patient with severe liver disease. The nurse notes new ecchymotic areas on the patients arms and legs. Which laboratory results will the nurse analyze regarding this finding?
1. Complete blood count 2. Coagulation studies
The nurse correlates the metabolic alkalosis in the patient diagnosed with hepatic encephalopathy to which potential causes? select all that apply.
1. Diarrhea 3. Diuretic therapy 5. Vomiting
The nurse has given a patient instruction about the possible complications of unresolved cholecystitis. Which statements by the patient would indicate correct understanding of the instruction?
1. I could have infected pus stored in my gallbladder. 2. My gallbladder could rot and cause a big infection in my abdomen. 3. My gallbladder trouble could become chronic
The nurse should include which teaching points when planning discharge for a patient who has a T-tube following a cholecystectomy?
1. Keep the skin around the site clean and free from bile drainage. 2. Report drainage of more than 500 mL per day to the health care provider. 4. Report skin redness or irritation in the drain site area.
The nurse monitors for which clinical manifestations in the patient diagnosed with acute pancreatitis? SATA
1. Steatorrhea 3. Nausea and vomiting 4. Elevated temperature 5. Severe epigastric pain
A patient with chronic pancreatitis is prescribed pancrelipase (Lipancreatin). What should the nurse instruct the patient about this medication?
1. Take the medication with meals or snacks. 4. Do not crush enteric coated doses of the medication. 5. Take this medication until advised otherwise by the healthcare provider.
The nurse is assessing a patient with liver cirrhosis. Which findings should the nurse relate to the patient's failed liver function?
1. The patient had two episodes of epistaxis. 2. The patient had toxic levels of a prescribed medication. 3. The patient is oriented to person and place but not to time.
During a health assessment the nurse becomes concerned that a patient is at high risk for pancreatic cancer. What assessment findings caused this concern?
1. The patient smokes cigarettes. 2. The patient has a body mass index of 32.5. 4. The patient's uncle died from pancreatic cancer. 5. The patient has been diagnosed with chronic pancreatitis.
A patient asks the nurse about ways to reduce the risk of developing gallstones and cholecystitis. The nurse should discuss which health promotion activities?
1. Walk for 30 minutes five times a week. 3. Eat a low-cholesterol diet.
A patient wants to reduce the risk of developing gallstones and cholecystitis. What should the nurse instruct this patient?
1. Walk for 30 minutes five times a week. 3. Eat unsaturated rather than saturated fats. 4. Eat a low-carbohydrate diet.
A patient recovering from Whipple's procedure is being transferred to the medical-surgical care area. On which interventions should the nurse focus to determine if the patient is developing a complication from the surgery?
1. assessing heart rate every 2 hours 2. monitoring urine output ever hour 4. measuring blood pressure every 2 hours
The nurse notes new areas of ecchymosis on the arms and legs of a patient with liver cirrhosis. Which laboratory test results should the nurse monitor because of this finding?
1. complete blood count with platelets 2. coagulation studies
In providing care to a patient with a Ranson's score of 7, the nurse recognizes that this indicates what chance of mortality?
100% mortality
The nurse is caring for a client with acute pancreatitis. The client's health care provider has ordered gentamicin (Garamycin) 3 mg/kg/day in three divided doses. The client weighs 264 lb. The client will receive _______ milligrams/dose of Garamycin.
120
A nurse explains to a client who recently ate in a fastfood restaurant where several people have developed hepatitis that the incubation period for this type of hepatitis is
15 to 30 days.
The nurse provides education to a patient who is diagnosed with chronic pancreatitis. Which patient statements indicate a correct understanding of the causes of this condition? Select all that apply.
2. "High cholesterol is associated with this diagnosis." 3. "Heavy alcohol use over the years is a cause of this condition." 4. "My mother also had problems with her pancreas when she was living."
The nurse is assessing a patient with cholelithiasis. Which statements by the patient indicate a progression to cholecystitis?
2. "I'm hot and sweating, then cold and shivering." 4. "I need an emesis basin; I've vomited four times." 5. "My abdomen and my back both hurt."
A patient with cholelithiasis is recovering from extracorporeal shock wave lithotripsy. Which statements indicate that the patient remembers the procedure accurately?
2. "They gave me some medication in my IV. I didn't feel much." 3. "Afterwards the nurses kept asking me if my abdomen hurt or if I was nauseated." 5. "They used a big machine to guide the shock waves to the stones."
The nurse monitors for which clinical manifestations in the patient diagnosed with chronic pancreatitis? Select all that apply.
2. Clay-colored stool 3. Diarrhea 4. Steatorrhea
The clinic nurse has been providing care for a patient with a long history of cholelithiasis. Which statement by the patient would make the nurse suspicious that the condition has progressed to cholecystitis?
2. Im hot and sweating, and then cold and shivering. 4. I need an emesis basin; Ive vomited four times. 5. My abdomen and my back both hurt.
The nurse is teaching a patient about modifiable risk factors for cholelithiasis. Which specific factors would the nurse discuss?
2. Obesity 3. Alternating rapid weight loss with rapid regaining of the weight 5. Elevated serum cholesterol
The nurse is concerned that a patient with injuries from a motor vehicle crash is experiencing bleeding from liver trauma. What did the nurse assess to make this clinical determination?
2. new onset of lightheadedness 3. heart rate 112 beats per minute 4. requesting more water to drink 5. respiratory rate 26 breaths per minute
The nurse is teaching a patient about modifiable risk factors for cholelithiasis. What risk factors will the nurse discuss?
2. obesity 3. alternating weight loss and gain 5. elevated serum cholesterol
Preparing for travel to an area of Africa where hepatitis A is endemic, a client receives immune serum. The nurse would remind the client that this prophylaxis is effective for up to
3 months
In reviewing the treatment plan for the patient diagnosed with ascites, which prescription does the nurse question?
A 3 g/day sodium diet
A nurse who provides care in a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients as having the highest risk for chronic pancreatitis?
A 39-year-old man with chronic alcoholism
During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?
A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)
A patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) has a serum potassium level of 3.2 mEq/L (3.2 mmol/L). Which action should the nurse take?
Administer the spironolactone.
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?
Administer the spironolactone.
A patient has come to the clinic complaining of blood in his stool. A FOBT test is performed but is negative. Based on the patients history, the physician suggests a colonoscopy, but the patient refuses, citing a strong aversion to the invasive nature of the test. What other test might the physician order to check for blood in the stool?
