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A patient with possible viral hepatitis reports recent intake of raw shellfish. Which type of hepatitis should the nurse consider the patient is experiencing?
a.
Hepatitis A virus
b.
Hepatitis B virus
c.
Hepatitis C virus
d.
Hepatitis D virus
- ANS: A
- Hepatitis A is spread by oral–fecal contamination of water, shellfish, eating utensils, or equipment. B. C. D. These types of hepatitis are spread through blood and body fluids.
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The employee health nurse is preparing vaccines to administer to patient care staff to permanently protect them from hepatitis. For which types of hepatitis does the nurse have vaccines?
a.
HAV
b.
HBV
c.
HCV
d.
Both HAV and HBV
- ANS: D
- Vaccines against HBV are available and provide permanent, active immunity to HBV. A vaccine for HAV has also been developed. C. A vaccine for hepatitis C does not exist.
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A patient with hepatic encephalopathy is required to consume 50 grams of protein each day. Which item should be provided to the patient for a mid-afternoon snack?
a.
Apple
b.
Crackers
c.
Peanut butter
d.
Whole grain bread
- ANS: C
- Only in cases of severe protein intolerance should protein be restricted and then for as short a time as possible with supplemental branched-chain amino acids administered until normal protein intake is resumed. Of the food choices, peanut butter has the most protein. A. B. D. An apple is protein free. Crackers and whole grain bread are carbohydrates.
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The nurse is caring for a patient after a liver transplant. Which symptom should the nurse report immediately as a possible indication of rejection of the liver?
a.
Pulse rate of 80 beats per minute
b.
Prothrombin time (PT) of 14 seconds
c.
Decreased alanine aminotransferase (ALT)
d.
A temperature greater than 101°F (38.3°C)
- ANS: D
- A fever is associated with immune system activity and possible rejection. C. Decreased ALT is desirable in liver disease. B. Normal PT is 8.8 to 11.6 seconds, so 14 seconds is near normal. A. Pulse of 80 beats/min is normal.
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The nurse is reinforcing teaching provided to a patient with chronic liver failure. What should the patient be instructed to help prevent injury?
a.
“Drink plenty of clear fluids.”
b.
“Brush your teeth with a soft-bristled brush.”
c.
“Be sure to get 20 minutes of exercise daily.”
d.
“Take an aspirin a day to prevent heart complications.”
- ANS: B
- Patients with chronic liver failure often have deficient clotting factors, and a firm toothbrush can cause bleeding gums. A. C. Fluids and exercise will not prevent injury and may be contraindicated. D. Aspirin has antiplatelet properties and can increase bleeding risk.
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A patient with liver failure and esophageal varices is prescribed to receive vasopressin. What should the nurse realize is the purpose for this medication?
a.
To promote portal circulation
b.
To reduce ammonia buildup and encephalopathy
c.
To constrict vessels causing bleeding in esophageal varices
d.
To maintain blood pressure in a patient with hypotension related to bleeding varices
- ANS: C
- Vasopressin is a vasoconstrictor and will reduce bleeding in varices. A. It reduces, and does not promote, circulation. D. It can maintain blood pressure, but that is not the primary reason it is given to patients with varices. B. It does not affect ammonia levels.
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The nurse is caring for a patient with chronic liver failure. Which laboratory value should the nurse expect as a late sign of liver failure?
a.
Low serum albumin
b.
Low serum bilirubin
c.
Low serum ammonia
d.
Low serum aspartate aminotransferase (AST)
- ANS: A
- Protein synthesis (albumin) is impaired in liver disease. B. C. D. Ammonia, bilirubin, and AST are all elevated in liver disease.
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The nurse is caring for a patient with hepatic encephalopathy. Which prescribed medication should the nurse question before providing to this patient?
a.
Vitamin K
b.
Neomycin sulfate
c.
Diazepam (Valium)
d.
Lactulose (Cephulac)
- ANS: C
- The nurse should question medications such as sedatives, opioids, and tranquilizers because these can precipitate hepatic encephalopathy. Valium is a sedative. A. B. D. These medications are all used in the treatment of liver disorders.
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The nurse is caring for a patient with esophageal varices. Which symptom should alert the nurse to possible bleeding?
a.
Asterixis
b.
Dark amber urine
c.
Hard formed stool
d.
Blood-streaked emesis
- ANS: D
- Blood from varices may streak emesis or may be more frank. B. C. Constipation and dark urine may accompany liver disease but are not signs of bleeding. A. Asterixis is a sign of encephalopathy.
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The nurse is reinforcing teaching provided to a patient with esophageal varices. Which activity should the patient be taught to avoid?
a.
