Lewis Chapter 46 - Liver, Pancreas, Biliary Tract TEST BANK

Question 1

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)

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

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.

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

ANS: A
Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not
associated with this drug therapy.

Question 6

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

Answer 6

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.

Question 7

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?”

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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.

Answer 10

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

Question 11

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.

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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.

Answer 15

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.

Question 16

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

Answer 16

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

Question 17

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.

Answer 17

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.

Question 18

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

Answer 18

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

Question 19

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

Answer 19

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.

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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.

Question 22

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

Answer 22

ANS: B
Pancreatic enzymes are used to help with digestion of nutrients and should be taken with
every meal or snacks.

Question 23

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.”

Answer 23

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.

Question 24

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

Answer 24

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.

Question 25

The nurse is caring for a patient with cirrhosis and esophageal varices who has a new
prescription for propranolol. Which of the following assessment findings is the best indicator that the medication has been effective?

a. The apical pulse rate is 68 beats/minute.
b. Stools test negative for occult blood.
c. The patient denies complaints of chest pain.
d. Blood pressure is less than 140/90 mm Hg.

Answer 25

ANS: B
Since the purpose of -blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for
propranolol is the lack of blood in the stools. Although propranolol is used to treat
hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

Question 26

The nurse is admitting a patient with acute bleeding from esophageal varices who asks the
nurse the purpose for the ordered pantoprazole. Which of the following responses by the nurse is best?

a. The medication will reduce the risk for aspiration.
b. The medication will decrease nausea and anorexia.
c. The medication will inhibit the development of gastric ulcers.
d. The medication will prevent irritation to the esophageal varices.

Answer 26

ANS: D
Pantoprazole is a proton pump inhibitor. Supportive measures during an acute variceal bleed include administration of fresh-frozen plasma and packed red blood cells, vitamin K, and proton pump inhibitors. Although ranitidine does decrease the risk for peptic ulcers, reduce
nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2
receptor blockade in this patient.

Question 27

The nurse is taking the BP of a patient with severe acute pancreatitis and notices carpal spasm of the patient’s hand. Which of the following actions should the nurse take next?

a. Ask the patient about any arm pain.
b. Retake the patient blood pressure.
c. Check the calcium level on the chart.
d. Notify the health care provider immediately

Answer 27

ANS: C
The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data
indicate a positive Trousseau’s sign. The health care provider should be notified after the
nurse checks the patient’s calcium level. There is no indication that the patient needs to have
the BP rechecked or that there is any arm pain.

Question 28

The nurse is caring for a patient with acute pancreatitis who has a nasogastric (NG) tube to
suction and is NPO. Which of the following information obtained by the nurse indicates that these therapies have been effective?

a. Bowel sounds are present.
b. Grey Turner sign resolves.
c. Electrolyte levels are normal.
d. Abdominal pain is decreased.

Answer 28

ANS: D
NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas
and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the
presence of bowel sounds does not indicate that treatment with NG suction and NPO status
have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced
by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be
appropriate to wait for this to occur to determine whether treatment was effective.

Question 29

The nurse is caring for a patient with acute pancreatitis. Which of the following findings is of most concern?

a. Absent bowel sounds
b. Abdominal tenderness
c. Left upper quadrant pain
d. Palpable abdominal mass

Answer 29

ANS: D
A palpable abdominal mass in the epigastric area may indicate the presence of a pancreatic
pseudocyst, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

Question 30

Which of the following actions should be included in the plan of care for a patient who has recently been diagnosed with asymptomatic non-alcoholic fatty liver disease (NAFLD)?

a. Teach symptoms of variceal bleeding.
b. Discuss the need to increase caloric intake.
c. Review the patient’s current medication list.
d. Draw blood for hepatitis serology testing.

Answer 30

ANS: C
Some medications can increase the risk for NAFLD and these should be eliminated. NAFLD
is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would
not be a concern in a patient with asymptomatic NAFLD.

Question 31

The nurse is caring for a patient with persistent hepatitis C infection who has these
medications prescribed. Which of the following medications require further discussion with
the health care provider prior to administration?

a. Ribavirin 600 mg PO bid
b. Pegylated -interferon SUBCUT daily
c. Diphenhydramine 25 mg PO every 4 hours PRN itching
d. Dimenhydrinate 50 mg PO every 6 hours PRN nausea

Answer 31

ANS: B
Pegylated -interferon is administered once weekly not daily. The other medications are
appropriate for a patient with chronic hepatitis C infection.

