Pancreas

The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? 1. "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis." 2. "I need to take good care of my belly and ankle skin where it is swollen." 3. "A scrotal support may be more comfortable when I have scrotal edema." 4. "I can use pillows to support my head to help me breathe when I am in bed."

1. "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis." If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider because this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. A scrotal support may improve comfort if there is scrotal edema. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency.

The nurse is performing education to a patient undergoing a Whipple procedure. Which statement demonstrates that the patient needs further education regarding the Whipple procedure? 1. "It involves complete removal of the stomach." 2. "It involves complete removal of the duodenum." 3. "It involves removal of a portion of the bile duct." 4. "It involves removal of a portion of the pancreas."

1. "It involves complete removal of the stomach." A Whipple procedure involves removing the distal part of the stomach, which is a partial removal of stomach. Therefore the student nurse's statement, "It involves complete removal of the stomach," is incorrect. However, the procedure does involve complete removal of the duodenum (a duodenectomy), removal of distal portion of the common bile duct, and removal of the proximal pancreas (a proximal pancreatectomy).

While caring for a patient with pancreatitis, a nurse finds that the patient's blood pressure is 80/70 mm Hg and the nurse suspects hypovolemia. Which treatment option does the nurse expect to be effective? 1. Administration of albumin 2. Administration of octreotide 3. Administration of cyclosporine 4. Administration of acetazolamide

1. Administration of albumin Acute pancreatitis may cause shock, which is manifested by decreased volume of body fluids and reduced circulatory volume, which results in decreased blood pressure. Albumin is a plasma volume expander that should be administered to help restore the circulatory volume. Octreotide is a drug used to treat esophageal varices in patients with liver cirrhosis. Cyclosporine is a calcineurine inhibitor used as an immunosuppressive drug in patients with liver transplantation. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and bicarbonate concentration of pancreatic secretion in patients with acute pancreatitis. Test-Taking Tip: Precipitation of shock causes hypotension. Use this tip to answer the question.

A patient with ascites is admitted to the hospital. What should be the primary nursing actions in this case? Select all that apply. 1. Anticipate paracentesis. 2. Provide a high-sodium diet. 3. Encourage high-fluid intake. 4. Monitor fluid and electrolytes. 5. Administer an albumin infusion.

1. Anticipate paracentesis. 4. Monitor fluid and electrolytes. 5. Administer an albumin infusion. Management of ascites focuses on sodium restriction, diuretics, and fluid removal. The fluid and electrolytes should be closely monitored; an imbalance may lead to an increase in ascites. An albumin infusion may be used to help maintain intravascular volume and adequate urine output by increasing plasma colloid osmotic pressure. Paracentesis can be done to remove the ascitic fluid from the peritoneum. The amount of sodium restriction is based on the degree of ascites. The patient is usually not on restricted fluids unless severe ascites develops; however, high-fluid intake should be avoided.

A patient comes with sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back. Pain is aggravated by eating and is not relieved by vomiting. What priority action should the nurse take in this situation? 1. Avoid oral intake of food. 2. Give small, frequent oral feedings. 3. Avoid giving spicy and fat-containing food. 4. Identify food products that aggravate the pain and avoid them.

1. Avoid oral intake of food. Sudden and severe pain in the left upper quadrant of the abdomen and radiating to the back indicates acute pancreatitis. Initially, it is very important to avoid giving anything by mouth to a patient with pancreatitis to reduce pancreatic secretions. Eventually, when food is allowed, small, bland, frequent feedings are given. The diet is usually high in carbohydrate content and low in fat because that is the least stimulating to the exocrine portion of the pancreas. Eventually, the patient should avoid foods that aggravate the pain, but that is not the priority nursing action.

A patient comes to the ambulatory clinic with complications of cirrhosis. On examination, the patient's abdomen is distended and has a shifting fluid wave. Which instructions should be included in the education for this patient? Select all that apply. 1. Avoidance of alcohol 2. Referral to nephrology 3. A sodium-restricted diet 4. The side effects of lactulose 5. The side effects of spironolactone

1. Avoidance of alcohol 3. A sodium-restricted diet 4. The side effects of lactulose 5. The side effects of spironolactone Management of cirrhosis focuses on slowing the progression of disease while preventing or treating complications. Sodium restriction is a hallmark of ascites management and can help prevent the re-accumulation of fluid; lactulose is frequently used to treat hepatic encephalopathy and manage ammonia levels; cessation of alcohol consumption will prevent further damage to the liver; and spironolactone is an aldosterone antagonist and potassium-sparing diuretic that is frequently used to help manage ascites. Referral to nephrology is not likely to be necessary at this point because kidney function is often preserved in early stages of liver disease.

A patient arrives in the emergency department with acute abdominal pain related to acute pancreatitis. What does the nurse recognize may cause this disorder? Select all that apply. 1. Gallstones 2. Cystic fibrosis 3. Alcohol abuse 4. Isoniazid therapy 5. Food contaminated by feces

1. Gallstones 2. Cystic fibrosis 3. Alcohol abuse Acute pancreatitis is an inflammation of the pancreas. Gallstones, cystic fibrosis, and alcohol abuse are the causes of acute pancreatitis. Isoniazid therapy is associated with acute liver failure. Contamination of food by feces causes hepatitis.

Which interventions does the nurse include in the care plan of a patient with pancreatitis who is on dicyclomine therapy? 1. Give plenty of fluids. 2. Follow fluid restrictions. 3. Do not apply lotion to the skin. 4. Give cool mist vapors through the nasal passages.

1. Give plenty of fluids. Dicyclomine belongs to the class of anticholinergics. Dry mouth is a side effect associated with the use of anticholinergics; therefore, the nurse should give plenty of fluids to the patient. Fluid restriction can increase the side effect of dry mouth. Dry skin is treated by applying lotions. Cool nasal vapors relieve a dry nose and nasal passages; however, dicyclomine therapy does not result in nasal congestion, so the nurse does not need to give cool nasal vapors to the patient.

A patient reports vomiting, nausea, and joint pain. An IgM antibody test has been prescribed. The nurse suspects what diagnosis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

1. Hepatitis A Hepatitis A is associated with nausea, vomiting, weight loss, and joint pain. When an individual is infected with the hepatitis A virus, the body produces the hepatitis A antibody immunoglobulin M (IgM). Because the primary health care provider prescribes an IgM antibody test, the nurse suspects that the patient has hepatitis A infection. Hepatitis B is diagnosed by performing anti-HBc IgG and anti-HBe tests. Anti-HCV, HCV genotyping, and HCV RNA quantification are performed to rule out hepatitis C. Hepatitis D is confirmed by performing anti-HDV and HDV antigen tests.

While caring for a patient with pancreatitis, a nurse observes that the patient is irritable, has jerking movements, and reports a loss of sensation in the fingers. Which electrolyte abnormality does the nurse suspect? Select all that apply. 1. Hypocalcemia 2. Hypoglycemia 3. Hyponatremia 4. Hypomagnesemia 5. Increased serum amylase

1. Hypocalcemia 4. Hypomagnesemia Acute pancreatitis is associated with complications of hypocalcemia and hypomagnesemia. Hypocalcemia is manifested by jerking, irritability, and numbness in fingers and around the lips. Hypomagnesemia causes weakness, abnormal heart rhythms, and tremors. Hypoglycemia and hyponatremia are not seen in pancreatitis. Serum amylase may be increased, but this is not an electrolyte.