A quantitative fecal immunochemical test
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patients treatment, the nurse should anticipate what intervention?
A regimen of antiviral medications
A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?
A slightly decreased size of the liver
A patients physician has ordered a liver panel in response to the patients development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.
A) Alanine aminotransferase (ALT) C) Gamma-glutamyl transferase (GGT) D) Aspartate aminotransferase (AST)
A patient with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the patient should be informed that this procedure will involve the removal of which of the following? Select all that apply.
A) Gallbladder B) Part of the stomach C) Duodenum D) Part of the common bile duc
A patients assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply.
A) How many alcoholic drinks do you typically consume in a week? C) Have you ever been diagnosed with gallstones?
A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.
A) Immunization B) Use of standard precautions
A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.
Administering diuretics Implementing fluid restrictions Enhancing patient positioning
A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?
Abdominal pain and hepatomegaly
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?
Abdominal pain is decreased.
A client is in the emergency department after a motor vehicle crash. In assessing the client, which clinical sign alerts the nurse to the presence of possible liver trauma?
Abdominal pain referred to the right shoulder
A female patient has presented to the emergency department with right upper quadrant pain; the physician has ordered abdominal ultrasound to rule out cholecystitis (gallbladder infection). The patient expresses concern to the nurse about the safety of this diagnostic procedure. How should the nurse best respond?
Abdominal ultrasound poses no known safety risks of any kind.
When assessing a patient who has cirrhosis, which finding would best indicate the patient is developing ascites?
Accumulation of fluid in the abdomen
A client with acute pancreatitis has developed a Cullen's sign. Which nursing diagnosis takes priority for this client?
Acute Pain
The nurse is caring for a client who had undergone a Whipple procedure 2 days previously. The nurse notes that the client's hands and feet are edematous, and urine output has decreased from the previous day. Which intervention does the nurse expect to provide for the client?
Add colloids to the client's IV solutions.
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis?
Adhere to dosing recommendations of OTC analgesics.
After an unimmunized person is exposed to hepatitis B through a needle-stick injury, which action should the nurse plan to take?
Administer hepatitis B vaccine. Test for antibodies to hepatitis B. Give hepatitis B immune globulin.
Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis?
Albumin level
The nurse correlates which data in the client's history as a predisposing factor for Laënnec's cirrhosis?
Alcohol abuse
A patient with liver cancer has been admitted to hospice. The patient asks why he developed this disease. The nurse knows there is a high likelihood this patient has which medical history?
Alcohol consumption
The nurse correlates which finding from a patient's health history as a risk factor for acute pancreatitis?
Alcoholism
What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?
Ammonia levels
Which of these laboratory test results will be most important for the nurse to monitor when evaluating the effects of therapy for a patient who has acute pancreatitis?
Amylase
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
An immune globulin injection
The nurse is preparing a patient with pancreatitis for discharge to home. The nurse is instructing the patient about decreasing pancreatic stimulation to reduce pain. What method should the nurse suggest?
Avoid the smell of food
A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?
Asterixis and lethargy
A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient's illness?
Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
A patient has had a laparoscopic cholecystectomy. The patient is now complaining of right shoulder pain. What should the nurse suggest to relieve the pain?
Application of heat 15 to 20 minutes each hour
The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube. Which nursing intervention prevents complications from this procedure?
Applying a skin barrier around the drainage tube site
A community health nurse is caring for a patient whose multiple health problems include chronic pancreatitis. During the most recent visit, the nurse notes that the patient is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurses most appropriate action?
Arrange for the patient to be transported to the hospital.
A client is admitted for suspected cholecystitis. On reviewing laboratory results, the nurse notes that the client's amylase is elevated. Which action by the nurse is best?
Ask the client about drinking habits.
How should the nurse prepare a patient with ascites for paracentesis?
Ask the patient to empty the bladder.
Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?
Ask the patient to extend both arms forward.
To evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy, which action should the nurse take?
Ask the patient to extend both arms to the front.
A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination
Ask whether the patient has been screened for hepatitis C.
A client is in the emergency department after a motor vehicle crash, and the nurse notices a "steering wheel mark" across the client's chest. Which action by the nurse is most appropriate?
Assess the client by gently palpating the abdomen for tenderness.
A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patients family how to safely perform which of the following actions?
Assessing the patency of the drainage catheter
A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patients plan of care?
Assessment for variceal bleeding
A client is scheduled for a paracentesis. Which activity does the nurse delegate to the unlicensed assistive personnel?
Assist the client to void before the procedure.
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
Asterixis
Probably the most widely used in-office or at-home occult blood test is the Hemoccult II. The patient has come to the clinic because he thinks there is blood in his stool. When you reviewed his medications, you noted he is on antihypertensive drugs and NSAIDs for early arthritic pain. You are sending the patient home with the supplies necessary to perform 2 hemoccult tests on his stool and mail the samples back to the clinic. What instruction would you give this patient?
Avoid vitamin C for 72 hours before you start the test.
Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?
Avoiding all alcohol use
A nurse is caring for a patient admitted with a suspected malabsorption disorder. The nurse knows that one of the accessory organs of the digestive system is the pancreas. What digestive enzymes does the pancreas secrete? Select all that apply.
B) Lipase C) Amylase D) Trypsin
A young adult waiter has been treated for viral hepatitis at a healthcare clinic. Which patient outcome requires an intervention by the nurse?
BMI changes from 24 to 21
The nurse is teaching a community group about pancreatic cancer. Which risk factor does the nurse instruct is known for development of this type of cancer?
BRCA2 gene mutation
A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?
Bed rest lowers the metabolic rate and reduces enzyme production.
A client is admitted with acute pancreatitis. The orders are for "pancreatic rest." The nurse would implement which of the following? (Select all that apply.)
Bed rest with appropriate positioning Withholding foods and liquids
A nurse is caring for a patient with biliary colic and is aware that the patient may experience referred abdominal pain. Where would the nurse most likely expect this patient to experience referred pain?
Below the right nipple
A patient returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the patient for signs and symptoms of what serious potential complication of this surgery?
Bile duct injury
The nurse correlates which factor as a potential cause of an elevated AST (aspartate aminotransferase) in the patient with acute pancreatitis?
Bile flow obstruction
The nurse correlates which data from the patient's health as a risk factor for the current diagnosis of cirrhosis?
