Lewis Chapter 46 - Liver, Pancreas, Biliary Tract Flashcards
A client with hepatitis A is in the acute phase. Which of the following should be considered in the nurse’s plan of care?
a. Pruritus is a common condition with jaundice in this phase.
b. The client 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.
B.
A client with acute hepatitis B is being discharged in 2 days. Which of the following instructions should the nurse include in the discharge teaching plan?
a. Resume alcohol as soon as he is symptom free.
b. Use a condom during sexual intercourse.
c. Have family members get an injection of immune globulin.
d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet.
B.
A client has been told that she has elevated liver enzyme caused by NAFLD. Which of the following instructions should the nurse’s teaching plan include?
a. Have genetic testing performed.
b. Follow a heart-healthy diet and a regular exercise program.
c. Lose weight quickly within the next 4 weeks.
d. Avoid using alcohol until the liver enzyme levels return to normal.
B.
A client with advanced cirrhosis asks the nurse why his abdomen is so swollen. The nurse’s response is based on knowledge of which of the following?
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 gastrointestinal tract contributes to gas formation and distension of the bowel.
d. Bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.
B.
In caring for a client with hepatocellular carcinoma, which of the following should the nurse perform?
a. Focus primarily on symptomatic and comfort measures.
b. Reassure the client that chemotherapy offers a good prognosis for recovery.
c. Promote the client’s confidence that surgical excision of the tumour will be successful.
d. Provide information necessary for the client to make decisions regarding liver transplantation.
A.
A client with pancreatic cancer is admitted to the hospital for evaluation for treatment. The client asks the nurse to describe Whipple procedure, which the surgeon has planned. Which of the following would the nurse include in the explanation to the client?
a. Creation of a bypass around the obstruction caused by the tumour 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 to the jejunum
d. Radical removal of pancreas, duodenum, and spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy
C.
The nursing management of a client with cholecystitis in association with cholelithiasis should include which of the following?
a. Recommendation of a diet low in saturated fat
b. Information that gallstones once removed tend not to recur
c. Avoidance of morphine in the management of pain
d. Treatment with oral bile salts that dissolve gallstones
A.
What information should be included in teaching about home management after a laparoscopic cholecystectomy?
a. Keep the bandages on the puncture sites for 48 hours.
b. Report any bile-coloured drainage or pus from any incision.
c. Use over-the-counter antiemetics if nausea and vomiting occur.
d. Empty and measure the contents of the bile bag from the T-tube every day.
B.
The nurse is caring for a patient who has a history of diabetes mellitus, malnutrition, osteomyelitis, and alcohol misuse. On admission, the patient has a serum amylase level of 280 units/L and a serum lipase level of 310 units/L. To which of the following diagnoses does the nurse attribute these findings?
A. Malnutrition
B. Osteomyelitis
C. Alcohol misuse
D. Diabetes mellitus
C. Alcohol misuse
The patient with alcohol misuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 100–200 units/L) and serum lipase (normal < 160 units/L) levels as shown.
The health care provider prescribes lactulose for a patient with hepatic encephalopathy. Which of the following assessment parameters should the nurse monitor to determine the effectiveness of this medication?
A. Relief of constipation
B. Relief of abdominal pain
C. Decreased liver enzymes
D. Decreased ammonia levels
D. 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.
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?
A. “The hepatitis vaccine will provide immunity from this exposure and future exposures.”
B. “I am afraid there is nothing you can do since the patient was infectious before admission.”
C. “You will need to be tested first to make sure you don’t have the virus before we can treat you.”
D. “An injection of immune globulin will need to be given to prevent or minimize the effects from this exposure.”
D. “An injection of immune globulin will need to be given to prevent or minimize the effects from this exposure.”
Immune globulin provides temporary (6–8 weeks) passive immunity and is effective for preventing hepatitis A if given within 1–2 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.
The nurse is planning care for a patient with cirrhosis. Which of the following nursing diagnoses is priority?
A. Imbalanced nutrition: less than body requirements
B. Impaired skin integrity related to edema, ascites, and pruritus
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.
Which of the following serum bilirubin levels would indicate the need for a clinical examination to detect jaundice?