The nurse is caring for a patient with pancreatitis who is on a regular diet. Which finding indicates to the nurse that food and fluids should be withheld for this patient? 1. Increased pain 2. Decreased abdominal girth 3. Decreased serum lipase levels 4. Decreased serum amylase levels

1. Increased pain A patient with pancreatitis experiences severe pain if he or she has intolerance to oral foods. A patient who shows intolerance to oral foods also experiences increased abdominal girth and elevated levels of serum lipase and amylase.

What is appropriate for the nurse to include when teaching a student nurse about open cholecystectomy? 1. It involves insertion of a T-tube following surgery. 2. It involves insertion of a needle into the core of the tumor. 3. It involves resection of the proximal pancreas and duodenum. 4. It involves administration of an embolic agent through a catheter.

1. It involves insertion of a T-tube following surgery. Open cholecystectomy involves removal of the gallbladder through an abdominal incision. The T-tube facilitates drainage from the common bile duct into an external collection device. The T-tube is then discontinued, and the insertion point heals spontaneously. Radiofrequency ablation involves insertion of a needle into the core of the tumor and is performed on patients with liver cancer. The Whipple procedure is used in pancreatic cancer and involves resection of the proximal pancreas and duodenum. Administration of an embolic agent through the catheter into the artery near the tumor is done in chemoembolization, which is a treatment option for patients with liver cancer.

The nurse should recommend what type of diet for a patient with acute cholecystitis? 1. Low-fat 2. Low-protein 3. Low-calcium 4. Low-carbohydrate

1. Low-fat Cholecystitis is inflammation of the gallbladder. Fats contribute to gallstone formation, worsening the inflammation; therefore, patients with cholecystitis should consume a low-fat diet. A diet low in protein is given to patients with kidney or liver disease. Patients with cholecystitis should be given a diet rich in calcium and carbohydrates.

A nurse is caring for a patient with pancreatitis. Which interventions should the nurse implement while taking care of the patient? Select all that apply. 1. Monitor calcium levels. 2. Monitor prothrombin time. 3. Monitor magnesium levels. 4. Monitor blood glucose levels. 5. Monitor blood urea nitrogen levels.

1. Monitor calcium levels. 3. Monitor magnesium levels. 4. Monitor blood glucose levels. Acute pancreatitis is associated with complications such as hypocalcemia, hypomagnesemia, and increased blood glucose levels. The nurse should monitor calcium levels because reduced levels of calcium result in tetany. The nurse should monitor magnesium levels because a decrease in magnesium levels can lead to fatal complications. Pancreatitis causes damage to beta cells of the pancreas. To assess damage to the beta cells, the nurse should monitor the blood glucose levels of the patient because lack of insulin release can precipitate hyperglycemia. Increased prothrombin time is a manifestation of liver cirrhosis, not pancreatitis. Increased levels of blood urea nitrogen are associated with liver injury and result in hepatic encephalopathy but are not related to pancreatitis.

Which type of monitoring should the nurse include in the care plan of a patient with cholecystitis? 1. Monitoring gums for bleeding 2. Monitoring blood glucose levels 3. Monitoring serum albumin levels 4. Monitoring serum creatinine levels

1. Monitoring gums for bleeding Cholecystitis is associated with decreased production of prothrombin, a clotting factor, thereby putting the patient at risk of bleeding. Common bleeding sites are mucous membranes of the gums, mouth, and nose, as well as injection sites. A patient with cholecystitis does not show alterations in blood glucose, serum albumin, and serum creatinine levels.

A patient returns to the surgical center 10 days after a cholecystectomy for his postoperative checkup. His wife is with him and is asking whether she should be concerned about having cholelithiasis as well. What is the most appropriate response by the nurse? 1. Obesity increases the risk, especially in women. 2. Pregnancy is not a risk factor for cholelithiasis in women. 3. The incidence of cholelithiasis is lower in women than in men. 4. Gender differences in the incidence decrease after 40 years of age.

1. Obesity increases the risk, especially in women. Obesity causes increased secretion of cholesterol in bile, increasing the prevalence of cholelithiasis. Gender differences in the incidence of cholelithiasis decrease after 50 years of age. Pregnancy is a high risk factor for cholelithiasis, and multiparous women have the greatest risk of all. Cholelithiasis is more common in women than in men.

Which action of the student nurse indicates effective learning about determining the effectiveness of pancreatic enzymes replacement in patients with chronic pancreatitis? 1. Observing the patient's stool 2. Observing the patient's urine 3. Observing the patient's saliva 4. Observing the patient's nasal secretions

1. Observing the patient's stool Patients with pancreatitis have diminished or absent pancreatic lipases, the enzymes that break down fat. This leads to steatorrhea, which is characterized by greasy and foul-smelling stools. Therefore observing the patient's stool for steatorrhea helps to determine the effectiveness of pancreatic enzymes. Though dry mouth and dark urine are manifestations of pancreatitis, the effectiveness of enzymes cannot be determined by observing the urine and saliva. There is no change in the patient's nasal secretions. Therefore observing nasal secretions will not be helpful in determining enzyme efficiency.

The nurse is caring for a patient who has an increase in gastric acid that is causing epigastric pain. Which drug does the nurse anticipate administering to the patient to reduce the gastric acid secretion? 1. Omeprazole 2. Dicyclomine 3. Nitroglycerin 4. Acetazolamide

1. Omeprazole Omeprazole is a proton pump inhibitor that acts by decreasing production of hydrochloric acid in the stomach. Dicyclomine is an antispasmodic used to relieve muscle spasms. Nitroglycerin is an example of a vasodilator drug, which dilates the blood vessels and is used to relax the smooth muscles. Acetazolamide is a carbonic anhydrase inhibitor used to decrease the volume and concentration of bicarbonate in pancreatic secretions.

While caring for a patient with chronic pancreatitis, a primary health care provider orders the nurse to administer nortriptyline. What beneficial effect of nortriptyline will the nurse monitor in this patient? 1. Reduction in neuropathic pain 2. Normalization of blood glucose 3. Decreased nausea and vomiting 4. Improved digestion of fatty foods

1. Reduction in neuropathic pain Nortriptyline is an antidepressant that is effective in reducing neuropathic pain in patients with chronic pancreatitis. Chronic pancreatitis is also associated with hyperglycemia, and insulin is injected to correct the increased blood glucose levels. Gastric acid secretions, nausea, and vomiting are reduced by antacids such as omeprazole. Patients with chronic pancreatitis have a deficiency of pancreatic enzymes. Products such as pancrelipase and Creon are prescribed to improve the digestion of fatty foods.

A patient who has undergone laparoscopic cholecystectomy reports difficulty breathing. The nurse suspects that which patient activity is contributing to this difficulty? 1. Resting in the supine position 2. Sleeping for prolonged periods 3. Performing isometric exercises 4. Performing deep-breathing exercises

1. Resting in the supine position Carbon dioxide used to inflate the abdominal cavity for laparoscopic cholecystectomy may result in breathing difficulty by irritating the phrenic nerve and diaphragm. To counteract this, the patient should not be placed in the supine position, to help to move the gas pocket away from the abdomen. Prolonged sleep does not cause breathing difficulty in the patient after the surgery. Isometric exercises help strengthen muscles and do not result in breathing difficulty. Deep-breathing exercises relieve stress and can do not cause difficulty breathing.

