chapter 46 Flashcards
The nurse clarifies that which event happens to unconjugated bilirubin, which is made up of
broken-down red cells?
a. It is stored in the gallbladder to make bile.
b. Water-insoluble bilirubin must be converted by the liver.
c. A by-product is excreted directly into the bowel for excretion.
d. Red blood cells are necessary for digestion of fats.
b. Water-insoluble bilirubin must be converted by the liver.
The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5
to 5 g/dL. Based on these findings, which would the nurse expect the patient to exhibit?
a. Jaundice
b. Edema
c. Copious urine output
d. Pallor
b. Edema
Which is an essential nursing measure to prevent injury to the patient who is to receive a
paracentesis?
a. Have patient sign a permit.
b. Pad side rails.
c. Check for allergy to contrast media or to shellfish.
d. Have patient void immediately before procedure.
d. Have patient void immediately before procedure.
Which should the nurse expect of a patient with a malabsorption of vitamin K?
a. Anemia
b. Excess platelet production
c. Increased coagulation time
d. Elevated for infection due to diminished white blood cell count
c. Increased coagulation time
A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and the patient underwent an open cholecystectomy with a T tube inserted into the common bile duct. Which is the purpose of the T tube?
a. To decompress the duct and relieve pain caused by stimulation of the sphincter of
Oddi.
b. To improve diaphragmatic expansion and prevention of atelectasis.
c. To shorten postoperative recovery and hasten the healing process.
d. To keep the duct open and allow drainage of the bile until edema resolves.
d. To keep the duct open and allow drainage of the bile until edema resolves.
The nurse caring for a patient who has had an open cholecystectomy with a T Tube will take
which action?
a. open the T tube to the air so that it will drain freely.
b. position and secure the drainage bag at mid-chest level.
c. place the collection bag so the tube is not kinked.
d. irrigate the T tube with normal saline to ensure the free flow of bile.
c. place the collection bag so the tube is not kinked.
Which nursing intervention should will be completed immediately after the health care provider has performed a needle liver biopsy?
a. Assisting to ambulate for the bathroom
b. Keeping the patient on the right side for a minimum of 2 hours
c. Taking vital signs every 4 hours
d. Keeping the patient on the left side for a minimum of 4 hours
b. Keeping the patient on the right side for a minimum of 2 hours
Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to
100, and no breath sounds can be heard on the affected side. Which will the nurse suspect?
a. Peritonitis
b. Pneumothorax
c. Hemorrhage of the liver
d. Pleural effusion
b. Pneumothorax
Which patient statement indicates that the patient requires additional teaching about an
endoscopic retrograde cholangiopancreatography?
a. “Right after the test, I want breakfast with black coffee.”
b. “The instrument will be put down my throat.”
c. “I haven’t had anything to eat or drink since 9 p.m. last night.”
d. “My doctor said I could have medicine to relax me before the test.”
a. “Right after the test, I want breakfast with black coffee.”
The nurse assisting in the treatment of a patient with ruptured esophageal varices who has
received vasopressin IV will carefully assess for which complication?
a. muscular twitching/spasm.
b. hematuria.
c. macular rash on trunk and arms.
d. evidence of cardiac ischemia.
d. evidence of cardiac ischemia.
Which will the nurse point out as a significant advantage of the laparoscopic cholecystectomy?
a. Slightly more invasive, but there is less pain
b. Can be performed on all patients of any age
c. Can be performed even when there are large stones present in the bile duct
d. Less invasive procedure
d. Less invasive procedure
Which should the nurse explain is the major purpose of the Sengstaken-Blakemore tube
(S/B tube)?
a. Decompress the stomach.
b. Control esophageal varices bleeding.
c. A route for tube feedings.
d. Obtain specimen for gastric analyzing.
b. Control esophageal varices bleeding.
The patient’s cirrhosis of the liver has also caused a dilation of the veins of the lower
esophagus secondary to portal hypertension, resulting in the development of which
complication?
a. esophageal varices.
b. diverticulosis.
c. Crohn disease.
d. esophageal reflux (GERD).
a. esophageal varices.
The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The
patient‘s hands flap when the patient stretches out the arm. How will the nurse interpret
this?
a. As an attempt to get the nurse’s attention
b. As asterixis
c. As an indication of respiratory obstruction from varices
d. As spasticity
b. As asterixis
How does the administration of neomycin reduce production of ammonia?
a. By assisting the hepatic cells to regenerate
b. By reducing ascites
c. By decreasing the bacteria in the gut
d. By helping to digest fats and proteins
c. By decreasing the bacteria in the gut
Which is the most common procedure for the removal of the gallbladder?
a. Laparoscopic cholecystectomy
b. Cholangiography
c. Open cholecystectomy
d. Choledochostomy
a. Laparoscopic cholecystectomy
Which assessment is the priority assessment for a patient who will be undergoing
intravenous cholangiography?
a. Patency of the intravenous line
b. Ensure the patient is fasting prior to the exam
c. An allergy to the iodine based radiographic dye
d. Whether or not the patient has signed the consent form
c. An allergy to the iodine based radiographic dye
Which is a classic location and radiation of the pain associated with cholecystitis?
a. Substernal, radiating to the left shoulder and arm
b. Epigastric, radiating to the back
c. Right upper abdomen, radiating to the back or right scapula
d. Left upper abdomen, radiating to the jaw and neck
c. Right upper abdomen, radiating to the back or right scapula
Which should the nurse avoid contamination from to prevent the transmission of hepatitis A?
a. Food or water
b. Blood transfusion
c. Needles
d. Sexual contact
a. Food or water
Which is the most appropriate method used by high-risk health workers to prevent hepatitis B?
a. Hepatitis B vaccine
b. Diligent hand washing
c. Wearing protective gear
d. Hb immune globulin injections
a. Hepatitis B vaccine
The nurse explains that the use of cyclosporine as an immunosuppressant has been
successful in the reduction of rejection of liver transplants because the drug has which
benefit?
a. increases the rate of the regeneration of liver cells.
b. can overcome complications presented by hepatitis C.
c. increases blood supply to transplant.
d. does not suppress bone marrow.
d. does not suppress bone marrow.