Lifting heavy objects
b.
Participating in aerobic activities
c.
Eating concentrated carbohydrates
d.
Rising suddenly from a reclining position
- ANS: A
- The straining associated with lifting can cause the thin-walled varices to tear, causing severe bleeding. C. Eating carbohydrates may be recommended if the patient also has encephalopathy. B. D. Aerobic activities and rising from a reclining position will not increase pressure in the varices.
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The nurse is collecting data from a patient with liver failure to detect encephalopathy. What instructions should the nurse give to the patient to collect this data?
a.
“Stand with your eyes closed.”
b.
“Hold out your arms and hands.”
c.
“Kneel on your hands and knees.”
d.
“Bear down as though you were having a bowel movement.”
- ANS: B
- Neuromuscular function is monitored by asking the patient to hold his or her arms out straight in front and steady. If asterixis, or liver flap, is present, the patient’s hands will unwillingly dip and return to the horizontal position in a flapping motion. A. C. D. These actions do not check for encephalopathy.
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The nurse is collecting data from a patient with acute pancreatitis. Which symptoms should the nurse anticipate?
a.
Low abdominal pain, bradycardia, and confusion
b.
Shortness of breath, hypotension, and restlessness
c.
Fever, tachycardia, right upper quadrant pain, and jaundice
d.
Abdominal distention, respiratory distress, and mid-epigastric pain
- ANS: D
- Patients with acute pancreatitis are very ill, with dull abdominal pain, guarding, a rigid abdomen, hypotension or shock, and respiratory distress from accumulation of fluid in the retroperitoneal space. The abdominal pain is generally located in the midline just below the sternum, with radiation to the spine, back, and flank. A. B. C. These manifestations are not associated with pancreatitis.
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The nurse is collecting data for a patient with acute pancreatitis. Which laboratory test result should the nurse expect?
a.
Decreased serum lipase
b.
Elevated serum amylase
c.
Elevated serum albumin
d.
Decreased serum ammonia
- ANS: B
- In acute pancreatitis, serum amylase (normal: 80 to 180 U/dL) rises quickly and then returns to normal in 3- 5 days. A. In acute pancreatitis. serum lipase (normal: 0 to 160 U/L) may be elevated 5 to 40 times normal. C. Albumin will be low. D. Ammonia is monitored in liver disease.
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The nurse is reinforcing teaching provided to a patient with a history of acute pancreatitis. Which item should the patient be instructed to avoid?
a.
High-sodium foods
b.
Alcoholic beverages
c.
Carbonated beverages
d.
Foods with preservatives
- ANS: B
- The major cause of chronic pancreatitis in men is excessive alcohol ingestion, which causes repeated attacks of acute pancreatitis. Advise patients with acute pancreatitis from excessive alcohol ingestion that abstinence could prevent recurrence of the pancreatitis and prevent the possibility of chronic pancreatitis. A. C. D. Carbonated beverages, sodium, and preservatives do not trigger pancreatitis.
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The nurse is caring for a patient with acute pancreatitis who is vomiting. What should the nurse frequently assess in this patient?
a.
Skin color and pain
b.
Vital signs and urinary output
c.
Bowel sounds and body weight
d.
Ability to move lower extremities
- ANS: B
- Complications of pancreatitis include cardiovascular, pulmonary, and renal failure. Monitoring vital signs and urinary output helps identify for the onset of these life-threatening complications. D. Lower extremity movement is not affected. A. Pain is expected and should be monitored, but it is not life threatening. C. Bowel sounds and body weight are also important, but changes are not as immediately life threatening as cardiovascular, pulmonary, and renal failure.
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A patient with acute pancreatitis is experiencing severe pain. What position should the nurse encourage the patient to assume?
a.
Semi-Fowler’s position
b.
Prone with a pillow under the abdomen
c.
Supine with legs elevated and head on a small pillow
d.
Sitting in a chair leaning forward with a pillow for back support
- ANS: D
- An upright position keeps abdominal organs from pressing against the inflamed pancreas. A. B. C. These positions increase the risk of organs pressing against the pancreas.
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The nurse is reinforcing discharge teaching about recurrence of pancreatitis to a patient with chronic pancreatitis. What information should the nurse include?
a.
Periodic epigastric pain is a normal occurrence.
b.
Report anorexia, hyperglycemia, or weight loss.
c.
Recurrence of pancreatitis is unlikely to happen.
d.
Report jaundice, flatulence, or amber-colored urine.