Biliary disease
The nurse is caring for a patient who has just returned from the ERCP removal of gallstones. The nurse should monitor the patient for signs of what complications?
Bleeding and perforation
A client is admitted with end-stage cirrhosis and severe vomiting. Which problem should the nurse monitor the client most carefully for?
Bleeding esophageal varices
A student nurse is caring for a patient who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments?
Blood glucose levels
An older adult patient is admitted to the hospital with blunt trauma to the abdomen after an autoaccident. The nurse monitors for which clinical manifestation of intra-abdominal bleeding?
Bluish tint around the umbilicus
The nurse is caring for a female client with cholelithiasis. Which assessment findings from the client's history and physical examination may have contributed to development of the condition? (Select all that apply.)
Body mass index (BMI) of 46 Pregnant with twins Glycosylated hemoglobin level of 15%
A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor liver be determined?
By objectively determining the patients medical need
Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?
Check blood pressure and heart rate.
When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next?
Check the calcium level in the chart.
The nurse correlates the secretion of which substance to the release of bile from the gallbladder?
Cholecystokinin
A patient who reports a severe, steady pain in the epigastric area along with nausea and vomiting states, This happens every time I eat barbecued ribs. It will go away in a little while, especially if I lie on my back. The nurse would consider which disorder as the likely cause of these symptoms?
Cholelithiasis
A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over 80% of the patients pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurses best response?
Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.
A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. For what complication is this patient at risk?
Central nervous system damage
After a patient has had a transjugular intrahepatic portosystemic shunt (TIPS) placement, which finding indicates that the procedure has been effective?
Decrease in episodes of variceal bleeding
The nurse is reviewing the laboratory results of an assigned patient. The serum bilirubin is 2.8 mg/dL. The nurse would anticipate which finding in the patient's urine?
Dark color
A client has returned from an open cholecystectomy. The nurse places the highest priority on which intervention?
Coughing and deep breathing
A client is admitted with cirrhosis and hepatopulmonary syndrome. Which clinical manifestation does the nurse monitor for progression or resolution of this problem?
Crackles on auscultation
In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change. C
Cullen's sign consists of ecchymosis around the umbilicus.
A client with an esophagogastric tube suddenly experiences acute respiratory distress. Which is the nurse's first action?
Cut the balloon ports and remove the tube.
A client who had a liver transplant a month ago is admitted with fever and tachycardia. Which medication does the nurse prepare to administer to this client?
Cyclosporine (Sandimmune)
The nurse correlates which finding in the patient history as a risk factor for chronic pancreatitis?
Cystic fibrosis
A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?
Death Anxiety
A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem?
Daily weights and abdominal girth measurement
Which finding in a patient who has a Sengstaken-Blakemore tube for esophageal varices is the priority for follow-up?
Decreased level of consciousness
In administering lactulose to the patient with hepatic encephalopathy, the nurse correlates effectiveness of this medication to which mechanism of action?
Decreases production of ammonia
A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following?
Delivery of a continuous chemotherapeutic dose
A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?
Destruction of the patients liver tumor
The nurse is caring for a client who has just been diagnosed with end-stage pancreatic cancer. The nurse assesses the client's emotional response to the diagnosis. Which is the nurse's initial action for the assessment?
Determine whether the client feels like talking about his or her feelings.
The nurse is providing care to a patient diagnosed with cirrhosis, and monitors for which clinical manifestation of stage 3 hepatic encephalopathy?
Difficulty to awaken
A patient with cystic fibrosis takes pancreatic enzyme replacements on a regular basis. The patients intake of trypsin facilitates what aspect of GI function?
Digestion of proteins
The nurse is providing care to a patient diagnosed with cirrhosis, and monitors for which clinical manifestation of stage 2 hepatic encephalopathy?
Disorientation
The nurse reading the laboratory reports for a patient with acute hepatitis is aware that an indicator supporting this diagnosis is:
increased prothrombin time.
A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis C in the workplace?
Disposing of sharps appropriately and not recapping needles
A patient is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. Which question by the nurse is most appropriate?
Do you use any over-the-counter (OTC) drugs?
The nurse is caring for a client who has just undergone traditional cholecystectomy surgery and has a Jackson-Pratt (JP) drain in place. The nurse notes serosanguineous drainage present in the drain. Which is the nurse's priority action?
Document the finding in the client's chart.
A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurses most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurses best response to this assessment finding?
Document the presence of normal bile output.
Which sound would the nurse expect to elicit when percussing the liver?
Dullness
The nurse assesses a patient who has cirrhosis secondary to liver failure. Which finding would require immediate follow-up by the nurse?
Dyspnea
A client has been admitted for suspected hepatic carcinoma. The client and family are anxious and agitated. Which intervention by the nurse would best support them?
Educate the client and family about upcoming procedures and tests.
A client with hepatitis C is being treated with ribavirin (Copegus). What nursing action takes priority
Educating the client on ways to remain complaint with the drug regimen
A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize?
Educating the patient about postdischarge lifestyle modifications
Which laboratory findings does the nurse recognize as potentially causing complications of liver disease?
Elevated prothrombin time and international normalized ratio (INR)
Which laboratory data does the nurse correlate with advanced disease in a client with cirrhosis?
Elevated serum ammonia level
A client is admitted with jaundice and suspected hepatitis B. Which intervention does the nurse add to the client's care plan?
Encourage rest during this period.
A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes after discharge. What is the nurses most appropriate response?
Encourage the patient to connect with a community-based support group.
The nurse is caring for a patient diagnosed with hepatitis during the posticteric phase of the condition. When planning care, which intervention should be of the highest priority?
Encouraging frequent rest periods
The postanesthesia care unit nurse is caring for a client who has just undergone an open Whipple procedure. The client has multiple tubes and drains in place after the surgery. Which does the nurse assess first?
Endotracheal tube with 40% fraction of inspired oxygen (FiO2)
The nurse is caring for a client with acute pancreatitis. During the physical assessment, the nurse notes a grayish-blue discoloration of the client's flanks. Which is the nurse's priority action?
Ensure that the client has a patent large-bore IV site.
The nursing care plan specifies obtaining abdominal girth measurements each shift. The nurse takes the measurement, but when compared with the previous measurement, the new finding is several millimeters off. Which action by the nurse is best?
Ensure that the client's abdomen and flanks are marked with pen.
