Lewis Chapter 46 - Liver, Pancreas, Biliary Tract TEST BANK Flashcards
A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the
patient’s illness, which of the following serological findings should the nurse expect?
a. Antibody to hepatitis D virus (anti-HDV)
b. Hepatitis B surface antigen (HBsAg)
c. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG)
d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
ANS: D
Hepatitis A is transmitted through the oral–fecal route, and antibody to HAV IgM appears
during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or
antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.
Which of the following findings in a blood specimen indicates that the administration of
hepatitis B vaccine to a patient has been effective?
a. HBsAg
b. Anti-HBs
c. Anti-HBc IgG
d. Anti-HBc IgM
ANS: B
The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the
vaccine. The other laboratory values indicate current infection with HBV.
A patient in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection.
Which of the following actions by the nurse is best?
a. Schedule the patient for HCV genotype testing.
b. Administer immune globulin and the HCV vaccine.
c. Instruct the patient on ribavirin treatment.
d. Teach that the infection will resolve in a few months.
ANS: A
Genotyping of HCV has an important role in managing treatment and is done before drug
therapy is initiated. Since most patients with acute HCV infection convert to a persistent state,
the nurse should not teach the patient that the HCV will resolve in a few months. Immune
globulin or vaccine is not available for HCV. Ribavirin is used for persistent HCV infection
The nurse is caring for a patient who is diagnosed with acute hepatitis B. Which of the
following information should the nurse include in the teaching plan?
a. Ways to increase exercise and activity level
b. Self-administration of -interferon
c. Adverse effects of nucleoside and nucleotide analogs
d. Measures that will be helpful in improving appetite
ANS: D
Maintaining adequate nutritional intake is important for regeneration of hepatocytes.
Interferon and antivirals may be used for persistent hepatitis B, but they are not prescribed for
acute hepatitis B infection. Rest is recommended
The nurse is caring for a patient with persistent hepatitis C who is prescribed combination
therapy of -interferon and ribavirin. Which of the following findings should the nurse
monitor for the presence of hepatitis C in the patient?
a. Leukopenia
b. Hypokalemia
c. Polycythemia
d. Hypoglycemia
ANS: A
Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not
associated with this drug therapy.
Which of the following patients should alert the nurse that screening for hepatitis C should be
done?
a. The patient eats frequent meals in fast-food restaurants.
b. The patient recently travelled to an undeveloped country.
c. The patient had a blood transfusion after surgery in 1998.
d. The patient reports a one-time use of IV drugs 20 years ago
ANS: D
Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions
given after 1992, when an antibody test for hepatitis C became available, do not pose a risk
for hepatitis C. Hepatitis C is not spread by the oral–fecal route and therefore is not caused by
contaminated food or by travelling in underdeveloped countries.
The nurse is caring for a patient who is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serological testing is negative for viral causes of hepatitis. Which of the following questions by the nurse is best?
a. “Is there any history of IV drug use?”
b. “Are you taking corticosteroids for any reason?”
c. “Do you use any over-the-counter (OTC) drugs?”
d. “Have you recently travelled to a foreign country?”
ANS: C
The patient’s symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms
suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as
acetaminophen. Travel to a foreign country and a history of IV drug use are risk factors for
viral hepatitis. Corticosteroid use does not cause the symptoms listed
The nurse is caring for a patient with cirrhosis who has 4+ pitting edema of the feet and legs.
Which of the following assessments is priority for the nurse to monitor?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin
ANS: D
The low oncotic pressure caused by hypoalbuminemia is a major pathophysiological factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the patient’s current symptoms
The nurse is preparing a teaching plan for a young adult patient who is diagnosed with early
alcoholic cirrhosis. Which of the following topics is most important to include in patient
teaching?
a. Need to abstain from alcohol
b. Use of vitamin B supplements
c. Maintenance of a nutritious diet
d. Treatment with lactulose
ANS: A
The disease progression can be stopped or reversed by alcohol abstinence. The other
interventions may be used when cirrhosis becomes more severe to decrease symptoms or
complications, but the priority for this patient is to stop the progression of the disease
The nurse is caring for a patient with cirrhosis who has scheduled doses of spironolactone and
furosemide and has a serum potassium level of 3.2 mmol/L. Which of the following actions
should the nurse take?
a. Give both drugs as scheduled.
b. Administer the spironolactone.
c. Administer the furosemide and withhold the spironolactone.
d. Withhold both drugs until talking with the health care provider.
ANS: B
Spironolactone is a potassium-sparing diuretic and will help to increase the patient’s
potassium level. The nurse does not need to talk with the doctor before giving the
spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient’s potassium level and should be held until the nurse talks with the health care provider
Which of the following actions should the nurse implement to evaluate the effectiveness of
treatment for a patient who has hepatic encephalopathy?
a. Request that the patient stand on one foot.
b. Ask the patient to extend both arms to the front.
c. Instruct the patient to perform the Valsalva manoeuvre.
d. Have the patient walk a few steps with the eyes closed.
ANS: B
Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic
encephalopathy. The other tests also might be done as part of the neurological assessment but
would not be diagnostic for hepatic encephalopathy.
The nurse is caring for a patient who has advanced cirrhosis and is receiving lactulose. Which of the following findings by the nurse indicates that the medication is effective?
a. The patient is alert and oriented.
b. The patient denies nausea or anorexia.
c. The patient’s bilirubin level decreases.
d. The patient has at least one stool daily
ANS: A
The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent
encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.
