CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems (9th Edition) // CHAPTER 43: Liver, Pancreas, and Biliary Tract Problems (10th Edition) Flashcards
*** 1. A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that
a. pruritus is a common problem with jaundice in this phase.
b. the patient is most likely to transmit the disease during this phase.
c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B.
d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase.
a. pruritus is a common problem with jaundice in this phase.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
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Ashley A.
*** 2. A patient with acute hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to
a. avoid alcohol for the first 3 weeks.
b. use a condom during sexual intercourse.
c. have family members get an injection of immunoglobulin.
d. follow a low-protein, moderate-carbohydrate, moderate-fat diet.
b. use a condom during sexual intercourse.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
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Irma G.
*** 3. A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include
a. having genetic testing done.
b. recommending a heart-healthy diet.
c. the necessity to reduce weight rapidly.
d. avoiding alcohol until liver enzymes return to normal.
b. recommending a heart-healthy diet.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Bridge to NCLEX Examination
Ashley A.
*** 4. The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse’s response is based on the knowledge that
a. a lack of clotting factors promotes the collection of blood in the abdominal cavity.
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel.
d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.
b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
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Huyen T.
*** 5. In planning care for a patient with metastatic liver cancer, the nurse should include interventions that
a. focus primarily on symptomatic and comfort measures.
b. reassure the patient that chemotherapy offers a good prognosis.
c. promote the patient’s confidence that surgical excision of the tumor will be successful.
d. provide information necessary for the patient to make decisions regarding liver transplantation.
a. focus primarily on symptomatic and comfort measures.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
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Ben J.
*** 6. Nursing management of the patient with acute pancreatitis includes (select all that apply)
a. checking for signs of hypocalcemia.
b. providing a diet low in carbohydrates.
c. giving insulin based on a sliding scale.
d. observing stools for signs of steatorrhea.
e. monitoring for infection, particularly respiratory tract infection.
a. checking for signs of hypocalcemia.
e. monitoring for infection, particularly respiratory tract infection.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Bridge to NCLEX Examination
Huyen T.
*** 7. A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves
a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum.
b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum.
c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.
d. radical removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy.
c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Bridge to NCLEX Examination
Leslie G.
*** 8. The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that
a. shock-wave therapy should be tried initially.
b. once gallstones are removed, they tend not to recur.
c. the disorder can be successfully treated with oral bile salts that dissolve gallstones.
d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.
d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Bridge to NCLEX Examination
Ben J.
*** 9. Teaching in relation to home management after a laparoscopic cholecystectomy should include
a. keeping the bandages on the puncture sites for 48 hours.
b. reporting any bile-colored drainage or pus from any incision.
c. using over-the-counter antiemetics if nausea and vomiting occur.
d. emptying and measuring the contents of the bile bag from the T tube every day.
b. reporting any bile-colored drainage or pus from any incision.
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Bridge to NCLEX Examination
Amanda Z.
*** 1. The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?
a. “It is safe to take acetaminophen up to four times a day for pain.”
b. “Lactulose (Cephulac) should be taken every day to prevent constipation.”
c. “Herbs and other spices should be used to season my foods instead of salt.”
d. “I will eat foods high in potassium while taking spironolactone (Aldactone).”
c. “Herbs and other spices should be used to season my foods instead of salt.”
A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems - 9th Edition
Pre-Test
Irma G.
*** 2. The nurse is caring for a group of patients. Which patient is at highest risk for pancreatic cancer?
a. A 38-year-old Hispanic female who is obese and has hyperinsulinemia
b. A 23-year-old who has cystic fibrosis–related pancreatic enzyme insufficiency
c. A 72-year-old African American male who has smoked cigarettes for 50 years
d. A 19-year-old who has a 5-year history of uncontrolled type 1 diabetes mellitus
c. A 72-year-old African American male who has smoked cigarettes for 50 years
Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer as compared with nonsmokers. The risk is related to duration and number of cigarettes smoked.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Pre-Test - 9th Edition
Ben J.
