liver and gallbladder disorders – Flashcards
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1. Which information about an 80-year-old man at the senior center is of most concern to the nurse? a. Decreased appetite b. Unintended weight loss c. Difficulty chewing food d. Complaints of indigestion
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ANS: B Unintentional weight loss is not a normal finding and may indicate a problem such as cancer or depression. Poor appetite, difficulty in chewing, and complaints of indigestion are common in older patients. These will need to be addressed but are not of as much concern as the weight loss.
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4. The nurse will plan to monitor a patient with an obstructed common bile duct for a. melena. b. steatorrhea. c. decreased serum cholesterol levels. d. increased serum indirect bilirubin levels.
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ANS: B A common bile duct obstruction will reduce the absorption of fat in the small intestine, leading to fatty stools. Gastrointestinal (GI) bleeding is not caused by common bile duct obstruction. Serum cholesterol levels are increased with biliary obstruction. Direct bilirubin level is increased with biliary obstruction.
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6. when nurse is obtaining a history from a patient who is admitted with jaundice, which statement is most indicative of a need for patient teaching? a. "I used cough syrup several times a day last week." b. "I take a baby aspirin every day to prevent strokes." c. "I use acetaminophen (Tylenol) every 4 hours for back pain." d. "I need to take an antacid for indigestion several times a week"
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ANS: C Chronic use of high doses of acetaminophen can be hepatotoxic and may have caused the patient's jaundice. The other patient statements require further assessment by the nurse, but do not indicate a need for patient education.
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9. when caring for a patient fowllwing a needle biopsy of the liver at a patient's bedside, the nurse should a. put pressure on the biopsy site using a sandbag. b. elevate the head of the bed to facilitate breathing. c. place the patient on the right side with the bed flat. d. check the patient's postbiopsy coagulation studies.
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ANS: C After a biopsy, the patient lies on the right side with the bed flat to splint the biopsy site. Coagulation studies are checked before the biopsy. A sandbag does not exert adequate pressure to splint the site.
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10. A 42-year-old woman is admitted to the outpatient testing area for an ultrasound of the gallbladder. Which information obtained by the nurse indicates that the ultrasound may need to be rescheduled? a. The patient took a laxative the previous evening. b. The patient had a high-fat meal the previous evening. c. The patient has a permanent gastrostomy tube in place. d. The patient ate a low-fat bagel 4 hours ago for breakfast.
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ANS: D Food intake can cause the gallbladder to contract and result in a suboptimal study. The patient should be NPO for 8 to 12 hours before the test. A high-fat meal the previous evening, laxative use, or a gastrostomy tube will not affect the results of the study.
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11. The nurse is assessing an alert and independent 78-year-old woman for malnutrition risk. The most appropriate initial question is which of the following? a. "How do you get to the store to buy your food?" b. "Can you tell me the food that you ate yesterday or past 24 hours?" c. "Do you have any difficulty in preparing or eating food?" d. "Are you taking any medications that alter your taste for food?"
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ANS: B This question is the most open-ended, and will provide the best overall information about the patient's daily intake and risk for poor nutrition. The other questions may be asked, depending on the patient's response to the first question.
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What 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
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ANS: D To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis.
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Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated? a. Hemoglobin b. Hematocrit c. Prothrombin time d. White blood cell count
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C The cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII, IX, and X. This causes the patient with cirrhosis to have bleeding tendencies. Prothrombin time measures clotting time.
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A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What 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.
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ANS: D If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves.
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If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to a. open the T-tube to air so that it will drain freely. b. position and secure the drainage bag at the abdominal level. c. make certain that the tube is tightly taped to the patient near the nipple. d. irrigate the T-tube with normal saline to ensure the free flow of bile.
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B The nurse will be responsible for the care of the T-tube if one is placed. The drainage bag for the T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated.
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After the physician has performed a liver biopsy, the nursing interventions would usually include a. allowing the patient to get up to use the bathroom if he desires. b. keeping the patient on the right side for minimum of 2 hours. c. taking vital signs every 4 hours. d. keeping the patient on the left side for minimum of 4 hours
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B Keep the patient lying on the right side for minimum of 2 hours to splint puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak.