The nurse needs to determine whether a patient is being compliant with the medication regimen for the treatment of pancreatitis. What type of sample should the nurse collect in order to see if the patient has steatorrhea? 1. Stool 2. Urine 3. Blood 4. Sputum

1. Stool Steatorrhea is manifested by fatty and foul-smelling stools. Therefore a stool sample is used to diagnose steatorrhea in patients with pancreatitis. Urine, blood, and sputum samples are not helpful in determining steatorrhea. They are helpful in determining abnormalities in the kidney, blood, and digestive system.

What points should a nurse emphasize while teaching a patient ways to protect oneself from exposure to hepatitis B infection? Select all that apply. 1. Use disposable needles and syringes. 2. Avoid sharing toothbrushes and razors. 3. Avoid eating food prepared in unhygienic ways. 4. Avoid touching or coming in contact with people with hepatitis B. 5. Avoid unsafe sex with multiple partners, and always use condoms.

1. Use disposable needles and syringes. 2. Avoid sharing toothbrushes and razors. 5. Avoid unsafe sex with multiple partners, and always use condoms. Hepatitis B spreads through sexual contact and through blood. Sharing razors or toothbrushes with an infected person may introduce infection in another person's body. Similarly, a needle used by an infected person can spread the infection. Hepatitis B also spreads via sexual exposure with an infected person. Using a condom gives some protection against the spread of infection. Hepatitis B doesn't spread through water and food. Hepatitis B doesn't spread with general casual contact.

The nurse finds that a patient admitted to the hospital with cirrhosis of the liver is disoriented, lethargic, and drowsy and has abnormal reflexes. Based on the patient's signs and symptoms, the nurse understands that the patient is in grade ___ hepatic encephalopathy. Fill in the blank using a whole number.

2 Hepatic encephalopathy has grades 0 to 4 based on three factors: level of consciousness, intellectual function, and neurologic findings. Grade 2 is characterized by lethargy, drowsiness, and inappropriate behavior (level of consciousness); disorientation (intellectual function); and asterixis and abnormal reflexes (neurologic findings). Grade 1 is characterized by a short attention span, mild confusion, and depression. Grade 3 is characterized by loss of meaningful conversation, marked confusion, and incomprehensible speech. Grade 4 is characterized by a complete lack of intellectual function. Grade 0 is characterized by insomnia, sleep disturbances, and a subtle change in computational skills.

The nurse provides education to a patient about postoperative care after an open cholecystectomy. Which statement made by the patient indicates the need for further teaching? 1. "I should consume a low-fat diet." 2. "I am permitted to resume weightlifting." 3. "I am permitted to engage in sexual intercourse." 4. "It is important to perform deep-breathing exercises."

2. "I am permitted to resume weightlifting." Patients who have undergone open cholecystectomy should not lift heavy weights for up to four to six weeks after surgery. An open cholecystectomy is not associated with dietary restrictions; however, a low-fat diet is recommended. Sexual activities are not contraindicated in a patient who has undergone open cholecystectomy. Deep-breathing exercises help relieve stress, keep the lungs clear, and avoid atelectasis after surgery.

The nurse provides discharge instructions to a patient with newly diagnosed cirrhosis. Which statement made by the patient indicates the need for further teaching? 1. "I should take frequent rest periods." 2. "I can eat anything that appeals to me." 3. "I can do without my glass of wine with dinner." 4. "I should take only medications that have been prescribed."

2. "I can eat anything that appeals to me." Even though a low-protein diet has been questioned in the treatment of patients with cirrhosis, it remains in use. In light of this, it is incorrect for the patient to say that he may eat anything. Patients with cirrhosis must also avoid alcohol. Frequent rest and limitation of medications to those that have been prescribed are appropriate resolutions in a newly diagnosed case of cirrhosis and therefore do not indicate the need for further teaching.

The nurse interviewing a patient with acute pancreatitis expects what finding in the patient's history? 1. COPD 2. Alcohol abuse 3. Diabetes mellitus 4. Congestive heart failure

2. Alcohol abuse In a majority of the cases of acute pancreatitis the cause is excessive alcohol intake or biliary tract disease. Alcohol abuse can cause the small pancreatic ducts to become clogged, resulting in pancreatic inflammation. Chronic obstructive pulmonary disease, diabetes mellitus, and congestive heart failure may be comorbidities but are not themselves directly related to acute pancreatitis.

A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect? 1. Aphasia 2. Asterixis 3. Hyperactivity 4. Acute dementia

2. Asterixis Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state.

What is the name of the substance that is a mixture of cholesterol crystals and calcium salts that may be found in a patient diagnosed with pancreatitis? 1. Apraxia 2. Biliary sludge 3. Biliary atresia 4. Pancreatic abscess

2. Biliary sludge Biliary sludge is a mixture of cholesterol crystals and calcium salts and is seen in patients with bile stasis. Apraxia is the inability to construct simple figures. Biliary atresia refers to congenital biliary abnormalities. Pancreatic abscess is a condition associated with the collection of pus in the pancreas.

A nurse assessing a patient with pancreatitis suspects the presence of Grey Turner's sign when the patient exhibits what? 1. Jaundice of the sclera 2. Bluish discoloration of the flank area 3. Bluish discoloration of the periumbilical area 4. Left abdominal pain that occurs with movement

2. Bluish discoloration of the flank area The Grey Turner's sign includes a bluish discoloration, or ecchymosis, on the left or right flank area, the result of internal bleeding caused by pancreatitis. Jaundice of the sclera is associated with liver disorders and with increased serum bilirubin. Bluish discoloration of the periumbilical area is also seen in bleeding associated with pancreatitis and is known as the Cullen's sign. Left abdominal pain that occurs with movement may be seen with pancreatitis but is not associated with the Grey Turner's sign.

The nurse notes that a patient is scheduled for a gallbladder removal. The patient will sign a consent form for what procedure? 1. Splenectomy 2. Cholecystectomy 3. Cholecystojejunostomy 4. Pancreaticoduodectomy

2. Cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Splenectomy is removal of the spleen. Cholecystojejunostomy is a surgical formation of means of communication between the gallbladder and jejunum. Pancreaticoduodectomy involves removal of the pancreas, gallbladder, and other organs.

The parent of a pediatric patient suffering from hepatitis A approaches the nurse and is worried about the spread of infection to other family members through use of the same bathroom. What should the nurse advise the patient's parent? Select all that apply. 1. Buy a separate commode for your son. 2. Clean the bathroom and commode thoroughly. 3. There is no need for concern; just use disposable toilet covers. 4. Ask your son to wash his hands thoroughly after using the bathroom. 5. Ask all other family members to wash their hands thoroughly before eating and after using the bathroom.