*** 3. The nurse is caring for a 55-year-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect the patient to exhibit?
a. Hematochezia
b. Left upper abdominal pain
c. Ascites and peripheral edema
d. Temperature over 102o F (38.9o C)
c. Left upper abdominal pain
Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner’s spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen’s sign, a bluish periumbilical discoloration).
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Pre-Test - 9th Edition
Ben J.
*** 4. The nurse instructs a 50-year-old woman about cholestyramine to reduce pruritis caused by gallbladder disease. Which statement by the patient to the nurse indicates she understands the instructions?
a. “This medication will help me digest fats and fat-soluble vitamins.”
b. “I will apply the medicated lotion sparingly to the areas where I itch.”
c. “The medication is a powder and needs to be mixed with milk or juice.”
d. “I should take this medication on an empty stomach at the same time each day.”
c. “The medication is a powder and needs to be mixed with milk or juice.”
For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Pre-Test - 9th Edition
Ben J.
*** 5. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobin (IG) injection?
a. A caregiver who lives in the same household with the patient
b. A friend who delivers meals to the patient and family each week
c. A relative with a history of hepatitis A who visits the patient daily
d. A child living in the home who received the hepatitis A vaccine 3 months ago
a. A caregiver who lives in the same household with the patient
IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 month previously or who have a history of HAV infection do not require IG.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Pre-Test - 9th Edition
Amy S.
*** 1. The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient’s plan of care?
a. Immediately start enteral feeding to prevent malnutrition.
b. Insert an NG and maintain NPO status to allow pancreas to rest.
c. Initiate early prophylactic antibiotic therapy to prevent infection.
d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.
d. Insert an NG and maintain NPO status to allow 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. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Adriana B.
*** 2. The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons?
Select all that apply.
a. There is decreased colloid oncotic pressure from the liver’s inability to synthesize albumin.
b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.
d. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids orally.
e. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.
a. There is decreased colloid oncotic pressure from the liver’s inability to synthesize albumin.
b. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention.
c. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.
The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Amy S.
*** 3. When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?
a. Impaired skin integrity related to edema, ascites, and pruritus
b. Imbalanced nutrition: less than body requirements related to anorexia
c. Excess fluid volume related to portal hypertension and hyperaldosteronism
d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume
d. 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 priorities.CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Huyen T.
*** 4. When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?
a. “I will use care when kissing my wife to prevent giving it to her.”
b. “I will need to take adofevir (Hepsera) to prevent chronic HCV.”
c. “Now that I have had HCV, I will have immunity and not get it again.”
d. “I will need to be checked for chronic HCV and other liver problems.”
d. “I will need to be checked for chronic HCV and other liver problems.”
The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Adriana B.
*** 5. A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?
a. Malnutrition
b. Osteomyelitis
c. Alcohol abuse
d. Diabetes mellitus
c. Alcohol abuse
The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Adriana B.
*** 6. The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?
a. “If I notice a fast heart rate or irregular beats, this is normal for cirrhosis.”
b. “I need to take good care of my belly and ankle skin where it is swollen.”
c. “A scrotal support may be more comfortable when I have scrotal edema.”
d. “I can use pillows to support my head to help me breathe when I am in bed.”
a. “If I notice a fast heart rate or irregular beats, this 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, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler’s or Fowler’s position will increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Amy S.
*** 7. When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include?
a. A lower-fat diet may be better tolerated for several weeks.
b. Do not return to work or normal activities for 3 weeks.
c. Bile-colored drainage will probably drain from the incision.
a. A lower-fat diet may be better tolerated for several weeks.
Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery. Normal activities can be gradually resumed 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.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Amy S.
- When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)?
Select all that apply.
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
e. Vitamin B
a. Vitamin A
b. Vitamin D
c. Vitamin E
d. Vitamin K
Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary obstruction.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
*** 9. 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?
a. Has completed a college education
b. Has been able to stop smoking cigarettes
c. Has well-controlled type 1 diabetes mellitus
d. The chest x-ray showed another lung cancer lesion.
d. 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 and/or alcohol abuse, and the inability to comprehend or comply with the rigorous post-transplant course.
CHAPTER 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
EVOLVE NCLEX Review Questions - 9th Edition
Adriana B.