Which of the following nursing actions should be included in the plan of care for a patient
who is being treated for bleeding esophageal varices with balloon tamponade using a device
such as a Blakemore tube?
a. Monitor the patient for shortness of breath.
b. Encourage the patient to cough every 4 hours.
c. Deflate the gastric balloon every 8–12 hours.
d. Verify the position of the balloon every 6 hours
ANS: A
A common complication of balloon tamponade is occlusion of the airway by the balloon, so it
is important to monitor the patient’s respiratory status. In addition, if the gastric balloon
ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8–12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal
balloon may occlude the airway
The nurse is caring for a patient with severe cirrhosis who has an episode of bleeding
esophageal varices. Which of the following laboratory tests should the nurse monitor to detect possible complications of the bleeding episode?
a. Bilirubin
b. Ammonia
c. Potassium
d. Prothrombin time
ANS: B
The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an
increase in ammonia level because the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels also should be monitored, but these will not be affected by the bleeding episode
Which of the following nursing actions should be included in the plan of care for a patient
with cirrhosis who has ascites and 4+ edema of the feet and legs?
a. Weekly weight of patient.
b. Reposition the patient every 4 hours.
c. Restrict sodium intake.
d. Perform passive range-of-motion QID.
ANS: C
To maintain skin integrity, restrict sodium intake as ordered to prevent additional fluid
retention. The patient should be weighed daily, not weekly. Repositioning the patient every 4
hours will not be adequate to maintain skin integrity; patients should be repositioned at least every two hours. Passive range of motion will not take pressure off areas like the sacrum that are vulnerable to breakdown.
The nurse is caring for a patient who has had a transjugular intrahepatic portosystemic shunt
(TIPS) placement. Which of the following indicate that the procedure has been effective?
a. Lower indirect bilirubin level
b. Increase in serum albumin level
c. Decrease in episodes of variceal bleeding
d. Improvement in alertness and orientation
ANS: C
TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding
from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by
shunting procedures. TIPS will increase the risk for hepatic encephalopathy
The health care provider plans a paracentesis for a patient with ascites caused by liver cancer.
Which of the following actions should the nurse implement to prepare the patient for the
procedure?
a. Place the patient on NPO status.
b. Assist the patient to lie flat in bed.
c. Ask the patient to empty the bladder.
d. Position the patient on the right side.
ANS: C
The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler’s position and would not be able to lie
flat without compromising breathing. Since no sedation is required for paracentesis, the
patient does not need to be NPO.
The nurse is assessing a patient who had a liver transplant a week previously and obtains the
following data. Which of the following findings is most important to communicate to the
health care provider?
a. Dry lips and oral mucosa
b. Crackles at both lung bases
c. Temperature 38.2°C (100.8°F)
d. No bowel movement for 4 days
ANS: C
Infection risk is high in the first few months after liver transplant and fever is frequently the
only sign of infection. The other patient data indicate the need for further assessment or
nursing actions, but do not indicate a need for urgent action
Which of the following laboratory test results is most important for the nurse to monitor when
evaluating the effects of therapy for a patient who has acute pancreatitis?
a. Calcium
b. Bilirubin
c. Amylase
d. Potassium
ANS: C
Amylase is elevated in acute pancreatitis. Although changes in the other values may occur,
they would not be as useful in evaluating whether the prescribed therapies have been
effective.
Which of the following assessment findings in a patient with acute pancreatitis should the
nurse report urgently to the health care provider?
a. Nausea and vomiting
b. Hypotonic bowel sounds
c. Abdominal tenderness and guarding
d. Muscle twitching and finger numbness
ANS: D
Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany
unless calcium gluconate is administered. Numbness or tingling around the lips and in the
fingers is an early indicator of hypocalcemia. Although the other findings also should be
reported to the health care provider, they do not indicate complications that require rapid
action.
The nurse is obtaining a health history from a patient with acute pancreatitis. Which of the
following information should the nurse specifically assess when conducting a health history?
a. Alcohol use
b. Diabetes mellitus
c. High-protein diet
d. Cigarette smoking
ANS: A
Alcohol use is one of the most common risk factors for pancreatitis in Canada. In Canada, the
most common cause is gallbladder disease (gallstones) followed by alcoholism. Cigarette
smoking, diabetes, and high-protein diets are not risk factors.
The nurse is educating a patient with persistent pancreatitis about the prescribed pancrelipase.
At which time would the nurse recommend taking the drug?
a. Bedtime
b. With every meal
c. Upon arising in the morning
d. As soon as abdominal pain starts
ANS: B
Pancreatic enzymes are used to help with digestion of nutrients and should be taken with
every meal or snacks.
The nurse is providing discharge instructions to a patient following a laparoscopic
cholecystectomy. Which of the following patient statements indicate that the teaching has
been effective?
a. “I can remove the bandages on my incisions tomorrow and take a shower.”
b. “I can expect some yellow-green drainage from the incision for a few days.”
c. “I should plan to limit my activities and not return to work for 4–6 weeks.”
d. “I will always need to maintain a low-fat diet since I no longer have a gallbladder.”
ANS: A
After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the
incisions. Patients are discharged the same (or next) day and have few restrictions on activities
of daily living. Drainage from the incisions would be abnormal, and the patient should be
instructed to call the health care provider if this occurs. A low-fat diet may be recommended
for a few weeks after surgery but will not be a lifelong requirement.
Which of the following data obtained by the nurse during the assessment of a patient with
cirrhosis is of most concern?
a. The patient’s hands flap back and forth when the arms are extended.
b. The patient has ascites and a 2-kg weight gain from the previous day.
c. The patient’s skin has multiple spider-shaped blood vessels on the abdomen.
d. The patient complains of right upper-quadrant pain with abdominal palpation
ANS: A
The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may
occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurological status.