2. Clean the bathroom and commode thoroughly. 4. Ask your son to wash his hands thoroughly after using the bathroom. 5. Ask all other family members to wash their hands thoroughly before eating and after using the bathroom. Hepatitis A spreads through the fecal-oral route. Transmission is prevented by maintaining hygiene. Proper hand washing is extremely important in preventing the spread of the virus. Buying a separate commode is unnecessary. Thorough cleaning of the bathroom and all the equipment is enough to limit spread of the virus. Use of disposable toilet sheets is not sufficient to prevent spread of the virus.

The nurse is performing an assessment on a patient that has been admitted with severe pancreatitis and discovers a bluish discoloration of the periumbilical area. How should the nurse document this finding? 1. Asterixis 2. Cullen's sign 3. Spider angioma 4. Grey Turner's sign

2. Cullen's sign Bluish discoloration of the periumbilical region is called Cullen's sign and can result from seepage of blood-stained exudate from the pancreas, which may occur in severe pancreatitis. Asterixis refers to tremors, which begin upon stretching the wrist. Spider angioma is a dilated blood vessel with a red center that branches out; it is a manifestation of cirrhosis. Grey Turner's sign is a bluish discoloration of the flank region.

The nurse is reviewing the laboratory studies for a patient with acute pancreatitis. Which abnormal finding does the nurse report that is seen in acute pancreatitis? 1. Decreased serum lipase 2. Decreased serum calcium 3. Decreased serum amylase 4. Decreased serum triglycerides

2. Decreased serum calcium Hypocalcemia is a complication of acute pancreatitis, which is characterized by decreased levels of calcium. Therefore, decreased serum calcium is an abnormal finding in acute pancreatitis. Serum lipase, serum amylase, and serum triglycerides are elevated in patients with acute pancreatitis.

While caring for a patient with pancreatitis, a nurse finds that the patient's blood pressure dropped to 90/60 mm Hg from an initial baseline of 125/80 mm Hg. The nurse administers isotonic fluid. Which medication should the nurse administer as prescribed by the primary health care provider? 1. Morphine 2. Dopamine 3. Omeprazole 4. Pancrelipase

2. Dopamine Acute pancreatitis is associated with hypotension. Therefore to return the blood pressure to normal, vasoactive drugs such as dopamine are prescribed. These drugs increase the total vascular resistance, thereby increasing blood pressure. Morphine is an analgesic and is used to relieve pain. Omeprazole is an antacid that reduces the production of gastric hydrochloric acid (HCl). Pancrelipase is a synthetic enzyme and is prescribed for chronic pancreatitis in which there is a deficiency of pancreatic enzymes.

Which intervention should the nurse implement to reduce the risk of parotitis in a patient with pancreatitis? 1. Encourage the patient to perform hand hygiene. 2. Encourage the patient to rinse his or her mouth frequently. 3. Encourage the patient to moisturize hands before sleeping. 4. Encourage the patient to practice deep-breathing exercises.

2. Encourage the patient to rinse his or her mouth frequently. Parotitis is inflammation of the parotid gland, which is located inside the mouth. Therefore to reduce the risk of developing parotitis, the nurse should encourage the patient to perform oral care by rinsing the mouth frequently. Though hand hygiene prevents the spread of infection, it is not beneficial in preventing parotitis. Moisturizing the hands will prevent dry skin. Deep-breathing exercises are effective for relieving anxiety.

During follow-up visits, a nurse finds that the patient is having an exacerbation of pancreatitis. Which action of the patient's caregiver is responsible for this condition? 1. Giving Creon along with meals 2. Giving three large meals a day 3. Checking for fatty stools in the patient 4. Giving omeprazole one hour after meals

2. Giving three large meals a day Patients with pancreatitis should be given small and frequent meals to reduce or prevent pancreatic stimulation. Therefore avoiding small frequent meals is responsible for the patient's condition. Creon is a pancreatic enzyme supplement to be given along with meals or snacks. Pancreatitis is associated with fatty and foul-smelling stools; monitoring of stools is required in patients with this disease. Omeprazole is an antisecretory agent used for reducing gastric acid in the stomach; it is given after meals to increase its duration of action.

Which hepatitis virus is transmitted parenterally from mother to fetus? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis E

2. Hepatitis B The hepatitis B virus is transmitted parentally from mother to fetus. Studies show that most mother-to-child HBV transmission occurs during or shortly before delivery. The hepatitis A virus is transmitted through the fecal-oral route by consuming foods or drinks contaminated with the hepatitis A virus. The hepatitis C virus is transmitted by sharing contaminated needles. The hepatitis E virus is also transmitted by the fecal-oral route.

What are the clinical manifestations of chronic hepatitis? Select all that apply. 1. Bilirubinuria 2. Hepatomegaly 3. Nausea and vomiting 4. Elevated liver enzymes 5. Decreased sense of taste

2. Hepatomegaly 4. Elevated liver enzymes Chronic hepatitis is manifested by hepatomegaly and elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Bilirubinuria, nausea, vomiting, and decreased sense of taste are associated with acute hepatitis.

The nurse is providing postoperative care to a patient who underwent open cholecystectomy three days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider? 1. Tolerance of a full-liquid diet 2. Oral temperature of 101.8° F 3. Report of pain at a level 5 on a scale of 0 to 10 4. An 8-hour fluid intake of 680 mL and an output of 660 mL

2. Oral temperature of 101.8° F An oral temperature of 101.8º F on the third postoperative day indicates a possible infection and requires further evaluation and modification of the nursing plan of care. Tolerating a full liquid diet and pain at a level of 5 on a 0 to 10 scale are appropriate outcomes at this time. Although fluid intake is low, it is in balance with the output; therefore, it would not be as high a priority as the increased temperature.

A student nurse is preparing a medication chart for a group of patients. Which patient's medication chart needs correction? 1. Liver Cancer - Sorafenib 2. Pancreatic Cancer - Tacrolimus 3. Chronic Pancreatitis - Fentanyl 4. Autoimmune Hepatitis - Cyclosporine

2. Pancreatic Cancer - Tacrolimus Patients with pancreatic cancer are prescribed anticancer drugs such as fluorouracil, gemcitabine, or erlotinib. However, the nurse has observed tacrolimus in Patient B's chart. Tacrolimus is used as an immunosuppressive drug in patients who underwent liver transplantation. Therefore Patient B's medication chart needs correction. Patients with liver cancer are treated using sorafenib, which inhibits the growth of new blood vessels into tumors in the body. Fentanyl is an analgesic used to relieve abdominal pain in patients with chronic and acute pancreatitis, such as Patient C. Cyclosporine is a cytotoxic drug effective in the treatment of autoimmune hepatitis.

The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation? 1. The patient has completed a college education. 2. The chest x-ray showed another lung cancer lesion. 3. The patient has been able to stop smoking cigarettes. 4. The patient has well controlled type 1 diabetes mellitus.

2. The chest x-ray showed another lung cancer lesion. Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course. It does not matter if the patient has a college education. The fact that the patient has quit smoking is not a contraindication for liver transplant. The patient is a well-controlled diabetic, which is not a contraindication.