Which is the priority nursing action when providing care to a patient with a nasogastric tube (NGT) following a pancreaticoduodenectomy (Whipple procedure)?
Ensuring that the tube is not manipulated
Which assessment data indicates to the nurse that the patient may be experiencing decreased clotting factors as a complication of cirrhosis?
Epistaxis
A patient admitted with acute pancreatitis has a nasogastric tube, is in pain, and is on bed rest. The patient says, I dont understand why I cant eat. How should the nurse respond?
Explain the purpose of the nasogastric tube and the reasons for keeping the patient NPO
The nurse correlates which factor as a potential cause of hypocalcemia in the patient with acute pancreatitis?
Fat necrosis and malnutrition
In documenting assessment data on the patient diagnosed with hepatic encephalopathy, the nurse uses which term to describe a sweet fecal smell of the breath?
Fetor hepaticus
A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?
Fever, increased heart rate and decreased blood pressure
Which finding indicates to the nurse that a patient's transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?
Fewer episodes of bleeding varices
The nurse assesses a patient with cirrhosis who is experiencing hypertension, edema, and shortness of breath. Which nursing diagnosis will the nurse establish?
Fluid Volume Excess
A patient with hepatitis has a prescription for alpha interferon. Which manifestation would indicate that the patient is experiencing an untoward effect of this medication
Flulike syndrome
During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?
Following proper hand-washing techniques
A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a patient admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?
Fried chicken
The nurse correlates which factor as a potential cause of an elevated ALT (alanine transaminase) in the patient with acute pancreatitis?
Gallstone pancreatitis
A patient presents to the emergency department (ED) complaining of severe right upper quadrant pain. The patient states that his family doctor told him he had gallstones. The ED nurse should recognize what possible complication of gallstones?
Gangrene of the gallbladder
A client has ascites and the nursing diagnosis Excess Fluid Volume. The nurse has orders to administer albumin and furosemide (Lasix). Which action by the nurse regarding this order is correct?
Give the albumin first and then give the furosemide.
The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene. Which action by the assistant requires intervention by the registered nurse?
Giving the client a basin of warm water and soap to use
In completing an admission assessment, which patient data meets the Ranson's criteria for acute pancreatitis?
Glucose 250mg/dL
A patient has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test?
Glucose tolerance test
In providing teaching to a patient about management of acute pancreatitis, the nurse explains which prescribed medication is used to decrease gastric acid secretions?
H2 antagonists
Fecal-oral transmission, acute onset
HAV
Transmission by contact with blood and body fluids, perinatal transmission from mother to infant
HBV
Most likely to lead to cirrhosis
HCV
Coexists with HBV
HDV
Prevalent in less developed countries
HEV
A patient is admitted with acute pancreatitis. The nurse recognizes that nutritional outcomes have been met after assessing which finding regarding the patients weight?
Has increased 0.5 pounds over 1 week
A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patients vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurses most appropriate action?
Have the patient assessed by the physician due to the risk of internal bleeding.
A patient has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study?
Have the patient refrain from food and fluids after midnight.
The nurse correlates which factor as the highest risk factor for the development of chronic pancreatitis?
Heavy alcohol use
The nurse recognizes which complication of liver trauma as the leading cause of death?
Hemorrhage
The nurse correlates which type of viral hepatitis to the fecal-oral route of transmission?
Hepatitis A (HAV)
The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B?
Hepatitis B surface antigen (HBsAg) antibodies
The advanced practice nurse uses which assessment approach to best determine a patient's liver span?
Hooking technique
A patient has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the patient is most likely to require which of the following?
Hospice care
A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patients presentation?
How many alcoholic drinks do you typically consume in a week?
After providing discharge instructions to a patient following a laparoscopic cholecystectomy, the nurse recognizes that teaching has been effective when the patient states,
I can remove the bandages on my incisions tomorrow and take a shower.
The nurse is caring for a patient who has just returned from a humanitarian trip to Central America. The patient is jaundiced and is diagnosed with hepatitis A. The patient is the parent of three school-age children. Which statement by the patient is a priority for follow-up?
I need to get home to take care of my children
When the nurse is obtaining a history from a patient who is admitted with jaundice, which statement is most indicative of a need for patient teaching?
I use acetaminophen (Tylenol) every 4 hours for chronic pain.
A patient with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the patient states:
I will take this medication for 2 weeks and then gradually stop taking it.
A patient with chronic pancreatitis is taking pancreatic enzymes. Which statement would indicate to the nurse that the patient correctly understands instruction about this medication?
I will take this medication with food.
A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?
IV administration of octreotide (Sandostatin)
A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this patient?
IV hydromorphone (Dilaudid)
A 15yearold client admitted with severe jaundice is having diagnostic testing. The nursing diagnosis that would have priority is
Impaired Skin Integrity related to jaundice
A nurse is preparing a plan of care for a patient with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize?
Impaired Skin Integrity.
A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurses priority?
Implementation of infection-control measures
The nurse, teaching a patient about portal hypertension, knows teaching has been effective when the patient makes which statement?
In portal hypertension, blood backs up in the liver. It causes enlarged blood vessels in my esophagus."
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
Inability of the liver to use vitamin K
A critical care nurse is caring for a patient diagnosed with acute pancreatitis. The nurse knows that the indications for starting parenteral nutrition (PN) for this patient are what?
Inability to take in adequate oral food or fluids within 7 days
The nurse correlates which factor as a potential cause of decreased serum albumin in the patient with acute pancreatitis?
Inadequate nutrition
The nurse correlates which laboratory result as a diagnosis of liver disease?
Increased ammonia
A patients abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patients laboratory studies, what finding is most closely associated with this diagnosis?
Increased bilirubin
A client just returned to the nursing unit after having a trans-jugular intrahepatic portal-systemic shunt (TIPS) procedure. Which clinical finding does the nurse expect to observe in this client?
Increased blood pressure
A patient who has portal system encephalopathy is receiving Neomycin (neomycin sulfate). Which manifestation would indicate to the nurse that the patients condition is improving?
Increased level of consciousness
The nurse is preparing to perform a patients abdominal assessment. What examination sequence should the nurse follow?
Inspection, auscultation, percussion, and palpation
A client admitted with hepatopulmonary syndrome is experiencing dyspnea but does not want oxygen increased because the client's nose keeps bleeding from it. The client becomes agitated when discussing this with the nurse. The client's oxygen saturation is 92%. What intervention by the nurse is best?