Question 32

During change-of-shift report, the nurse learns about the following four patients. Which
patient requires the most rapid assessment?

a. 50-year-old with persistent pancreatitis who has gnawing abdominal pain
b. 48-year-old who has compensated cirrhosis and is complaining of anorexia
c. 45-year-old with cirrhosis and severe ascites who has an oral temperature of
38.8°C (101.8°F)
d. 56-year-old who is recovering from a laparoscopic cholecystectomy and has severe
shoulder pain

Answer 32

ANS: C
This patient’s history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patient are consistent with their diagnoses and do not indicate complications are occurring.

Question 33

The nurse is admitting a patient who is homeless and has viral hepatitis with symptoms of severe anorexia and fatigue. Which of the following patient goals should have the highest
priority when the nurse is developing the plan of care?

a. Increase activity level.
b. Maintain adequate nutrition.
c. Establish a stable home environment.
d. Identify the source of exposure to hepatitis.

Answer 33

ANS: B
The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the
infection would be appropriate activities, but they do not have as high a priority as ensuring
adequate nutrition. Although the patient’s activity level will be gradually increased, rest is
indicated during the acute phase of hepatitis.

Question 34

The nurse is admitting a patient to the emergency department with pancreatitis who has been vomiting blood. Which of the following actions should the nurse take first?

a. Insert a large-gauge IV catheter.
b. Draw blood for coagulation studies.
c. Check BP, heart rate, and respirations.
d. Place the patient in the supine position

Answer 34

ANS: C
The nurse’s first action should be to determine the patient’s hemodynamic status by assessing
vital signs. Drawing blood for coagulation studies and inserting an IV catheter also are
appropriate. However, the vital signs may indicate the need for more urgent actions. Since
aspiration is a concern for this patient, the nurse will need to assess the patient’s vital signs
and neurological status before placing the patient in the supine position.

Question 35

The nurse is planning care for a patient with acute severe pancreatitis. Which of the following patient outcomes is priority?

a. Expressing satisfaction with pain control
b. Developing no ongoing pancreatic problems
c. Maintaining normal respiratory function
d. Having adequate fluid and electrolyte balance

Answer 35

ANS: C
Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of
adequate respiratory function is the priority goal. The other outcomes also would be
appropriate for the patient.

Question 36

Which of the following nursing actions is a priority when the nurse is caring for a patient with pancreatic cancer?

a. Offer high-calorie, high-protein dietary choices.
b. Offer psychological support for anxiety or depression.
c. Educate about the need to avoid scratching pruritic areas.
d. Administer prescribed opioids to relieve pain as needed.

Answer 36

ANS: D
Effective pain management will be necessary in order for the patient to improve nutrition, be
receptive to education, or manage anxiety or depression.

Question 37

The nurse is admitting a patient with acute cholecystitis. Which of the following findings is
most important for the nurse to report to the health care provider?

a. The patient’s urine is bright yellow.
b. The patient’s stools are clay coloured.
c. The patient complains of persistent heartburn.
d. The patient has an increase in pain after eating.

Answer 37

ANS: B
The clay-coloured stools indicate biliary obstruction, which requires rapid intervention to
resolve. The other data are not unusual for a patient with this diagnosis, although the nurse
also would report the other assessment information to the health care provider

Question 38

The nurse is caring for a patient following an incisional cholecystectomy for cholelithiasis.
Which of the following actions is priority for the nurse to implement?

a. Patient education about low-fat food choices.
b. Perform leg exercises hourly while awake.
c. Ambulate the evening of the operative day.
d. Turn, cough, and deep breathe every 2 hours.

Answer 38

ANS: D
Postoperative nursing care for incisional cholecystectomy is the same as general postoperative nursing care. Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions also are important to implement but are not as high a priority as ensuring adequate ventilation.

Question 39

Which of the following diagnoses is often a misdiagnosis for older-adult patients with liver
disease?

a. Fulminate hepatic failure
b. Cirrhosis
c. Dementia
d. Epstein-Barr virus

Answer 39

ANS: C

In older persons with liver disease, hepatic encephalopathy may be misdiagnosed as dementia