A primary health care provider orders nasojejunal tube feeding for a patient with acute pancreatitis. What does the nurse suspect to be the reason behind ordering enteral feeding rather than intravenous parental nutrition? 1. To ensure fast absorption 2. To prevent risk of infection 3. To reduce patient's noncompliance 4. To ensure easy insertion of the tube

2. To prevent risk of infection Parenteral nutrition is associated with an increased risk of infection, because it must be administered via an intravenous catheter. Therefore the primary health care provider opted for nasojejunal tube feeding instead of parenteral nutrition. Parenteral nutrition is given through intravenous route, thereby ensuring fast absorption. When a patient is noncompliant with the treatment plan, high-risk invasive procedures such as parenteral nutrition are not prescribed. Enteral nutrition involves nasogastric intubation, which is not as easy to administrate as parenteral nutrition.

The nurse provides education to a patient about laparoscopic cholecystectomy. Which statement made by the patient indicates the need for further teaching? 1. "Small punctures will be made into my abdomen." 2. "I may be discharged the same day as the surgery." 3. "I will have work restrictions for 4 to 6 weeks after the surgery." 4. "An instrument with a camera attached is inserted into the abdomen."

3. "I will have work restrictions for 4 to 6 weeks after the surgery." Laparoscopic cholecystectomy is a minimally invasive surgery that involves removal of the gallbladder. Postoperative pain is minimal, and the patient can resume his or her work within one week of the surgery. The procedure involves making small punctures into the abdomen through which an instrument called a laparoscope is inserted. The patient is discharged on the day of surgery or a day after. The laparoscope has a camera attached to it, which is inserted through the punctures.

The nurse is teaching a student nurse about postoperative care for a patient that has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? Select all that apply. 1. "I will monitor for bleeding." 2. "I will encourage the patient to practice deep breathing." 3. "I will most likely need to administer narcotics for pain control." 4. "The patient will use a bedside commode for the first 24 hours after surgery." 5. "The patient will need to return to the office in 7 to 10 days for removal of stitches."

3. "I will most likely need to administer narcotics for pain control." 4. "The patient will use a bedside commode for the first 24 hours after surgery." 5. "The patient will need to return to the office in 7 to 10 days for removal of stitches." With laparoscopic cholecystectomy, there are small incisions that are covered by small adhesive bandages that can be removed in about five days. The stitches dissolve over time. Patients who have undergone laparoscopic cholecystectomy can usually walk to the bathroom, so there is no need for a bedside commode. Postoperative pain can usually be controlled with over-the-counter pain relievers. A cholecystectomy may result in changes in prothrombin time and may cause bleeding. Therefore the nurse should monitor for bleeding. Deep-breathing exercises should be encouraged to prevent postoperative pneumonia and to help relieve the patient's discomfort.

What is the average incubation period of the hepatitis E virus? 1. 28 days 2. 56 days 3. 26 to 42 days 4. 56 to 96 days

3. 26 to 42 days The average incubation period of the hepatitis E virus is 26 to 42 days. The average incubation period of the hepatitis A virus is 28 days. The average incubation period of the hepatitis C virus is 56 days. The average incubation period of hepatitis B is 56 to 96 days.

When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include? 1. Do not return to work or normal activities for three weeks. 2. Bile-colored drainage probably will drain from the incision. 3. A lower-fat diet may be tolerated better for several weeks. 4. Keep the bandages on and the puncture site dry until it heals.

3. A lower-fat diet may be tolerated better for several weeks. Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess? 1. Breath sounds 2. Bowel sounds 3. Abdominal girth 4. Recent blood work

3. Abdominal girth Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement occur. Reviewing the results of the most recent blood work will not show direct measurement of the effectiveness of diuretic therapy.

The nurse expects what physical finding in a patient with cholecystitis? 1. Spider angioma 2. Flapping tremors 3. Abdominal rigidity 4. Grey Turner's sign

3. Abdominal rigidity Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.

The nurse is reviewing the laboratory reports of a patient who was admitted with sudden onset severe abdominal pain. After reviewing these results, the nurse suspects that the patient may have which disorder? Refer to chart. Serum amylase: 920 (N: 30-220) Serum lipase: 704 (N: 0-160) Serum glucose (fasting): 205 (N: 70-110) Serum calcium: 3.9 (N: 4.5-5.6) 1. Liver cirrhosis 2. Acute hepatitis 3. Acute pancreatitis 4. Chronic pancreatitis

3. Acute pancreatitis The primary diagnostic tests for acute pancreatitis are serum amylase and lipase. The serum amylase level usually is elevated early and remains elevated for 24 to 72 hours. Serum lipase level, which also is elevated in acute pancreatitis, is an important test because other disorders (e.g., mumps, cerebral trauma, renal transplantation) may increase serum amylase levels. Other findings include an increase in liver enzymes, triglycerides, glucose, and bilirubin and a decrease in calcium. Liver cirrhosis, acute hepatitis, and chronic pancreatitis do not apply to these chart levels.

The nurse is admitting a patient with cirrhosis. The nurse checks the patient's history for which most frequent risk factor associated with cirrhosis? 1. Hepatitis A 2. Polypharmacy 3. Alcohol abuse 4. Intravenous drug abuse

3. Alcohol abuse Cirrhosis is highly correlated with alcohol abuse. Polypharmacy, drug abuse, and hepatitis A are not linked to cirrhosis.

A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the nurse attribute these findings to? 1. Malnutrition 2. Osteomyelitis 3. Alcohol abuse 4. Diabetes mellitus

3. Alcohol abuse In the patient with alcohol abuse, liver disease could develop as a complication, increasing the liver function tests above the normal levels. The normal ALT range is 7 to 56 IU/L, and the normal AST range is 5 to 40 IU/L. Diabetes would result in elevated blood sugar levels. Malnutrition would be evidenced by low protein levels. Osteomyelitis is an infection of the bone, which would result in an elevated white blood cell count.

The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood? 1. Sodium 2. Calcium 3. Ammonia 4. Potassium

3. Ammonia A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium are not directly affected by liver dysfunction or hepatic coma.

What is the cause of the formation of biliary sludge? 1. Ascites 2. Hepatitis 3. Bile stasis 4. Biliary colic

3. Bile stasis Biliary sludge is a mixture of cholesterol and bile salts and is caused by bile stasis. Ascites is associated with low serum albumin levels and liver cirrhosis. Hepatitis is inflammation of the liver; it does not cause biliary sludge. Patients with gallstones have severe pain due to the presence of stones. This pain is referred to as biliary colic.

The nurse reviews a patient's laboratory values and recognizes which finding as an indication of resolution of acute pancreatitis? 1. Increasing hemoglobin level 2. Falling serum bilirubin level 3. Decreasing serum amylase level 4. Increasing serum alkaline phosphatase level

3. Decreasing serum amylase level Serum amylase is a major indicator of pancreatic function and will be increased during acute pancreatitis. A decreasing serum amylase level indicates resolution of pancreatic inflammation. The nurse would evaluate the hemoglobin level if the acute pancreatitis were hemorrhagic in nature. Although serum bilirubin and serum alkaline phosphatase levels may be increased in acute pancreatitis, they are not most indicative of recovery from acute pancreatitis.