- ANS: B
- Symptoms of chronic pancreatitis include epigastric or left upper quadrant (LUQ) pain, weight loss, and anorexia. Malabsorption, fat intolerance, and diabetes mellitus occur late in the disease. D. Jaundice is a sign of liver and gallbladder disease. C. Recurrence is likely. A. Pain is not normal—it is a warning sign.
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The nurse is caring for a patient after surgery to drain a pancreatic abscess. Which action should the nurse take to monitor for complications?
a.
Document output.
b.
Monitor blood glucose.
c.
Monitor for hyperproteinemia.
d.
Review serum potassium levels.
- ANS: B
- Hyperglycemia will occur if the insulin-producing islets of Langerhans are affected by the surgery. A. Intake and output may be recorded, but they do not directly relate to complications from surgery. C. D. Hyperkalemia and hyperproteinemia are not directly related to pancreatic surgery, although electrolyte imbalances may occur with many surgeries. Low protein level is more likely than high.
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The nurse is reinforcing teaching provided to a patient with gallstones. What substance should the nurse instruct that makes up most gallstones?
a.
Sodium
b.
Calcium
c.
Cholesterol
d.
Phosphorus
- ANS: C
- Cholelithiasis is the presence of stones in the gallbladder. These stones are most often composed primarily of cholesterol. B. Pigment stones appear to be composed of calcium bilirubinate, which occurs when free bilirubin combines with calcium; however, this is not the most frequent substance. A. D. Sodium and phosphorus are not primary components of gallstones.
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A patient with gallstones asks why jaundice has developed. What should the nurse explain as the most likely cause for the patient’s jaundice?
a.
Hepatitis
b.
Cirrhosis
c.
Hemolysis
d.
Bile duct obstruction
- ANS: D
- Jaundice occurs when the bile duct is obstructed and free flow of bile into the intestine is interrupted. A. B. C. Hemolysis, cirrhosis, and hepatitis can all cause jaundice but are not the most common cause in patients with gallbladder disease.
-
A patient with cholelithiasis is having clay-colored stools. What should the nurse realize as the most common cause of clay-colored stools?
a.
Retrograde bile flow into the liver
b.
Accumulation of bile salts in the skin
c.
Cirrhosis from chronic liver irritation
d.
A gallstone lodged in the common bile duct
- ANS: D
- Obstruction of bile flow (e.g., from a stone in the duct) may result in stools that are clay-colored, because bile is not present in the stool to give it color. A. B. C. Other liver and gallbladder disorders can also cause clay-colored stools, but in a patient with cholelithiasis, a stone lodged in the duct would be the most common.
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The nurse is contributing to the teaching plan for a patient recovering from a cholecystectomy. Which dietary modification should the nurse recommend for the first few weeks after surgery?
a.
Decrease intake of fresh fruits and vegetables to minimize pressure on the small intestine.
b.
Consume at least four servings of meat, cheese, and peanut butter daily to boost protein intake and aid healing.
c.
Distribute fat intake in small portions throughout the day to prevent excessive fat in the intestine at any one time.
d.
Take pancreatic enzymes with meals to replace enzymes that would normally have been secreted before the cholecystectomy.
- ANS: C
- Patients are put on high-protein, low-fat diets. Fat should be slowly reintroduced into the diet. Once the duodenum becomes accustomed to constant infusion of bile, the patient’s individual tolerance for fat becomes the only restriction for diet. A. Fruits and vegetables are not contraindicated. B. Meat, cheese, and peanut butter are high in fat. D. Pancreatic enzymes are not necessary—the pancreas has not been removed.
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A patient with cholecystitis is prescribed promethazine (Phenergan) for nausea. Which adverse effect of the medication should the nurse instruct the patient to report?
a.
Diarrhea
b.
Insomnia
c.
Dry mouth
d.
Urine retention
- ANS: D
- Urine retention can be life threatening and should be reported immediately. B. C. Dry mouth and insomnia are not emergencies. A. Constipation, not diarrhea, is more likely to occur.
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The nurse is caring for a patient with chronic liver failure. Which medication order should the nurse question?
a.
Lactulose
b.
Neomycin
c.
Multivitamins
d.
Acetaminophen
- ANS: D
- Acetaminophen (Tylenol) overdose is the most common cause of ALF. Acetaminophen should not exceed 3000 mg in a 24 hour period. A. B. C. Multivitamins, Lactulose, and Neomycin are all used to treat symptoms of liver disease.
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A patient recovering from a cholecystectomy earlier in the day is reluctant to deep breathe and cough. What intervention should the nurse use to assist the patient to cough and breathe?
a.
