prepU quiz 5 (301) – Flashcards
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A nurse is providing dietary instructions to a client with a history of pancreatitis. Which instruction is correct?
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"Maintain a high-carbohydrate, low-fat diet."
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A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
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"You may have eaten contaminated restaurant food."
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A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
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anorexia, nausea, and vomiting
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When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately?
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Change in mental status
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Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency?
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Scurvy
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The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase?
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rash
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A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
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Vitamin A
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Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses?
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Ultrasonography
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The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?
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Spironolactone (Aldactone)
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Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:
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The digestion of dietary and blood proteins
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A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
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cirrhosis
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When caring for a client with acute pancreatitis, the nurse should use which comfort measure?
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Positioning the client on the side with the knees flexed
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A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority?
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Acute pain related to biliary spasms
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A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?
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The client's hepatic function is decreasing
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A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
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"How did this happen? I've been faithful my entire marriage."
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Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid?
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Paracentesis
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From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography?
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Mark, suspected of having stones in the gallbladder
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A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?
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Liver biopsy
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When reviewing the history of a client with pancreatic cancer, the nurse would identify which of the following as a possible risk factor?
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History of pancreatitis
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A nurse educator is teaching a group that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?
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The effect of liver problems on medication metabolism
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The nursing student has just reviewed material in the course textbook regarding pancreatitis. The student knows that a major symptom of pancreatitis that causes the client to seek medical care is:
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Severe abdominal pain
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Which of the following aids in digestion of fats?
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Lipase
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Which of the following would be included as a postoperative intervention for the patient undergoing a laparoscopic cholecystectomy?
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Observe color of sclera
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Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?
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ammonia
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The mode of transmission of hepatitis A virus (HAV) includes which of the following?
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Fecal-oral
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The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching?
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Decrease the amount of protein in the diet.
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The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?
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Asterixis
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A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?
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"You must have the second one in 1 month and the third in 6 months."
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A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review?
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Serum bilirubin level greater than 1.0 mg/dL
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A patient is diagnosed with mild acute pancreatitis. What does the nurse understand is characteristic of this disorder?
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Edema and inflammation
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A client is admitted to the health care facility with abdominal pain, a low-grade fever, abdominal distention, and weight loss. The physician diagnoses acute pancreatitis. What is the primary goal of nursing care for this client?
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Relieving abdominal pain
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A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note:
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yellow sclerae
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Which type of jaundice is the result of increased destruction of red blood cells?
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Hemolytic
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The most common cause of esophageal varices includes which of the following?
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Portal hypertension
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Which of the following indicates an overdose of lactulose?
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Watery diarrhea
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Which of the following would be the least important assessment in a patient diagnosed with
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Foul-smelling breath
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When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?
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Measure abdominal girth according to a set routine.
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A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?
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Abstain from drinking alcohol
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Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?
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Spironolactone (Aldactone)
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A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
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Hepatitis C increases a person's risk for liver cancer
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A client is admitted to the healthcare facility suspected of having acute pancreatitis and undergoes laboratory testing. Which of the following would the nurse expect to find?
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Elevated urine amylase levels
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Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis?
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Severe, radiating abdominal pain
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Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis?
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Such clients cannot tolerate high-glucose concentration
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When caring for a client with cirrhosis, which of the following should a nurse notify immediately? Choose all correct options.
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- Change in mental status - Signs of GI bleeding
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A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the:
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Gallbladder
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Which of the following is the most effective strategy to prevent hepatitis B infection?
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Vaccine
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During chronic pancreatitis, the patient's stool may become frothy and foul-smelling. This would be documented as which of the following?
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Steatorrhea
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A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by:
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Selective vasodilation of the portal system
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An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:
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Acetaminophen
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The severity of pancreatitis is directly proportional to the number of indicators present. A patient with five to six signs indicative of pancreatitis would have a __________% chance of mortality.
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40%
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A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?
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Loss of 2.2 lb (1 kg) in 24 hours
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The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
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Purpura and petechiae
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A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?
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Administering morphine I.V. as ordered
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Which type of jaundice seen in adults is the result of increased destruction of red blood cells?
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Hemolytic
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Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
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Hypotension
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The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?
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"How often do you drink alcohol?"
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A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate?
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liver disorder
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A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?
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Hepatic encephalopathy
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A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.
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- Enlarged liver size - Ascites - Hemorrhoids
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A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?
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The physician will use an ultrasound guided paracentesis
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The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient?
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Respiratory assessment related to increased thoracic pressure
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A nurse should monitor blood glucose levels for a patient diagnosed with hyperinsulinism. What blood value does the nurse recognize as inadequate to sustain normal brain function?
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30 mg/dL
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The nurse reviews the laboratory values for a patient being evaluated for alcoholic cirrhosis. The nurse is aware that a diagnostic indicator present in greater than 70% of cases is which of the following?
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AST/ALT ratio >3.0
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When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
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Irritability and drowsiness
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Which of the following would be most appropriate for a client who is experiencing biliary colic?
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Ensure that the client rests.
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Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes?
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increased appetite and thirst
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A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?
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vitamin K
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Which of the following conditions is most likely to involve a nursing diagnosis of fluid volume deficit?
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Pancreatitis
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The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:
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serum lipase
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A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply.
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- Acetaminophen - Ketoconazole - Valproic acid
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Gynecomastia is a common side effect of which of the following diuretics?
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Spironolactone (Aldactone)
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Which of the following is the imaging modality of choice for assessment of both acute and chronic pancreatitis?
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CT
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A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?