Instruct the client to sit in as upright a position as possible.
A nurse is caring for a patient with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The patient askshow this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drugs pharmacodynamics?
It inhibits the synthesis and secretion of cholesterol.
A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?
Keep patient NPO until the patients gag reflex returns.
The client with end-stage cirrhosis presents with GI bleeding, combativeness, and confusion. The nurse anticipates an order to administer which medication?
Lactulose (Heptalac)
A patient with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the patient will undergo what intervention?
Laparoscopic cholecystectomy
In providing care to the patient diagnosed with gallstones, the nurse includes information about which preferred treatment for this disease process?
Laparoscopic cholecystectomy
A patient with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?
Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.
The nurse is caring for a client with cholecystitis. The client is a poor historian and is unable to tell the nurse when the symptoms started. Which assessment finding indicates to the nurse that the condition is chronic rather than acute?
Light-colored stools
Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?
Lipase
Based on age-related changes in the gastrointestinal system, the nurse correlates decreased bile synthesis to which structure?
Liver
The nurse correlates a prolonged prothrombin time (PT) to a disorder of which organ?
Liver
Which assessment finding in a patient who is being admitted to the hospital is most important to report to the health care provider?
Liver edge 3 cm below the costal margin
A previously healthy adults sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what?
Liver transplantation
Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention?
Lobectomy
A patient has chronic pancreatitis and a serum amylase level of 180 units/L. The nurse should instruct the patient to follow which dietary plan?
Low fat, no alcohol
An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this patients plan of care?
Measure the patients abdominal girth daily.
A client is receiving an infusion of vasopressin (Pitressin) to treat bleeding esophageal varices. Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring?
Midsternal chest pain
A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?
Monitor the patient for shortness of breath.
Which nursing action will be included in the plan of care for a patient who is being treated for bleeding esophageal varices with balloon tamponade?
Monitor the patient for shortness of breath.
The nurse monitors for which clinical manifestation in the patient diagnosed with cholecystitis?
Murphy's sign
Which assessment finding in a patient with acute pancreatitis would the nurse need to report most quickly to the health care provider?
Muscle twitching and finger numbness
Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis?
Muscle twitching and finger numbness
The nurse is caring for a patient with hepatitis C who is treating the illness with licorice root. Which statement by the patient requires follow-up regarding this medication?
My fingers are swollen.
The nurse planning the care of a client admitted with severe pancreatitis would anticipate the diet order of
NPO with TPN.
A patient has sought care because of recent dark-colored stools. As a result, a fecal occult blood test has been ordered. The nurse should instruct the patient to avoid which of the following prior to collecting a stool sample?
NSAIDs
The nurse is assessing a client with mild liver disease. Which assessment does the nurse perform to detect the presence of ascites in this client?
Palpate the abdomen in assessing for a fluid wave.
In providing teaching to a patient about management of acute pancreatitis, the nurse explains which prescribed medication is used for digesting fats and proteins?
Pancreatic enzymes
A 32-year-old patient is diagnosed with early alcoholic cirrhosis. Which topic is most important to include in patient teaching?
Need to abstain from alcohol
The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (Select all that apply.)
Obesity Diabetes mellitus Taking cholesterollowering drugs Mexican American ethnicity
A client with massive ascites had a paracentesis. The site continues to leak through several layers of dressings, despite the nurse holding pressure. Which intervention should the nurse do first?
Obtain a urostomy pouch and apply it at the puncture site.
The nurse is planning education for an adolescent patient recently diagnosed with hepatitis. The patient moved back to the parents' home. Which recommendation to the parents will best prevent them from acquiring hepatitis B (HBV)?
Obtaining postexposure prophylaxis
In providing care for an older adult patient with a history of alcohol abuse, the nurse correlates which treatments as relevant to the treatment of acute pancreatitis? Select all that apply.
Opioid analgesics Total parenteral nutrition Nasogastric tube to suction
A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?
Orange and foamy urine
A patient with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine postsurgical appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?
Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain.
Which assessment finding is of most concern for a patient with acute pancreatitis?
Palpable abdominal mass
A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice?
Patient who requires pain management for chronic pancreatitis
A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration?
Pegylated -interferon (Pegasys) orally once daily
A patient is being assessed for a suspected deficit in intrinsic factor synthesis. What diagnostic or assessment finding is the most likely rationale for this examination of intrinsic factor production?
Persistently low hemoglobin and hematocrit
Which assessment data indicates to the nurse that the patient may be experiencing increased ammonia levels, a complication of cirrhosis?
Personality changes
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver?
Place hand under right lower rib cage and press down lightly with the other hand.
The health care provider sees a patient at 10 AM and writes an order for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which of these actions that are included in the agency policy for ERCP should the nurse take first?
Place the patient on NPO status.
A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?
Place the patient on a pressure-relief mattress.
What action should the nurse take after assisting with a needle biopsy of the liver at a patient's bedside?
Place the patient on the right side with the bed flat.
A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?
Position the patient on the right side with a pillow under the costal margin after the procedure.
A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy?
Positive urine pregnancy test
Results of a patients preliminary assessment prompted an examination of the patients carcinoembryonic antigen (CEA) levels, which have come back positive. What is the nurses most appropriate response to this finding?
Prepare to meet the patients psychosocial needs.
The nurse monitors for which clinical manifestation in the patient diagnosed with pancreatic cancer?
Yellowing of the sclera
The nurse is reviewing the laboratory results from a patient who has been diagnosed with liver disease. Which finding would be consistent with this condition?
Prothrombin time (PT) 10 seconds
A patient arrives at the clinic for follow-up care for pancreatitis. The patient lives alone, has high cholesterol levels, and admits to alcoholism. What is the priority intervention for this patient?
Provide information on alcohol cessation programs.
A client has cirrhosis. Which nursing intervention would be most effective in controlling ascites?
Providing a low-sodium diet
For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?
Providing oral hygiene after a meal
The nurse is preparing instructions for a patient who is at risk for cholelithiasis. What lifestyle modification should the nurse include in this teaching?
Reduce fat consumption.
The nurse should instruct the patient with a diagnosis of cholelithiasis to make which lifestyle modification to alleviate symptoms?
Reduce fat consumption.
A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patients plan?
Reduction in sodium intake
The nurse is instructing a patient recovering from a liver transplant. What should the nurse include in this teaching?
