Test 5

Question 1

1. Cholecystitis client education and assessment

Answer 1

Assessment Finding
 RUQ pain
 Digestion problems from reduced or absent bile
 If biliary obstruction present will show dark or amber urine
 If biliary obstruction present will show fatty stools

Nursing Management
 Encourage low-fat foods
 Monitor for jaundice: dark skin look at palms of hands/feet; sclera and hard palate of mouth

Question 2

2. Hepatitis risk factors

Answer 2

 History of illicit IV drug use
 Occupational exposure through sharps injuries (needlesticks)
 Perinatal exposure (child born to woman who has hepatitis)
 Blood transfusion
 Organ transplant
 Exposure to contaminated equipment that penetrates the skin (includes tattoos and body piercings)
 Sexual contact with a person who is infected
 Hemodialysis
 Impaired immune response

Question 3

2. Hepatitis prevention (pg. 632)

Answer 3

 Receive hepatitis A virus (HAV)and B (HBV) vaccine, especially when considered at high risk (health care workers, day care workers, food preparers, foreign travel).
 Obtain immune globulin (IG) injection if exposed (in household or sexual contacts with infected individuals) to hepatitis without previous immunization.
 Observe standard precautions. Wear gloves if hands come into contact with body fluids; wear gown and face shield if body fluids may be splashed.
 Require child care staff to wear gloves during diaper changes and to perform adequate hand washing.
 Perform conscientious hand washing, even after removing gloves.
 Screen food handlers.
 Avoid eating from public salad bars and buffets that do not have sneeze guards or other hygienic devices and practices to prevent food contamination.
 Use liquid soap dispensers and hand dryers in public restrooms rather than bar soap and cloth towels.
 Avoid placing fingers and handheld objects in mouth.
 Do not share cigarettes, eating utensils, or beverage containers.
 Avoid eating raw seafood or seafood harvested from possibly polluted water.
 Use a pocket mask when giving pulmonary resuscitation.
 Drink bottled water in developing countries. Avoid ice unless it was made from bottled water.

 Do not recap needles.
 Dispose of needles and other sharp objects in a puncture-resistant container.
 Use a condom when engaging in sexual intercourse.
 Do not share razors, fingernail tools, toothbrushes, or any personal care item that may come into contact with blood or body fluids.
 If contemplating surgery, investigate the possibility of donating and storing your own blood for later use.
 Wear a mouth shield when giving mouth-to-mouth resuscitation.

Question 4

3. Ascites nursing considerations and medical management

Answer 4

 Hepatorenal syndrome; serum protein into peritoneal cavity
 Abdominal paracentesis: diet-sodium restriction
 Drug therapy- Aldactone/hold if sodium too low

Question 5

4. Cirrhosis manifestations

Answer 5

-Chronic fatigue
-Anorexia
-Dyspepsia
-Nausea
-Clay-colored stools
-Diarrhea
-Constipation
-Tea-colored urine
-Weight loss
-Abdominal discomfort
-Ascites
-Hemorrhoids
-Shortness of breath
-Nosebleeds
-Enlarged liver
-Gynecomastia in men
-Spider angioma

Question 6

4. Cirrhosis nursing interventions

Answer 6

 Monitor vital signs, daily weight, intake, output, and abdominal girth every 8 hours; small meals
 Elevate hob for relief of ascites
 Client response to drug therapy: change in mental status, signs of GI bleed
 Implement fall precautions
 Encourage low sodium diet
 Bleeding precautions

Question 7

5. Bile duct obstruction manifestations

Answer 7

 Dark or amber urine
 Show fatty stools

Question 8

6. Acute pancreatitis nursing interventions

Answer 8

 Monitor vitals every 1-2 hours
 Perform the prescribed treatment measures: NG tube, IV fluids, NPO
 Bed rest-to minimize metabolic activity
 Monitor urine output hourly
 Encourage deep breathing/coughing every hour

Question 9

6. Acute pancreatitis risk factors

Answer 9

 Gallstones
 Excess alcohol use /Tobacco
 Trauma
 Obesity
 Diabetes

Question 10

7. Chronic pancreatitis client education

Answer 10

 Increase calorie intake
 Increase protein
 Low-fat diet
 No alcohol
 Monitor labs closely

Question 11

8. GI bleed manifestations

Answer 11

 Black tarry stools
 Ground emesis
 Hypotension
 Tachycardia
 Pale, clammy, sweating
 Abdominal pain

Question 12

9. Viral hepatitis nursing actions

Answer 12

 Symptomatic treatment:
- bed rest
- IV fluid
- vitamins
- antiemetics
 Liver transplantation, immunosuppressives

Question 13

9. Viral hepatitis types

Answer 13

 Hepatitis A: oral–fecal route/uncooked foods
 Hepatitis B: blood or bodily fluids
 Hepatitis C: usually blood to blood/tattoos

Question 14

10. Esophageal Varices

Answer 14

 Result of portal hypertension
 Esophageal bleeding: treatment BUN and bilirubin will be elevated if client ingesting blood
 Sclerotherapy, variceal band ligation, Sengstaken–Blakemore tube
 IV fluids; blood products