A. 24 mcmol/L
B. 17 mcmol/L
C. 35 mcmol/L
D. 30 mcmol/L
C. 35 mcmol/L
Normal serum bilirubin levels are between 5.1 and 17 mcmol/L, but jaundice is not detected by careful examination until these levels have doubled to greater than 34 mcmol/L, twice the normal upper limit. Jaundice is usually first noticed in the sclera of the eyes, as they achieve a yellow discolouration.
Which time frame represents the incubation period of hepatitis A?
A. 15 to 50 days
B. 115 to 180 days
C. 14 to 180 days
D. 2 to 26 weeks
A. 15 to 50 days
Hepatitis A has an incubation period of 15 to 50 days. Patients are most infectious during 2 weeks before onset of symptoms and infectious until 1 to 2 weeks after the start of symptoms.
Hepatitis B has an incubation period of 115 to 180 days. Patients are most infectious before and after symptoms appear, can be infectious for months, and carriers continue to be infectious for life.
Hepatitis C has an incubation period of 14 to 180 days, with the average being 56 days. Patients are infective 1 to 2 weeks before symptoms appear with 75% to 85% developing chronic hepatitis C and remain infectious.
Hepatitis D has an incubation period of 2 to 26 weeks, and can only be contracted if the patient has hepatitis B.
Which definition accurately describes cryoglobulinemia?
A. Presence of blood in the urine
B. Presence of abnormal proteins in the blood
C. Inflammation of the blood vessels
D. Blockage of the nephrons
B. Presence of abnormal proteins in the blood
Cryoglobulinemia is defined as the presence of abnormal proteins in the blood. In viral hepatitis, destruction of hepatocytes leads to the alteration in protein metabolism.
Which route is hepatitis A primarily transmitted?
A. Fecal-oral transmission
B. Parental transmission
C. Perinatal transmission
D. Sexual transmission
A. Fecal-oral transmission
Hepatitis A is transmitted primarily through the fecal–oral route (by ingesting contaminated foods or water) and rarely parenterally.
Which action places an individual at risk for transmitting hepatitis B?
A. Sexual intercourse
B. Sharing food
C. Kissing
D. Hugging
A. Sexual intercourse
Hepatitis B can be transmitted by sexual intercourse, perinatally, percutaneously, and horizontally by permucosal exposure to infectious blood, blood products, or other body fluids such as semen and vaginal secretions.
Which hepatitis C genotype would a nurse in Canada most likely treat?
A. Genotype 1
B. Genotype 2
C. Genotype 3
D. Genotype 4
A. Genotype 1
Hepatitis C virus has six genotypes. In Canada, 75% of hepatitis C virus (HCV) infections are caused by HCV genotype 1.
Which health teaching related to nutrition is appropriate for a patient with acute hepatitis?
A. Eat large meals twice per day.
B. Maintain mouth hygiene.
C. Restrict fluids to prevent ascites.
D. Avoid carbonated beverages.
B. Maintain mouth hygiene.
The nurse should encourage measures to stimulate the appetite, such as mouth care, antiemetics, and attractively served meals in pleasant surroundings.
Which teaching point would the nurse include when providing education to a patient with hepatitis?
A. “You should eat infrequent large meals to get adequate nutritional intake.”
B. “Starting a rigorous exercise program is recommended to improve liver function.”
C. “Transmission among family members is unlikely as hepatitis is nontransmissible.”
D. “Some signs and symptoms of worsening liver function include excessive bleeding, abdominal swelling and confusion.”
D. “Some signs and symptoms of worsening liver function include excessive bleeding, abdominal swelling and confusion.”
The nurse should educate a patient with hepatitis about signs and symptoms of worsening liver function and when to seek medical assistance. Bleeding tendencies may indicate an increased international normalized ratio (INR), abdominal swelling may be ascites, vomiting blood and tarry stools may indicate varices bleeding, and confusion may be assign of encephalopathy.
Which laboratory test is used to evaluate the liver’s function?
A. Serum albumin
B. Serum potassium
C. Serum creatinine
D. Serum urea
A. Serum albumin
Serum albumin, serum bilirubin, and prothrombin time (PT) are all laboratory tests used to evaluate liver function.