Report sore throats to the healthcare provider.
Which teaching point is appropriate for a nurse to include when teaching a patient who has undergone a liver transplant?
Report sore throats to your health care provider.
A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent assessment reveals subtle changes in the patients cognition and behavior. What is the nurses most appropriate response?
Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.
Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?
Review the patient's current medication list.
A nurse is assessing a patient who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the patients pain, the nurse should anticipate that it may radiate to what region?
Right shoulder
A patient who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this patient knows to immediately report what assessment finding to the physician?
Rigidity of the abdomen
A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?
Risk for Infection Related to Immunosuppressant Use
The nurse is teaching a client with a history of cholelithiasis to select menu items for dinner. Which selections made by the client indicate that the nurse's teaching was effective?
Roasted chicken breast, baked potato with chives, hot tea with sugar
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?
Schedule for liver cancer screening every 6 months.
A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate?
Schedule the patient for HCV genotype testing
The nurse correlates the secretion of which substance to the release of sodium bicarbonate from the liver and pancreas?
Secretin
The correlates which diagnostic results to the patient diagnosed with advanced cirrhosis?
Serum albumin 3.0 mg/dL Serum magnesium 1.2 mg/dL Serum sodium 130 mEq/L
A client has cirrhosis and has developed ascites and edema. Which laboratory value does the nurse correlate with this condition?
Serum albumin, 2.1 g/dL
A client is hospitalized with acute pancreatitis. The nursing assistant reports to the nurse that when a blood pressure cuff was applied, the client's hand had a spasm. Which additional finding does the nurse correlate with this condition?
Serum calcium, 5.8 mg/dL
A client is receiving lactulose (Heptalac). Which laboratory value leads the nurse to intervene?
Serum potassium, 2.6 mEq/L
A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patients abdomen is rigid, and there is bruising to the patients flank. The patients wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem?
Severe pancreatitis with possible peritonitis
The nurse monitors for which clinical manifestation assessed in the patient diagnosed with liver cancer?
Shortness of breath
The nurse correlates which data from a patient's health history to a risk factor for acalculous cholecystitis?
Sickle cell disease
A patient has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize which of the following topics?
Signs and symptoms of intra-abdominal complications
A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly patient may include what?
Signs and symptoms of septic shock
The nurse is caring for a client who had a T-tube placed 3 days ago. Which assessment finding indicates to the nurse that the procedure was successful?
Soft, brown, formed stool this morning
In providing teaching to a patient about management of acute pancreatitis, the nurse explains which prescribed medication is used to relax the sphincter of Oddi?
Spasmolytics
A nurse is caring for a patient with hepatic encephalopathy. The nurses assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
Stage 3
In caring for a patient with hepatitis B, the nurse would follow:
Standard Precautions.
A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?
Stools test negative for occult blood.
The nurse is caring for a client after a Whipple procedure. Which manifestations might indicate that a complication from the operation has occurred? (Select all that apply.)
Substernal chest pain Shortness of breath Lack of bowel sounds or flatus Urine output of 20 mL/6 hr
A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a sick gallbladder. What rationale would underlie the nurses response?
Surgery is delayed until the acute symptoms subside.
When assessing a patient who had a liver transplant a week previously, the nurse obtains the following data. Which finding is most important to communicate to the health care provider?
Temperature 100.8 F (38.2 C)
Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?
Temperature 100.8° F (38.2° C)
The nurse teaches the patient diagnosed with hepatitis B about which oral medication used to treat this health problem?
Tenofovir
A client is bleeding from esophageal varices. The health care provider is arranging sclerotherapy for the client. Before the client goes to interventional radiology, the nurse prepares to administer which medication?
Terlipressin (Glypressin)
The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurses best response?
The bed automatically moves, so shes less likely to develop pressure sores while shes in bed.
A patient in the icteric phase of hepatitis asks the nurse, Why are my stools no longer brown? How should the nurse respond?
The bilirubin that causes the coloration is going into your blood and turning your skin yellow.
A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patients health problem?
The enzymes that your pancreas produces have damaged the pancreas itself.
A patient with cholelithiasis has a serum amylase level of 300 units/L. What should the nurse consider as the most likely explanation for the laboratory finding?
The gallstone is blocking the common bile duct
The nurse is caring for a patient with cholelithiasis who has a new laboratory finding of serum amylase of 300 units/L. The patient states, My primary health care provider said I dont have pancreatitis. What is the most likely explanation for the laboratory finding?
The gallstone is blocking the common bile duct.
Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices?
The medication will prevent irritation of the enlarged veins.
A nurse is caring for a patient who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this patient, the nurse should describe what aspect of this diagnostic procedure?
The use of moderate sedation
The physician has prescribed neomycin enemas for a patient with cirrhosis. The patient questions why they are being used. Which response by the nurse is most appropriate?
These enemas kill intestinal flora.
A patient with pancreatitis asks the nurse, Why are my stools so frothy and smell so bad? What is the nurses best response?
This indicates your stools have more fat in them
The nurse is providing care to a patient diagnosed with cirrhosis, and monitors for which clinical manifestation of stage 1 hepatic encephalopathy?
Tremors
A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patients current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?
Two to 3 soft bowel movements daily
A patient is admitted to the ICU with acute pancreatitis. The patients family asks what causes acute pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?
Undiagnosed chronic pancreatitis
A client had a paracentesis 1 hour ago. Which assessment finding requires action by the nurse?
Urine output of 20 mL/hr
Which nursing action will be included in the plan of care for a patient with cirrhosis who has ascites and 4+ edema of the feet and legs?
Use a pressure-relieving mattress
A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringers lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient?
Volume expanders
A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C) and right flank pain. Which is the nurse's best response?
You should go to the hospital immediately to have your new liver checked out."
The nurse recognizes that the individual at highest risk for development of gallstones is
a 60yearold white woman being treated for obesity.
The nurse would explain to a client that the persistent presence of hepatitis B surface antigen (HBsAg) without overt manifestations strongly suggests that the client is
a carrier of hepatitis B.
The nurse is reviewing pathophysiology concepts to understand what is occurring with an adult patient who has abdominal pain and a serum conjugated bilirubin level of 1.2 mg/dL. What should the nurse suspect is occurring with this patient?
a disorder of the biliary system
The nurse is aware that risk factors for the development of pancreatic cancer include: (Select all that apply.)
a. obesity. c. diabetes mellitus. e. smoking.