A patient returning from a 2-week camping trip a few days ago, reports having nausea,
anorexia, and dark urine. Which additional information would assist in diagnosing hepatitis A?
a. Exposure to blood
b. Recent ingestion of raw fish
c. History of intravenous drug use
d. Multiple sex partners
b. Recent ingestion of raw fish
When caring for an extremely jaundiced patient with cirrhosis, which does the nurse expect
to see included in the plan of care?
a. Encouraging consumption of a high-fat diet
b. Skin care to relieve pruritus
c. Offering foods rich in fat-soluble vitamins
d. Meticulous foot care
b. Skin care to relieve pruritus
The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early
stage as an elevation can be assessed as early as how many hours after the onset of pancreatic disease?.
a. 2 hours
b. 8 hours
c. 24 hours
d. 36 hours
a. 2 hours
The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune
serum globulin. What should the dose (.02 mL/kg) be?
a. 0.9 mL
b. 1.4 mL
c. 1.6 mL
d. 1.8 mL
a. 0.9 mL
A patient with cirrhosis of the liver will have which blood test results monitored?
a. Blood urea nitrogen (BUN)
b. Platelet counts
c. Aspartate aminotransferase (AST)
d. Hemoglobin and Hematocrit (HGB and HCT)
c. Aspartate aminotransferase (AST)
The nurse would expect to see a provision in the plan of care for a person who has had a
liver transplant to prevent which complication?
a. fluid congestion.
b. fatigue.
c. infection.
d. urinary retention.
c. infection.
The nurse is aware that the hepatitis A immunization provides immunity in:
a. 5 days.
b. 10 days.
c. 15 days.
d. 30 days.
d. 30 days.
What is the challenge in encouraging coughing and deep breathing for a postoperative
patient who had an open cholecystectomy?
a. High placement of incision
b. Excessive nausea
c. Weakened abdominal muscles
d. Poor oxygenation
a. High placement of incision
Why is it advantageous for a live person to be a liver donor?
a. Because the donor is not at risk for any complication.
b. Because the recipient is more likely to avoid rejection.
c. Because the donor donates only a part of the liver.
d. Because the blood supply is more dependable in the donated liver.
c. Because the donor donates only a part of the liver.
Which factors are most commonly associated with pancreatitis?
a. Coronary artery disease
b. Alcoholism and biliary tract disease
c. Cirrhosis
d. History of myocardial infarction
b. Alcoholism and biliary tract disease
A patient with pancreatitis is on nothing by mouth status (NPO). The patient asks the nurse
“ Why am I unable to have anything by mouth?”. Whichis the best response?
a. “Diagnostic tests depend on you not eating anything.”
b. “The pancreas is stimulated whenever you eat or drink and causes pain.”
c. “Eating causes the need for a bowel movement, which excretes your medication
too rapidly.”
d. “Resting your gastrointestinal tract will cure your pancreatitis.”
b. “The pancreas is stimulated whenever you eat or drink and causes pain.”
Why is morphine contraindicated in the patient with pancreatitis?
a. Meperidine is less expensive.
b. Tylenol is more effective at managing this type of pain.
c. Morphine may cause spasms of the sphincter of Oddi.
d. These patients do not experience pain.
c. Morphine may cause spasms of the sphincter of Oddi.
Which factors may increase a patient’s risk of developing cancer of the pancreas?
a. Diet high in carbohydrates and dairy products
b. Cardiovascular disease and glaucoma
c. Tea and cola consumption
d. Cigarette smoking and having diabetes mellitus
d. Cigarette smoking and having diabetes mellitus
Which assessment indicates possible gallbladder disease?
a. Dull pain in the right upper quadrant region
b. Changes in color of urine or stool
c. Distention of veins in upper part of body
d. Aching muscles and tenderness in the liver
b. Changes in color of urine or stool
What should the nurse monitor in caring for the patient undergoing a paracentesis?
a. The urinary output
b. Hypervolemia
c. Fluid removal over at least 30 minutes
d. Seizure
c. Fluid removal over at least 30 minutes
A patient with a T tube for an open cholecystectomy has resumed oral intake. The T tube is
clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of
fat. During the time the tube is clamped the patient complains of abdominal pain and
nausea. Which intervention is most appropriate?
a. Notify the health care provider.
b. Unclamp the tube immediately.
c. Increase the IV fluids.
d. Change the T-tube dressing.
b. Unclamp the tube immediately.
The nurse clarifies that deterioration progresses through stages before presenting with liver
disease. The first stage is destruction. What is the last stage?
a. Liver disease
b. Inflammation
c. Hepatic insufficiency
d. Destruction
e. Fibrotic regeneration
a. Liver disease
Which is a by-product of protein metabolism?
a. Urine
b. Protease
c. Amylase
d. Ammonia
d. Ammonia
? is a condition characterized by yellowing of the sclera and the skin.
jaundice
The disease that is on the increase because of the growing obesity population and is
associated with coronary artery disease and use of corticosteroids is ?
NAFLD
Hepatitis D is usually seen as a coinfection with ?
Heapatitis b