A patient with type 2 diabetes mellitus has been diagnosed with non-alcoholic fatty liver disease (NAFLD). The nursing teaching plan should include which of the following? 1. Having genetic testing done 2. Eliminating carbohydrates from the diet 3. Following measures to gain tighter glucose control 4. Avoiding alcohol until liver enzymes return to normal

3. Following measures to gain tighter glucose control NAFLD can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For those who are overweight, weight reduction is important. Weight loss improves insulin sensitivity and reduces liver enzyme levels. NAFLD does not show up positive on a genetic test. It is not recommended to completely eliminate carbohydrates from the diet. NAFLD is not caused by alcohol, and the question does not imply that the patient drinks.

A patient reports nausea, a 5 kg weight loss in six days, and pain in the abdomen radiating to the back. After reviewing the magnetic resonance imaging (MRI) report, a primary health care provider orders a CA 19-9 test to confirm the diagnosis. Which condition is suspected? 1. Cholecystitis 2. Cholelithiasis 3. Pancreatic cancer 4. Acute pancreatitis

3. Pancreatic cancer Nausea, rapid weight loss, and dull abdominal pain that radiates to the back are clinical manifestations of pancreatic cancer. The CA 19-9 is a cancer-associated antigen that is elevated in patients with pancreatic cancer. Therefore the primary health care provider suspects pancreatic cancer. Nausea, vomiting, fever, and jaundice are characteristics of cholecystitis. Abdominal pain accompanied by tachycardia and perspiration are characteristics of cholelithiasis. Moreover, diagnostic studies such as abdomen ultrasound, liver function tests, and serum amylase are ordered to confirm disorders of the biliary tract such as cholecystitis and cholelithiasis. In acute pancreatitis, the cancer-associated antigen CA 19-9 may not be elevated.

A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. The nurse identifies that which intervention will be beneficial to the patient? 1. Administrating lactulose 2. Administrating rifaximin 3. Performing gastric decompression 4. Performing endotracheal intubation

3. Performing gastric decompression Gastric decompression is performed to remove the gastric contents via a nasogastric tube to prevent aspiration of food contents and reduce the incidence of nausea and vomiting. Lactulose is a laxative and is used to treat constipation. Rifaximin is an antibiotic prescribed for patients with hepatic encephalopathy. Endotracheal intubation is a means of providing ventilation to the patient.

Which nursing action should be performed immediately for a patient with acute pancreatitis who has developed acute respiratory distress syndrome (ARDS)? 1. Infuse normal saline. 2. Give chest compressions. 3. Provide ventilator support. 4. Call someone in the x-ray department to do a portable chest x-ray.

3. Provide ventilator support. Difficulty in breathing and shortness of breath are characteristics of ARDS. If ARDS develops, the patient would require ventilator support because mechanical ventilation and intubation are required to save the patient from this life-threatening condition. A chest x-ray is ordered to confirm obstructions in the respiratory tract; however, immediate action to save the patient's life does not involve performing an x-ray. Normal saline contains sodium chloride, an electrolyte solution, and will not resolve breathing difficulty. Chest compressions may further worsen the condition because severe compressions may cause lung injury.

Which clinical manifestation of pain does the nurse expect to identify in a patient who has cholecystitis? 1. Left flank pain with intermittent exacerbations 2. Right lower quadrant pain with rebound tenderness 3. Right upper quadrant pain radiating to the patient's back 4. Epigastric pain that intensifies when the patient is lying down

3. Right upper quadrant pain radiating to the patient's back The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula. Left flank pain with intermittent exacerbations may be caused by renal calculi. Right lower quadrant pain with rebound tenderness may be related to acute appendicitis, Crohn's disease, or peritonitis. Epigastric pain that intensifies when the patient is lying down may be related to gastroesophageal reflux disease or hiatal hernia.

A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily in which way? 1. During sexual intercourse 2. By contact with infected body secretions 3. Through fecal contamination of food or water 4. Through kissing that involves contact with mucous membranes

3. Through fecal contamination of food or water Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected body secretions, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate? 1. "The hepatitis vaccine will provide immunity from this exposure and future exposures." 2. "I am afraid there is nothing you can do because the patient was infectious before admission." 3. "You will need to be tested first to make sure you don't have the virus before we can treat you." 4. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

4. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure." Immunoglobulin provides temporary (one to two months) passive immunity and is effective for preventing hepatitis A if given within two weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is used only for pre-exposure prophylaxis.

Which statement indicates a need for further teaching by a student nurse about nutritional therapy in patients with acute pancreatitis? 1. "I should feed the patient through a nasojejunal tube." 2. "I should monitor the patient's blood triglyceride levels." 3. "I should give small quantities of food frequently to the patient." 4. "I should include fat-rich food substances in the patient's dietary plan."

4. "I should include fat-rich food substances in the patient's dietary plan." Patients with acute pancreatitis should be provided with food that does not stimulate the pancreas much. Fats are broken down by the enzymes produced by pancreas; therefore, fat-rich food substances should not be given to the patient. Patients with pancreatitis are given nasojejunal tube feeding. Patients with pancreatitis have malfunctioning of the pancreas and therefore do not metabolize fats. If fat-rich substances or intravenous lipids are given, then the blood triglyceride level may rise. Therefore the nurse should monitor the patient's blood triglyceride levels. To avoid burden on the pancreas, feedings should be given frequently in small quantities.

A patient is scheduled for a secretin stimulation test and asks the nurse what this will evaluate. What is the best response by the nurse? 1. "It will evaluate if you have Wilson's disease." 2. "It will evaluate if you have diabetes mellitus." 3. "It will determine if you have acute pancreatitis." 4. "It will determine if you have chronic pancreatitis."

4. "It will determine if you have chronic pancreatitis." The secretin stimulation test is performed in patients with chronic pancreatitis to determine the degree of pancreatic function. A test to check serum ceruloplasmin level is ordered in patients with Wilson's disease. A diagnosis of diabetes mellitus is determined by blood glucose levels in the body, not by the secretin stimulation test. Acute pancreatitis is diagnosed by a contrast-enhanced CT scan.

The patient is scheduled for a q12hr dose of lactulose 30 grams orally. Available is an oral solution containing 5 g/10 mL. How much solution should be poured into the medication cup to give the required dose? 1. 15 mL 2. 30 mL 3. 45 mL 4. 60 mL

4. 60 mL Using the medication-calculation equation of dose desired (30 grams) divided by dose on hand (5 grams) and multiplied by the quantity (10 mL), the answer is 60 mL.

A patient reports severe pain in the abdomen to a nurse. The nurse finds the patient's body temperature is 100° F. The laboratory reports show a white blood cell (WBC) count of 13,000/µL, lipase of 180 U/L, and amylase of 150 U/L. What finding does the nurse anticipate? 1. Hepatitis 2. Cholelithiasis 3. Liver cirrhosis 4. Acute pancreatitis

4. Acute pancreatitis Acute pancreatitis is manifested by abdominal pain, low-grade fever, tachycardia, leukocytosis, and elevated amylase and lipase values. A normal WBC count is 4,000 to 11,000/-µL, a normal lipase range is 0 to 160 U/L, and a normal amylase range is 30 to 122U/L. The patient's laboratory values of WBC at 13,000/-µL, lipase at 180 U/L, and amylase at 150 U/L indicate leukocytosis and high lipase and amylase levels. Nausea, vomiting, arthralgias, and jaundice are manifestations of hepatitis. Cholelithiasis is manifested by pain, fever, and jaundice. Liver cirrhosis is manifested by skin lesions, leucopenia, and endocrine problems, such as gynaecomastia in men or amenorrhea in women.