The infection control nurse wants to decrease the number of health care professionals who contract viral hepatitis at work. Which actions does the nurse initiate? (Select all that apply.)
a.Strengthen policies related to consistent use of Standard Precautions. c.Implement a needleless system for IV therapy. d.Reduce the number of "sharps" needed for client care where possible. e.Provide postexposure prophylaxis in a timely manner.
The nurse is assessing a patient who is experiencing hepatocellular failure. Which finding best indicates that the patient is developing ascites?
accumulation of fluid in the abdomen
The nurse preparing to discharge a client with acute hepatitis B instructs the client to avoid
acetaminophen and aspirin.
In obtaining a medication history from a client who reports taking all the following medications, the nurse would know that the medication considered hepatotoxic is
acetaminophen.
The nurse counseling a client who has used oral contraceptives (OCs) since age 17 would make the client aware that the use of OCs has increased the incidence of
adenomas of the liver.
A client who had onset of acute pancreatitis 6 days ago has a respiratory rate of 26 with fine crackles throughout lung fields, and seems a little confused and agitated. The nurse would continue to assess this client for manifestations of
adult respiratory distress syndrome.
A patient with cirrhosis has 4+ pitting edema of the feet and legs. The data indicate that it is most important for the nurse to monitor the patients
albumin level.
A client admitted with a diagnosis of Laënnec's cirrhosis would be questioned by the nurse about the etiologic factor of
alcohol ingestion.
When obtaining a health history from a patient with acute pancreatitis, the nurse asks the patient specifically about a history of
alcohol use.
A patient who had a laparoscopic cholecystectomy 4 hours ago complains of fullness in the abdomen and mild discomfort. Because his vital signs are stable, the nurse should:
ambulate the patient to reduce gas.
A patient with severe cirrhosis has an episode of bleeding esophageal varices. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor
ammonia levels.
A 20yearold college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse recommends that he get immediate protection by acquiring:
an injection of hepatitis B immune globulin (HBIG).
The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patients blood reveals
anti-HBs.
The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals:
anti-HBs.
A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patients illness, the nurse would expect serologic testing to reveal
anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
When a client is admitted to the hospital for treatment of acute cholecystitis, the nurse would anticipate that the immediate medical management will be
antibiotic therapy.
The assessment of bulging flanks on a patient who is supine with knees flexed leads the nurse to assess further for:
ascites.
The nurse is assessing the nutritional status of a patient who has cholelithiasis and a body mass index of 35. What action should the nurse take initially?
ask the patient to discuss typical daily menu choices
The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. To prepare the patient for the procedure, the nurse
asks the patient to empty the bladder.
A client returned to the nursing unit after cholecystectomy with common bile duct exploration has bile leaking from around the wound. The most appropriate nursing intervention at this time would be to
assess the client further, asking about pain.
The nurse caring for a patient with acute pancreatitis will include in the daily assessments: (Select all that apply.)
auscultation of bowel sounds to detect paralytic ileum. amount of food eaten each meal. effectiveness of pain control. urine output.
Health promotion activities a nurse could recommend to a client in order to prevent pancreatitis include (Select all that apply)
avoiding alcohol abuse. losing weight if needed
The nurse plans for the skin care of the patient with ascites, which would include: (Select all that apply.)
bathing in tepid water. applying emollients to decrease itching. cutting the patient's fingernails short. changing the patient's position every 1 to 2 hours.
The nurse would be aware that the condition present in a client that is a predisposing factor in development of liver abscess is
bile duct obstruction with a stone.
The nurse notes on a client's chart a report revealing unconjugated hyperbilirubinemia. The nurse explains the presence of unconjugated bilirubin indicates
biliary obstruction is preventing blood flow through the liver.
A client is being admitted for "hematochezia." The nurse would plan to assess for
blood in the stool
A patient who has had his fifth attack of gallstones is encouraged to have a cholecystectomy to prevent the threat of:
cancer of the gallbladder.
The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit, 72%; blood urea nitrogen (BUN), 42 mg/dL; and sodium, 166 mEq/L. Which action by the nurse is most appropriate?
check the client's blood pressure and pulse.
A client is being admitted for the eighth exacerbation of chronic pancreatitis in 2 years. The client is frail and emaciated and becomes agitated when the nurse asks about pain medication. Which referral can the nurse make to best meet this client's needs and address potential complications of the condition? The nurse should request a referral to a
chemical dependency counselor to assess and treat substance abuse.
In a client with esophageal varices who is receiving vasopressin, the nurse would closely monitor for
chest pain
A patient with esophageal varices is receiving potent vasoconstrictors to help prevent hemorrhage. The nurse will be concerned if the patient complains of pain in the:
chest.
A patient comes to the emergency department with the complaint of severe vomiting and nausea and a temperature elevation to 101° F. The patient complains of stomach pain that radiates to his right scapula. These assessments suggest:
cholecystitis.
A patient who reports a severe, steady pain in the epigastric area, nausea, and vomiting states, "This happens every time I eat barbecued ribs." What should the nurse consider as the most likely cause of the patient's symptoms?
cholelithiasis
The nurse is providing care to a patient diagnosed with cirrhosis, and monitors for which clinical manifestation of stage 4 hepatic encephalopathy?
coma
A client with a history of cholelithiasis presents at the hospital with nausea and vomiting, abdominal pain, and jaundice. The nurse would assess the client for
common bile duct obstruction.
The nurse assesses that a patient with cirrhosis is deteriorating when there is evidence of:
confusion related to rising ammonia levels.
The nurse explains that the jaundice observed in a person with hepatitis is related to the:
congestion in the liver obstructing bile flow.
A patient with epigastric pain has a serum amylase level of 369 units/L. What should the nurse do?
contact the primary healthcare provider
A patient who has portal systemic encephalopathy is receiving Neomycin (neomycin sulfate). Which manifestation should indicate to the nurse that the patient's condition is improving?
increased level of consciousness
In a patient who had a cholecystectomy 3 days ago, the nurse assesses that the bile is no longer obstructed from entering the bowel by the appearance of:
dark brown stool.
The nurse is caring for a patient with a Sengstaken-Blakemore tube. Which assessment finding should the nurse immediately report for follow-up?
decreased level of consciousness
A patient with liver failure is taking lactulose (Chronulac). Which laboratory data indicates that the medication is having the desired effect?
decreased serum ammonia level
A patient with cirrhosis complains of the blandness of the lowprotein diet and questions its effectiveness. The nurse reminds the patient that the lowprotein diet helps his condition by:
decreasing the production of ammonia.