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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. What should the nurse suspect? a. Peritonitis b. Pneumothorax c. Hemorrhage of the liver d. Pleural effusion
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ANS: B Pneumothorax is a possible complication of paracentesis. The patient's head of the bed should be raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented.
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2. A 62- year-old man reports chronic constipation. To promote bowel evacuation, the nurse will suggest that the patient attempt defecation a. in the mid-afternoon. b. after eating breakfast. c. right after getting up in the morning. d. immediately before the first daily meal.
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ANS: B The gastrocolic reflex is most active after the first daily meal. Arising in the morning, the anticipation of eating, and physical exercise do not stimulate these reflexes.
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What should 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
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ANS: D The laparoscopic cholecystectomy is less invasive and causes less pain and a quick recovery. If there are large stones present a sphincterotomy is done before the laparoscopic cholecystectomy. Persons with bleeding tendencies, pathologic conditions of the abdomen, stones in the bile duct, and extensive adhesions are not good candidates.
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The patient's cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of: a. Varices b. Diverticulosis c. Crohn's disease d. Achalasia cyst
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A Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension.
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The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should 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
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ANS: B Asterixis is the "flapping tremor" seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy.
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How does the administration of neomycin (Mycifradin) reduce the 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
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ans: c The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced.
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The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n) a. laparoscopic cholecystectomy. b. cholangiography. c. open cholecystectomy. d. choledochostomy.
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A The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder.
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The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic? 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 shoulder d. Left upper abdomen, radiating to the jaw and nec
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C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area.
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The nurse can prevent the transmission of hepatitis A by avoiding
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food or water
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Which would be most appropriate in the prevention of hepatitis B in high-risk health workers?
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Hepatitis B vaccine
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The nurse knows that which two immunosuppressants are the most effective? a.Azathioprine (Imran) and everolimus (Zortress) b.Cyclosporine (Sandimmune) and tacrolimus (Programm) c.Methotrexate (Rheumatrex) and muromonab-CD3 (Orthoclase OKT3) d.Sirolimus (Rapamune) and methylprednisolone
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ANS: B Cyclosporine and tacrolimus are the most effective immunosuppressants available does not suppress bone marrow
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A patient returned from a camping trip complains of nausea and anorexia and dark urine. What additional information would assist in diagnosing hepatitis A?
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Recent ingestion of raw fish
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When caring for an extremely jaundiced patient with cirrhosis, what should the nurse include provisions for 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
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ANS: B Jaundice causes pruritus and can lead to skin lesions and pressure ulcers.
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protein-restricted diet for advanced liver disease with hepatic encephalopathy purpose:
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"The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system."
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liver transplant - monitor postoperatively for
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infection
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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
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ANS: A The high placement of the incision of the cholecystectomy makes the patient reluctant to cough. Splinting the incision is beneficial.
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Which factors are most commonly associated with pancreatitis?
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Alcoholism and biliary tract disease
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3. When caring for a patient with a history of a total gastrectomy, the nurse will monitor for a. constipation. b. dehydration. c. elevated total serum cholesterol. d. cobalamin (vitamin B12) deficiency.
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ANS: D The patient with a total gastrectomy does not secrete intrinsic factor, which is needed for cobalamin (vitamin B12) absorption. Because the stomach absorbs only small amounts of water and nutrients, the patient is not at higher risk for dehydration, elevated cholesterol, or constipation.
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pancreatitis patient is NPO because
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"The pancreas is stimulated whenever you eat or drink and may aggravate your condition."
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The nurse explains that morphine contraindicated in the patient with pancreatitis because: a. Demerol (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.
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C A common complaint is constant, severe pain; in such cases, meperidine (Demerol) PCA is often administered. Morphine may cause spasms of the sphincter of Oddi.
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Which factors may increase a patient's risk of developing cancer of the pancreas?
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Cigarette smokers and people with diabetes mellitus
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5. The nurse receives the following information about a 51-year-old woman who is scheduled for a colonoscopy. Which information should be communicated to the health care provider before sending the patient for the procedure? a. The patient has a permanent pacemaker to prevent bradycardia. b. The patient is worried about discomfort during the examination. c. The patient has had an allergic reaction to shellfish and iodine in the past. d. The patient refused to drink the ordered polyethylene glycol (GoLYTELY).