The nurse suspects that a patient has hepatitis A. Which symptom will the patient most likely report that it developed first? 1. Ascites 2. Itching 3. Jaundice 4. Anorexia

4. Anorexia The preicteric phase of hepatitis is usually marked by severe anorexia, malaise, and fever. Itching and jaundice appear later in the hepatitis disease process in a stage known as the icteric phase. Ascites may develop as a long-term effect of diffuse liver damage.

The nurse teaches a caregiver about postoperative care for a patient who has undergone an open cholecystectomy. Which action by the caregiver may aggravate the patient's condition? 1. Encouraging deep-breathing exercises 2. Allowing bile to drain from the insertion site 3. Ensuring that the room is sufficiently ventilated 4. Avoiding the skin around the T-tube insertion site while cleaning

4. Avoiding the skin around the T-tube insertion site while cleaning Postoperative care for a patient who has undergone open cholecystectomy involves cleaning the skin around the insertion site with an antiseptic such as hydrogen peroxide. Deep-breathing exercises should be encouraged to prevent respiratory complications after the surgery. Bile drainage should be maintained. The caregiver should ensure that the room is sufficiently ventilated.

A patient reports severe abdominal pain. A primary health care provider diagnoses it to be chronic pancreatitis secondary to cholecystitis. Which treatment option does the nurse anticipate will be beneficial? 1. Cholecystectomy 2. Whipple procedure 3. Chemoembolization 4. Choledochojejunostomy When a patient with chronic pancreatitis is diagnosed with a biliary tract disease, surgery is required to treat the condition. The surgery involves diversion of bile flow and relieving the duct from obstruction. In patients with chronic pancreatitis, choledochojejunostomy is performed to divert bile flow around the ampulla of Vater. Therefore the nurse anticipates that choledochojejunostomy will be beneficial to the patient. Cholecystectomy is performed in patients with gallbladder disease. A Whipple procedure is the treatment option for patients with pancreatic cancer. Chemoembolization is performed in patients with liver cancer.

4. Choledochojejunostomy When a patient with chronic pancreatitis is diagnosed with a biliary tract disease, surgery is required to treat the condition. The surgery involves diversion of bile flow and relieving the duct from obstruction. In patients with chronic pancreatitis, choledochojejunostomy is performed to divert bile flow around the ampulla of Vater. Therefore the nurse anticipates that choledochojejunostomy will be beneficial to the patient. Cholecystectomy is performed in patients with gallbladder disease. A Whipple procedure is the treatment option for patients with pancreatic cancer. Chemoembolization is performed in patients with liver cancer.

Which condition is associated with the formation of stones in the gallbladder? 1. Biliary colic 2. Cholangitis 3. Cholecystitis 4. Cholelithiasis

4. Cholelithiasis Cholelithiasis is the formation of stones in the gallbladder. The pain associated with cholelithiasis is called biliary colic. Cholangitis is inflammation of bile ducts. Inflammation of the gallbladder is called cholecystitis.

The nurse finds that a patient with cholelithiasis is experiencing severe itching. The laboratory findings reveal a 2.1 mg/dL bilirubin level. The nurse expects that which medication will be prescribed? 1. Nadolol 2. Lactulose 3. Vasopressin 4. Cholestyramine

4. Cholestyramine Bilirubin levels in a healthy individual are between 0.3 and 1.9 mg/dL. The patient's laboratory reports indicate hyperbilirubinemia, which results in jaundice. Moreover, the patient has severe itching, which is a sign of pruritus. Pruritus that is accompanied by jaundice is treated with cholestyramine. Nadolol is a beta blocker used for patients with cirrhosis to reduce bleeding from varices. Lactulose is used for relieving constipation. Vasopressin is a vasoconstrictor drug that controls bleeding from the varices and maintains hemostasis.

A patient, whose body temperature is 99° F, reports abdominal pain, nausea, vomiting, dark urine, and foul-smelling stool. The laboratory reports reveal increased levels of bilirubin in the blood. What does the nurse suspect this indicates? 1. Liver cancer 2. Acute liver failure 3. Acute pancreatitis 4. Chronic pancreatitis

4. Chronic pancreatitis The symptoms of chronic pancreatitis include nausea, vomiting, fever, jaundice with dark urine, and steatorrhea. Jaundice presents with clinical reports of hyperbilirubinemia, which is increased levels of bilirubin in blood. Steatorrhea is associated with foul-smelling fatty stools. Because the patient's laboratory reports reveal all of the above findings, the nurse suspects the patient to have chronic pancreatitis. Symptoms of liver cancer include nausea, vomiting, and jaundice, and the laboratory findings show elevated levels of serum alpha-fetoprotein. Acute liver failure is manifested by jaundice and coagulation abnormalities. Patients with acute liver failure have increased serum levels of bilirubin and prolonged prothrombin time. Acute pancreatitis is manifested by nausea, vomiting, and abdominal pain; the laboratory tests reveal increased serum amylase and lipase levels.

The nurse is caring for a patient with gallstones and expects what assessment finding? 1. Tachycardia 2. Hypotension 3. Hyperglycemia 4. Clay-colored stools

4. Clay-colored stools The presence of gallstones results in bile flow obstruction, which is manifested by fever, clay-colored stools, and dark urine. Tachycardia and hypotension are the clinical manifestations of acute pancreatitis. Hyperglycemia is seen in patients with chronic pancreatitis.

The health care provider prescribes lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what? 1. Relief of constipation 2. Relief of abdominal pain 3. Decreased liver enzymes 4. Decreased ammonia levels

4. Decreased ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy. Lactulose does not relieve constipation or abdominal pain or decrease liver enzymes.

During history-taking, a patient tells the nurse, "Gallstones were removed by passing shock waves into my gallbladder." Which procedure is the patient referring to? 1. Cholecystojejunostomy 2. Pancreaticoduodenectomy 3. Balloon sphincteroplasty 4. Extracorporeal shock-wave lithotripsy (ESWL)

4. Extracorporeal shock-wave lithotripsy (ESWL) Extracorporeal shock-wave lithotripsy (ESWL) is a procedure involving the use of high-energy shock waves to disintegrate gallstones. This method is used when endoscopic procedures cannot be used to remove the stones. Cholecystojejunostomy is surgical removal of the gallbladder. Pancreaticoduodenectomy is the surgical formation of a means of communication between the gallbladder and jejunum. Balloon sphincteroplasty is an adjunct procedure used with extracorporeal shock-wave lithotripsy to dilate the biliary duct.

Assessment findings of a patient include asterixis, hyperventilation, fetor hepaticus, fatigue, a body temperature of 95° F, and continuous lip smacking. Which condition does the nurse suspect? 1. Hepatitis 2. Liver cirrhosis 3. Hepatorenal syndrome 4. Hepatic encephalopathy

4. Hepatic encephalopathy Hepatic encephalopathy is a mental disorder that occurs due to acute or chronic liver injury. Hypothermia, grimacing reflexes (actions like lip smacking and lip puckering), fatigue, asterixis, hyperventilation, and fetor hepaticus are the clinical manifestations of hepatic encephalopathy. Hepatitis is an inflammatory condition of the liver, characterized by anorexia, nausea, vomiting, and fever. Liver cirrhosis is a liver disease manifested by symptoms ranging from portal hypertension to liver failure. Hepatorenal syndrome occurs in patients with decompensated liver cirrhosis and can lead to renal failure.