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Octreotide (Sandostatin)
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A patient with acute pancreatitis puts the call bell on to tell the nurse about an increase in pain. The nurse observes the patient guarding; the abdomen is boardlike and no bowel sounds are detected. What is the major concern for this patient?
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The patient has developed peritonitis.
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A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?
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Stage 2
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A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
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subnormal serum glucose and elevated serum ammonia levels
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A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions?
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Hepatic encephalopathy
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A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?
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Reposition the client every 2 hours
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Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?
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Asterixis
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Several clinical manifestations are associated with a tumor of the head of the pancreas. Choose all that apply.
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- Clay-colored stools - Dark urine - Jaundice
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Which of the following is commonly associated with acute episodes of pancreatitis?
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Long-term use of alcohol
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The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet?
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A pear
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The nurse is caring for a patient with acute pancreatitis. The patient has an order for an anticholinergic medication. The nurse explains that the patient will be receiving that medication for what reason?
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To reduce gastric and pancreatic secretions
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During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in:
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Vitamin K
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The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
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Alpha-interferon
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A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention?
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Discuss meals that include low-fat high-carbohydrate content
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Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?
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Alcoholic cirrhosis
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Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?
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7 months
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A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply.
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- Instructing the client to remove salty and salted foods from the diet - Administering prescribed spironolactone (Aldactone) - Assisting with placement of a transjugular intrahepatic portosystemic shunt
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Which of the following diagnostic studies definitely confirms the presence of ascites?
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Ultrasound of liver and abdomen
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Which type of deficiency results in macrocytic anemia?
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Folic acid
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Most pancreatic cancers develop in which area of the pancreas?
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Head
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A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?
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Transjugular intrahepatic portosystemic shunting (TIPS)
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A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
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wash her hands after touching the client
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A nursing student has learned about many collaborative interventions to achieve pain relief for clients with acute pancreatitis. Which of the following are appropriate? Choose all that apply.
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- Encourage bed rest to decrease the client's metabolic rate. - Teach the client about the correlation between alcohol intake and pain. - Withhold oral feedings to limit the release of secretin.
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A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?
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Vasopressin (Pitressin)
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A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing?
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Vitamin K deficiency
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A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?
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Ineffective breathing pattern
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Which of the following medications are used to decrease portal pressure, halting bleeding of esophageal varices?
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Vasopressin (Pitressin)
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A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?
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excrete bile
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A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.
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2.5
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Pain associated with pancreatitis frequently occurs within which time frame?
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24 to 48 hours
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A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for?
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Ultrasonography
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When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.)
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- Encouraging bed rest to decrease the metabolic rate - Withholding oral feedings to limit the release of secretin - Administering parenteral opioid analgesics as ordered
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A nurse is responsible for monitoring the diet of a patient with hepatic encephalopathy. The nurse knows that the 185-pound male should have a daily protein intake between __________.
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42 and 126 grams
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Part of preoperative patient preparation for liver transplantation is informing the patient about postoperative complications. The most severe complication is:
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Primary graft nonfunction
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What is the most appropriate nursing diagnosis for the client with acute pancreatitis?
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Deficient fluid volume
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A client diagnosed with acute pancreatitis is being transferred to another facility. The nurse caring for the client completes the transfer summary, which includes information about the client's drinking history and other assessment findings. Which assessment findings confirm his diagnosis?
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Recent weight loss and temperature elevation
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Which of the following is the major cause of morbidity and mortality in patients with acute pancreatitis?
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Pancreatic necrosis
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The nurse admits a woman reporting severe right upper quadrant pain after eating Christmas dinner. The nurse suspects gallbladder disease. Statistics show that incidence of gallbladder disease is greater for women who are
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- Multiparous - Obese - Older than 40 years
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Chronic pancreatitis, commonly described as autodigestion of the pancreas, is often not detected until what percentage of the exocrine and endocrine tissue is destroyed?
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80% to 90%
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While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.
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- Jaundice - Petechiae - Ecchymoses
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Which of the following are risk factors for pancreatic cancer? Select all that apply.
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- Tobacco - Obesity - Nonhereditary chronic pancreatitis - Diabetes mellitus
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The nurse is admitting a patient to the intensive care unit with a diagnosis of acute pancreatitis. What does the nurse expect was the reason the patient came to the hospital?
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Severe abdominal pain
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The patient admitted with acute pancreatitis has passed the acute stage and is now able to tolerate solid foods. What type of diet will increase caloric intake without stimulating pancreatic enzymes beyond the ability of the pancreas to respond?
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High-carbohydrate, low-protein, low-fat diet
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In actively bleeding patients with esophageal varices, the initial drug of therapy is usually:
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Pitressin
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A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:
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level of consciousness (LOC)
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A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
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Albumin
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A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?
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Reserving an antecubital site for a peripherally inserted central catheter (PICC)
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A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy?
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Low platelet count
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A 67-year-old client is returning for a follow-up appointment to the primary care group where you practice nursing. At his last appointment, he received the diagnosis of portal hypertension and the physician instituted interventions to begin treatment of this condition. What is the primary aim of portal hypertension treatment? Choose all correct options.
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- Reduce fluid accumulation - Reduce venous pressure
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A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply.
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- Infection at school - Suboptimal sanitary habits - Consumption of sewage-contaminated water or shellfish - Sexual activity
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A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?
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Until the gag reflex returns
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A patient is receiving pharmacologic therapy with ursodeoxycholic acid or chenodeoxy-cholic acid for treatment of small gallstones. The patient asks the nurse how long the therapy will take to dissolve the stones. What is the best answer the nurse can give?
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6 to 12 months
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Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of:
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Two 6 oz glasses of wine
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A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's:
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Electrocardiogram