The nurse explains to a patient with cholelithiasis that the purpose of the cholescintigraphy (HIDA scan) is to:
diagnose abnormal contraction of the gallbladder.
The nurse is assessing a patient with ascites caused by liver failure. Which finding would require immediate follow-up by the nurse?
dyspnea
A nurse is serving food trays. From the tray of a client with hepatic encephalopathy, the nurse would remove
eggs.
A client experiencing hepatic encephalopathy is receiving lactulose. An irate family member asks, "Why in the world would the doctor give my husband something that gives him diarrhea when he is already so sick?" The nurse's response would include that the purpose of the lactulose is to
empty the bowel of protein.
The nurse is working in an area experiencing an outbreak of hepatitis. The manifestations that the nurse would identify as early manifestations of the disease are
epigastric pain and flulike manifestations.
The nurse caring for a client with jaundice would assess for other findings frequently associated with this condition, such as
excess pigmentation to the hands.
A large, frothy, foulsmelling stool that floats in toilet water indicates to the nurse that the client has an alteration in the metabolism of
fats
A patient with hepatitis is receiving interferon alpha. Which manifestation indicates that the patient is experiencing an untoward effect of this medication?
flulike syndrome
A client had an endoscopic retrograde papillotomy for stone removal and has returned to the nursing unit. The client is asking for ice chips. What assessment takes priority? The nurse should assess
gag reflex
The nurse performing an assessment of a 69yearold man with a long history of complex medical problems would be aware that a systemic manifestation suggestive of hepatic dysfunction is
gynecomastia.
The nurse is caring for a patient diagnosed with gallstones. The patient's medical record indicates the presence of two gallstones less than 1.5 inches. The patient is obese and has a history of insulin dependent diabetes. The patient asks the nurse why he could not have a lithotripsy. The nurse points out that the criteria for the procedure are rigid and that he failed to meet them because:
he is obese.
A clinic patient has described recent dark-colored stools;the nurse recognizes the need for fecal occult blood testing (FOBT). What aspect of the patients current health status would contraindicate FOBT?
hemorrhoids
A patient asks the nursing assistant for a bedpan. When the patient is finished, the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. What is this most likely a result of?
hemorrhoids
The nurse assesses asterixis while monitoring the blood pressure of a client with viral hepatitis. The nurse would interpret this finding as an indication of
hepatic encephalopathy.
The nurse is preparing to immunize a client who has had sexual contact with a known carrier of hepatitis B. The nurse would know that the medication providing the best immediate protection against hepatitis B is
hepatitis B immune globulin.
A patient is notified of a diagnosis of hepatitis by the healthcare provider and informed that it can be transmitted to others even though the patient has not been ill. The patient has a distant history of injection substance use. For which type of hepatitis should the nurse plan care for this patient?
hepatitis C
The nurse explains that a large increase of urobilinogen in the client's urine is consistent with the diagnosis of
hepatitis or other liver disease.
To best facilitate an effective breathing pattern, the nurse would place a client with massive ascites in the
highFowler position.
A client with acute pancreatitis has a drop in blood pressure from to mm Hg at 2 hours after admission. The client has not voided and has become short of breath. The nurse would anticipate that the abnormal laboratory value consistent with these manifestations is
hypoalbuminemia.
The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis blocks the blood flow through the liver, the result is: (Select all that apply.)
portal hypertension. decrease in metabolic processes of the liver. decrease in clotting factors. increase in ascites.
The morning after admission, a client being treated for gallstones begins to vomit about every 15 minutes and is complaining of abdominal pain. The most appropriate action by the nurse would be to
prepare to insert a nasogastric tube.
The nurse is caring for a patient with pancreatic cancer. The nurse closely monitors for jaundice, knowing that which assessments closely correlate with jaundice?
pruritus, skin lesions
The nurse would counsel a client that the portosystemic shunt will
reduce portal hypertension only.
A client has been admitted with a diagnosis of "fatty liver." The nurse is aware that manifestations of this condition are
related to the degree of fat infiltration.
The nurse would explain that Whipple's operation involves
removal of the head of the pancreas and portions of the stomach and duodenum.
The nurse explains that for a client who is a poor surgical risk, one of the nonsurgical alternatives for gallstone disease is
retrograde endoscopy.
In caring for a client who has an esophageal tamponade, the nurse would be alerted that the tamponade is inadequate with the assessment of
rising ammonia level.
In caring for a client admitted to the hospital for treatment of cirrhosis, the nurse would know that priority interventions revolve around the client's
risk for hemorrhage related to bleeding tendencies.
The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found not only in blood but also in: (Select all that apply.)
semen. vaginal secretions. breast milk. human feces.
To attempt to alleviate the pain of a client with acute pancreatitis, the nurse would place the client in the
sidelying position with a pillow splinting the abdomen.
Often a patient with pancreatic cancer tends to lose weight due to the inability of the body to absorb nutrients. The nurse instructs the patient to be alert to which finding that may indicate malabsorption?
steatorrhea
A client who had pancreatic surgery has been started on medication therapy with pancrelipase (Pancrease). The manifestation that the nurse would report as an indication that the dosage may be insufficient is
steatorrhea.
The client with esophageal varices has a SengstakenBlakemore tube in place for esophageal tamponade. As a measure to prevent aspiration of saliva, the nurse would
suction saliva accumulation with a nasogastric tube.
A patient with cirrhosis is experiencing hypertension, edema, and shortness of breath. What should the nurse identify as the patient's priority problem?
too much bodily fluid
Immediately following a liver biopsy, the nurse should: (Select all that apply.)
turn the patient to the right side for 2 hours. provide sandbag support for pressure on puncture site. monitor vital signs every 15 minutes. assess for hematoma at puncture site.
A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to
turn, cough, and deep breathe every 2 hours.
The nurse recognizes that the client with gallstones who would be the best candidate for treatment with extracorporeal shock wave lithotripsy (ECSL) is a client with
two gallstones
When educating a patient with chronic pancreatitis about the prescribed pancrelipase (Viokase), the nurse will teach the patient to take the medication
with every meal.
The factor in a client's history that the nurse would recognize as placing the client at risk for developing hepatitis A is
working as a nursing assistant in a nursing home.