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication prescription should the nurse question because it is most likely to cause hepatic complications? 1. Tramadol 2. Hydromorphone 3. Oxycodone with aspirin 4. Hydrocodone with acetaminophen

4. Hydrocodone with acetaminophen The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage. Tramadol, hydromorphone, and oxycodone with aspirin are less likely to cause complications than acetaminophen.

When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? 1. Impaired skin integrity related to edema, ascites, and pruritus 2. Imbalanced nutrition: less than body requirements related to anorexia 3. Excess fluid volume related to portal hypertension and hyperaldosteronism 4. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

4. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priority. Impaired skin integrity, imbalanced nutrition, and excess fluid volume are all seen in patients with cirrhosis, but they are not priorities at this time.

The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care? 1. Immediately start enteral feeding to prevent malnutrition 2. Initiate early prophylactic antibiotic therapy to prevent infection 3. Administer acetaminophen (Tylenol) every four hours for pain relief 4. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest

4. Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. Enteral feedings will be used only for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is needed only with acute necrotizing pancreatitis and signs of infection. The pain will be treated with IV morphine because of the NPO status.

A patient reports severe abdominal pain, nausea, and vomiting. The nurse assesses that the patient has a mass in the upper region of the abdomen. The laboratory reports show the white blood cell (WBC) count as 12,000 cells/µL. What does the nurse anticipate that the patient will be treated for? 1. Pseudocyst 2. Cullen's sign 3. Spider angioma 4. Pancreatic abscess

4. Pancreatic abscess A normal count of WBC is 4,500 to 10,000 cells/µL. The laboratory reports reveal an increased WBC count, which indicates that the patient has leukocytosis. Abdominal mass, abdominal pain, nausea, vomiting, and leukocytosis are manifestations of pancreatic abscess. Therefore the primary health care provider suspects that the patient has pancreatic abscess. Though pseudocysts have the same manifestations as those of pancreatic abscess, the laboratory findings of pseudocysts include elevated serum amylase rather than increased WBC. Cullen's sign is manifested by discoloration of the abdominal wall and the periumbilical region. Spider angioma is a manifestation of liver cirrhosis, wherein the patient has a dilated blood vessel with a red center that branches like a spider web.

Which condition is associated with the accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates? 1. Biliary sludge 2. Biliary atresia 3. Pancreatic abscess 4. Pancreatic pseudocyst

4. Pancreatic pseudocyst A pancreatic pseudocyst is an accumulation of fluid, pancreatic enzymes, tissue debris, and inflammatory exudates surrounded by a wall. Biliary sludge is a mixture of cholesterol crystals and calcium salts. Biliary atresia is a congenital condition in which the bile duct is closed or absent. Pancreatic abscess is a collection of pus resulting from necrosis of the pancreas.

The nurse is caring for a patient who is undergoing radiation therapy for pancreatic cancer. What nursing action is most beneficial for this patient? 1. Giving a low-fiber diet 2. Ignoring persistent skin irritation 3. Increasing dairy products in the diet 4. Providing brightly-colored and attractive food

4. Providing brightly-colored and attractive food Patients undergoing radiation therapy experience loss of appetite. Serving brightly colored and attractive food may increase the patient's appetite. Giving low-fiber foods can result in constipation in the patient. Radiation therapy causes skin irritation, which should be brought to the primary health care provider's notice. Increasing dairy products in the diet may not improve the patient's appetite.

The nurse is providing care to a patient with cholecystitis that is experiencing severe nausea and vomiting. The nurse should include what intervention? 1. Encouraging exercise 2. Assisting with ambulation 3. Assisting with repositioning 4. Providing oral care every two hours

4. Providing oral care every two hours Patients with cholecystitis may have severe nausea and vomiting. Therefore the nurse should give frequent oral care to the patient to avoid discomfort. Encouraging exercise, assisting with ambulation, and repositioning are not interventions that address the problem of severe nausea and vomiting.

During a follow-up visit, the nurse finds that the condition of a patient with cholelithiasis has improved. Which food included in the patient's diet most likely facilitated the improvement? 1. Butter 2. Yogurt 3. Cheese 4. Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.

4. Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.

A patient admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. What is the priority action that the nurse should take in this situation? 1. Give propranolol orally. 2. Check for signs of cirrhosis. 3. Send for endoscopic variceal ligation. 4. Stabilize the patient and manage the airway.

4. Stabilize the patient and manage the airway. Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications.

A patient with cirrhosis of the liver has ascites and is being prepared for a paracentesis. What instructions should the nurse give the patient? 1. The patient should fast overnight. 2. The patient should not pass urine until the procedure. 3. The patient should not take any fluids before the procedure. 4. The patient should void urine immediately before the paracentesis.

4. The patient should void urine immediately before the paracentesis. The nurse should instruct the patient to void prior to the paracentesis to prevent accidental puncture of the bladder. During the procedure, the patient sits on the side of the bed or is placed in high Fowler's position. There is no need to keep the patient on NPO status (taking nothing by mouth) or to restrict fluid intake.

The nurse reviews the medication records for a group of patients. The nurse should question the medication that has been prescribed for which patient? Patient A: Cirrhosis - Standard Interferon Patient B: Chronic hepatitis C - Ribavirin Patient C: Chronic hepatitis B - Telbivudine Patient D: Autoimmune hepatitis - Azathioprine

Patient A: Cirrhosis - Standard Interferon Patients with cirrhosis have multiple complications such as portal hypertension, gastric and esophageal varices, peripheral edema, and ascites. Drugs such as nadolol, octreotide, and vasopressin are given to reduce the risk of bleeding and to stop bleeding. Standard interferon, which is effective in treating infections, has been prescribed for patient A. This medication should be questioned for patient A because there is no indication that patient A has an infection. Patients with chronic hepatitis C are prescribed ribavirin, a guanosine analog, used to stop RNA replication. Telbivudine is a thymidine nucleoside analogue and is used to stop DNA replication, so it helps in the treatment of chronic hepatitis B for patient C. Azathioprine is an immunosuppressant used in treating autoimmune diseases, such as in patient D.

The nurse collects data on a group of patients and suspects that which patient has cirrhosis? Patient A: Small, dilated blood vessels with bright red center point Patient B: Rapid flexion and extension movements of the hands Patient C: Musty, sweet odor of the breath Patient D: Bluish flank discoloration

Patient A: Small, dilated blood vessels with bright red center point Small, dilated blood vessels with a bright red center point and spider-like branches around them indicate spider angioma, one of the clinical manifestations of cirrhosis, so Patient A is correct. Inability to stretch the hands, instead performing a series of rapid flexion and extension movements of the hands, indicates asterixis, the characteristic clinical manifestation of hepatic encephalopathy, for Patient B. Fetor hepaticus, a musty and sweet odor of the patient's breath, is a clinical manifestation of hepatic encephalopathy, for Patient C. Acute pancreatitis is associated with bluish discoloration of the flanks, for Patient D.