Which complication may occur if hepatitis B is left untreated?
A. Hepatocellular carcinoma
B. Hepatomegaly
C. Deep vein thrombosis (DVT)
D. Pancreatitis
A. Hepatocellular carcinoma
Hepatocellular carcinoma, cirrhosis, and liver failure are all potential complications of untreated hepatitis B.
Which condition is a prehepatic cause of jaundice?
A. Sickle cell anemia
B. Alcoholic hepatitis
C. Cirrhosis
D. Liver cancer
A. Sickle cell anemia
Prehepatic causes of jaundice include sickle cell disease, thalassemia major, and blood transfusion reactions.
Which medication is a mainstay treatment for chronic hepatitis B?
A. Nucleotide analogues
B. Glecaprevir/pibrentasvir (Maviret)
C. Ribavirin
D. Avaxim
A. Nucleotide analogues
Oral nucleoside and nucleotide analogues (NAs) are the mainstay of treatment for chronic hepatitis B. These medications inhibit viral deoxyribonucleic acid (DNA) replication by mimicking normal DNA building blocks. Once they become incorporated into the hepatitis B virus DNA, they stop the DNA reproduction and are thus able to lower the amount of virus in the blood.
Which medication for treatment of hepatitis C is a genotype-specific regimen?
A. Ledipasvir/sofosbuvir (Havoni)
B. Glecaprevir/pibrentasvir (Maviret)
C. Sofosbuvir/velpatasvir (Epclusa)
D. Sofosbuvir/velpatasvir/voxilaprevir (Vosevi)
A. Ledipasvir/sofosbuvir (Havoni)
Medications that are genotype-specific regimens for treatment of hepatitis C include Ledipasvir/sofosbuvir (Havoni), Paritaprevir/ritonavir/ombitasvir + dasabuvir (Holkira-pak), Paritaprevir/ritonavir/ombitasvir (Technivie) and Sofosbuvir + daclatasvir (Sovaldi + Daklinza).
Which teaching point about vaccinations and hepatitis D would the nurse include when providing education?
A. “Vaccination against hepatitis B will reduce the risk of contracting hepatitis D.”
B. “Hepatitis D specific vaccinations are available.”
C. “Hepatitis D vaccinations are not necessary when you have hepatitis B.”
D. “Hepatitis D carry a high risk of deep vein thrombosis and pulmonary embolism.”
A. “Vaccination against hepatitis B will reduce the risk of contracting hepatitis D.”
The nurse is accurately recommending that the patient gets vaccinated for hepatitis B to reduce the risk of contracting hepatitis D as hepatitis D is only contracted when hepatitis B is present.
Which teaching point about preventing hepatitis B infections would the nurse include when providing education?
A. Wash your vegetables thoroughly before ingesting.
B. Avoid hugging or kissing an infected individual.
C. Do not share razors, toothbrushes, or personal items with someone who has hepatitis B.
D. Good hand hygiene and environmental sanitation is recommended to prevent hepatitis B infections.
C. Do not share razors, toothbrushes, or personal items with someone who has hepatitis B.
The nurse is accurate in recommending that the patient not share razors, toothbrushes, and personal items with someone who has hepatitis B as this is a risk for infection.
Which statement describes steatosis symptomatically?
A. Simple fatty liver with no hepatic inflammation
B. Nonalcoholic fatty liver with inflammation
C. Severe liver scarring
D. Liver inflammation due to viral infection
A. Simple fatty liver with no hepatic inflammation
Steatosis refers to a simple fatty liver with no hepatic inflammation and a less severe disorder on the nonalcoholic fatty liver disease (NAFLD) spectrum.
Which manifestation is most common for patients with nonalcoholic fatty liver disease (NAFLD)?
A. Absence of symptoms
B. Confusion
C. Sharp abdominal pain
D. Headache
A. Absence of symptoms
Most patients with nonalcoholic fatty liver disease (NAFLD) have no symptoms. Symptoms, if present, are nonspecific and may include fatigue, malaise, and vague pain in the right upper abdominal quadrant.
