Quiz 4

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding?

. Direct bilirubin 2.1 mg/dL i. Expect the client who has cholelithiasis to have an elevated direct bilirubin level if the bile duct is obstructed. A direct bilirubin level of 2.1 mg/dL is above the expected reference range

13. A patient's physician has ordered a liver panel in response to the patient's 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 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?

A) Asterixis

A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace?

A) Disposing of sharps appropriately and not recapping needles

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?

A) Following proper hand-washing techniques

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?

A) Glucose tolerance test

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?

A) How many alcoholic drinks do you typically consume in a week?

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's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the patient's laboratory studies, what finding is most closely associated with this diagnosis?

A) Increased bilirubin

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?

A) 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?

A) Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.

An adult patient has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this patient's plan of care?

A) Measure the patient's abdominal girth daily.

A 37-year-old male patient presents at the emergency department (ED) complaining of nausea and vomiting and severe abdominal pain. The patient's abdomen is rigid, and there is bruising to the patient's flank. The patient's 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?

A) Severe pancreatitis with possible peritonitis

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention?

B) A regimen of antiviral medications

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?

B) Adhere to dosing recommendations of OTC analgesics

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 patient's plan of care?

B) Assessment for variceal bleeding

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?

B) IV hydromorphone (Dilaudid)

A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response?

B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.

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 nurse's response?

B) Surgery is delayed until the acute symptoms subside.

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?

C) A 39-year-old man with chronic alcoholism

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?

C) Arrange for the patient to be transported to the hospital.

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?

C) Bed rest lowers the metabolic rate and reduces enzyme production.

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?

C) Blood glucose levels

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?

C) Central nervous system damage

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 patient's pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response?

C) Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost.

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?

C) Fever, increased heart rate and decreased blood pressure

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (SATA)

Clamp T-tube for 1 hr before and after meals i. T-tube is clamped 1 hr before and after meals to provide the bile needed for digestion of food b. Keep the drainage system above the level of the abdomen i. The provider may prescribe elevation of the T- above the level of the abdomen to prevent the total loss of bile

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 patient's plan?

C) Reduction in sodium intake

A patient is admitted to the ICU with acute pancreatitis. The patient's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what?

C) Undiagnosed chronic pancreatitis

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?

D) An immune globulin injection

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 nurse's most appropriate response?

D) Encourage the patient to connect with a community-based support group.

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?

D) Gangrene of the gallbladder

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?

D) Maintain the patient in a semi-Fowlers position whenever possible.

A nurse is assessing a patient who has been diagnosed with cholecystitis and is experiencing localized abdominal pain. When assessing the characteristics of the patient's pain, the nurse should anticipate that it may radiate to what region?

D) Right shoulder

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 patient's health problem?

D) The enzymes that your pancreas produces have damaged the pancreas itself.

A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following as a risk factor for cholecystitis?

Is considered a risk factor for the development of cholecystitis

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 transplant

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.

9. A nurse is caring for a patient with hepatic encephalopathy. The nurse's 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

A nurse is reviewing a new prescription for ursodiol (10) /chenodiol (11.0) with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching?

This medication dissolves gallstones gradually over a period of up to 2 years i. Ursodiol/Chenodiol is a bile acid that gradually dissolves cholesterol-based gall stones. The medication can be taken for up to 2 years

A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's 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 nurse is completing nutrition teaching for a client who has pancreatitis. Which of the following statements by the client indicates an understanding of the teaching? (SATA)

a. "I plan to eat small, frequent meals." i. Small, frequent meals are recommended for the client who has pancreatitis b. "I will eat easy-to-digest foods with limited spice." i. Bland, easy-to-digest foods are recommended for the client who has pancreatitis c. "I will use skim milk when cooking." i. Low-fat foods are recommended for the client who has pancreatitis

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis?

a. Brownie with nuts i. Foods that are high in fat such as a brownie with nuts can cause cholecystitis

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? (SATA) -

a. Change in orientation i. Indicates hepatic encephalopathy in a client who has advanced cirrhosis b. Asterixis i. A coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy c. Fetor hepaticus i. Is a fruity, musty breath odor is a finding of hepatic encephalopathy in the client who has advanced cirrhosis

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (SATA) -

a. Diuretic i. Facilitate excretion of excess fluid from the body in a client who has cirrhosis b. Beta-blocking agent i. Prescribed for a client who has cirrhosis to prevent bleeding from varices c. Lactulose i. To aid in the elimination of ammonia in the stool for a client who has cirrhosis

A nurse is completing an admission assessment of a client who has pancreatitis. Which of the following findings should the nurse expect? -

a. Epigastric pain radiating to the left shoulder i. Client who has pancreatitis will report severe, boring epigastric pain that radiates to the back, left flank or left shoulder

A nurse is assessing a client who has pancreatitis. Which of the following findings should the nurse identify as a manifestation of pancreatitis?

a. Gray-blue discoloration of the skin around the umbilicus i. A gray-blue discoloration in the periumbilical area is a manifestation of pancreatitis

A nurse is completing the admission assessment of a client who has acute pancreatitis. Which of the following findings is the priority to report?

a. Hand spasms present when blood pressure is checked i. The greatest risk to the client is ECG changes and hypotension from hypocalcemia. Hand spams when taking a blood pressure is a manifestation of hypocalcemia

A nurse is reviewing the admission laboratory results of a client who has acute pancreatitis. Which of the following findings should the nurse expect? -11.0

a. Increased blood glucose level i. The client will experience an increased blood glucose level due to pancreatic cell injury, which results in impaired metabolism of carbohydrates due to a decrease in the release of insulin

7 A nurse is assessing a client who has pancreatitis. Which of the following actions should the nurse take to assess the presence of Cullen's sign. -

a. Inspect the skin around the umbilicus i. Cullen's sign is indicated by a bluish-gray discoloration

A nurse is teaching a client who has hepatitis B about home care. Which of the following instruction should the nurse include in the teaching? (SATA)

a. Limit physical activity i. Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B b. Avoid alcohol i. Alcohol metabolized in the liver and should be avoided by the client who has hepatitis B c. Eat small frequent meals i. The client who has hepatitis B should eat small, frequent meals to promote improved nutrition due to the presence of anorexia

A nurse is preparing to administer pancrelipase to a client who has pancreatitis. Which of the following actions should the nurse take?

a. Offer a glass of water following medication administration i. Client should drink a full glass of water following administration of pancrelipase

A nurse is caring for a client who has a new diagnosis of hepatitis C. which of the following laboratory findings should the nurse expect?

a. Positive EIA test i. A positive EIA test is an expected laboratory finding in a client who has a new diagnosis of hepatitis C

A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care?

a. Provide a high-calorie, high-carbohydrate diet. i. Client who has hepatitis B should have a diet high in calories and carbohydrates

A nurse is providing discharge teaching to a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instructions should the nurse include in the teaching?

a. Resume a diet of choice i. Client is able to resume a regular diet of choice upon discharge, b. Cleanse the puncture site using mild soap and water i. Client should cleanse the puncture site with mild soap and water to decrease the risk of infection

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching?

a. You might have shoulder pain after surgery i. It's expected postoperatively due to free air that is introduced into the abdomen during laparoscopic surgery