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ANS: D If the patient has had inadequate bowel preparation, the colon cannot be visualized and the procedure should be rescheduled. Because contrast solution is not used during colonoscopy, the iodine allergy is not pertinent. A pacemaker is a contraindication to magnetic resonance imaging (MRI), but not to colonoscopy. The nurse should instruct the patient about the sedation used during the examination to decrease the patient's anxiety about discomfort.
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7. To palpate the liver during a head-to-toe physical assessment, the nurse a. places one hand on the patient's back and presses upward and inward with the other hand below the patient's right costal margin. b. places one hand on top of the other and uses the upper fingers to apply pressure and the bottom fingers to feel for the liver edge. c. presses slowly and firmly over the right costal margin with one hand and withdraws the fingers quickly after the liver edge is felt. d. places one hand under the patient's lower ribs and presses the left lower rib cage forward, palpating below the costal margin with the other hand.
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ANS: A The liver is normally not palpable below the costal margin. The nurse needs to push inward below the right costal margin while lifting the patient's back slightly with the left hand. The other methods will not allow palpation of the liver.
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8. Which finding by the nurse during abdominal auscultation indicates a need for a focused abdominal assessment? a. Loud gurgles b. High-pitched gurgles c. Absent bowel sounds d. Frequent clicking sounds
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ANS: C Absent bowel sounds are abnormal and require further assessment by the nurse. The other sounds may be heard normally.
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12. A 54-year-old man has just arrived in the recovery area after an upper endoscopy. Which information collected by the nurse is most important to communicate to the health care provider? a. The patient is very drowsy. b. The patient reports a sore throat. c. The oral temperature is 101.6° F. d. The apical pulse is 104 beats/minute.
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ANS: C A temperature elevation may indicate that a perforation has occurred. The other assessment data are normal immediately after the procedure.
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13. A 30-year-old man is being admitted to the hospital for elective knee surgery. Which assessment finding is most important to report to the health care provider? a. Tympany on percussion of the abdomen b. Liver edge 3 cm below the costal margin c. Bowel sounds of 20/minute in each quadrant d. Aortic pulsations visible in the epigastric area
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ANS: B Normally the lower border of the liver is not palpable below the ribs, so this finding suggests hepatomegaly. The other findings are within normal range for the physical assessment.
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14. A 58-year-old woman has just returned to the nursing unit after an esophagogastroduodenoscopy (EGD). Which action by unlicensed assistive personnel (UAP) requires that the registered nurse (RN) intervene? a. Offering the patient a drink of water b. Positioning the patient on the right side c. Checking the vital signs every 30 minutes d. Swabbing the patient's mouth with cold water
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ANS: A Immediately after EGD, the patient will have a decreased gag reflex and is at risk for aspiration. Assessment for return of the gag reflex should be done by the RN. The other actions by the UAP are appropriate.
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15. A patient is being scheduled for endoscopic retrograde cholangiopancreatography (ERCP) as soon as possible. Which actions from the agency policy for ERCP should the nurse take first? a. Place the patient on NPO status. b. Administer sedative medications. c. Ensure the consent form is signed. d. Teach the patient about the procedure.
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ANS: A The patient will need to be NPO for 8 hours before the ERCP is done, so the nurse's initial action should be to place the patient on NPO status. The other actions can be done after the patient is NPO.
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16. While interviewing a 30-year-old man, the nurse learns that the patient has a family history of familial adenomatous polyposis (FAP). The nurse will plan to assess the patient's knowledge about a. preventing noninfectious hepatitis. b. treating inflammatory bowel disease. c. risk for developing colorectal cancer. d. using antacids and proton pump inhibitors.
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ANS: C Familial adenomatous polyposis is a genetic condition that greatly increases the risk for colorectal cancer. Noninfectious hepatitis, use of medications that treat increased gastric pH, and inflammatory bowel disease are not related to FAP.
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17. Which area of the abdomen shown in the accompanying figure will the nurse palpate to assess for splenomegaly? a. 1 b. 2 c. 3 d. 4
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ANS: B The spleen is usually not palpable, but when palpated, it is located in left upper quadrant of abdomen.
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Which data obtained by the nurse during the assessment of a patient with cirrhosis will be 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.
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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 neurologic status.