Remind the patient to deep breathe and cough every hour.
b.
Teach the patient to use relaxation and distraction techniques.
c.
Medicate the patient for pain, and assist to splint the abdomen.
d.
Reinforce the importance of the deep breathing and coughing activities.
- ANS: C
- Patients are usually reluctant to cough and deep breathe after cholecystectomy because the high incision makes coughing painful. Medicating for pain and splinting the incision allow the patient to cough without excessive pain. A. D. Simply reminding and teaching do not solve the problem. B. Relaxation is helpful but should be in addition to, not instead of, analgesia.
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The nurse is identifying care to delegate to unlicensed assistive personnel. Which actions could be safely delegated in the care of a patient with fulminant liver failure?
a.
Evaluating the patient’s mental status
b.
Assisting with bathing and positioning
c.
Assessing the stool and urine for blood
d.
Monitoring laboratory studies for abnormal values
- ANS: B
- Unlicensed assistive personnel can safely bathe and position a patient in liver failure. A. C. D. Assessment, monitoring, and evaluating are nursing functions and are beyond the scope of practice for unlicensed assistive personnel.
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A patient with biliary colic is prescribed an anticholinergic medication to help treat biliary colic. For which medical diagnosis should the nurse question the administration of this medication?
a.
Asthma
b.
Psoriasis
c.
Diabetes mellitus
d.
Prostatic hypertrophy
- ANS: D
- Anticholinergic medications are contraindicated in patients with prostatic hypertrophy. A. B. C. Anticholinergic medications are not contraindicated in diabetes, asthma, or psoriasis.
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The nurse is providing a patient with cholelithiasis the medication ursodiol (Actigall). What should the nurse instruct the patient about this medication?
a.
This medication is used prior to having surgery.
b.
This medication works best with a high-fat diet.
c.
This medication may take a few months to work.
d.
This medication makes sure the stones never return.
- ANS: C
- Dissolution of small non-calcified stones (less than 2 centimeters) with the bile acid drugs ursodiol (Actigall) is used for those who are not surgical candidates. Treatment with the dissolution drugs may take months and stones may return.
-
A patient with chronic liver disease is prescribed dexlansoprazole (Kapidex). What should the nurse instruct the patient about this medication?
a.
Take the entire dose of medication whole.
b.
Crush the medication and sprinkle in water.
c.
Take this medication with a full glass of milk.
d.
Take half the medication with breakfast and the other half with dinner.
- ANS: A
- This medication is a delayed-release proton pump inhibitor. The medication should be taken whole and not crushed. Milk does not need to be taken with this medication.
-
A patient with liver failure takes acetaminophen (Tylenol) 650 mg tablets by mouth for severe arthritis pain. How many tablets should the nurse instruct that the patient can safely take in one 24 hour period?
a.
2
b.
3
c.
4
d.
5
- ANS: C
- Acetaminophen (Tylenol) overdose is the most common cause of ALF. Acetaminophen should not exceed 3000 mg in a 24 hour period. If each tablet contains 650 mg, then divide 3000 mg/650 mg = 4.6 tablets. The patient can safely take 4 tablets of the medication in one day.
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The nurse is caring for a patient recovering from an incisional cholecystectomy. Which activities should the nurse identify as having the highest priority for this patient? (Select all that apply.)
a.
Managing pain
b.
Performing leg exercises
c.
Coughing and deep breathing
d.
Ambulating early and frequently
e.
Choosing low-fat foods from the menu
f.
Encouraging use of an incentive spirometer
- ANS: A, C, D, F
- Preventing respiratory complications is the priority as the high incision can be painful with respiration and may make the patient reluctant to cough and clear secretions. Controlling pain so the patient will be willing to deep breathe and cough and use an incentive spirometer are important. Ambulation as soon as ordered promotes lung expansion to prevent respiratory complications. B. E. These actions are important but not the highest priority.
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The nurse is reinforcing teaching provided to a patient recovering from an acute attack of cholecystitis. Which foods should the nurse caution the patient to avoid? (Select all that apply.)
a.
Rice
b.
Eggs
c.
Cheese
d.
Lean meats
e.
Fresh fruits
- ANS: B, C
- Eggs and cheese are high in fat content and will stimulate gallbladder contraction. A, D, E, Fruits, lean meats, and rice are low in fat content and therefore safer for the patient to consume.
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The nurse is providing education to a patient recovering from a recent cholecystectomy. What should the nurse include in the teaching? (Select all that apply.)
a.
“Fat should be less than 20% of total diet.”
b.
“Raw fruits and vegetables should be avoided.”
c.
“It is important to increase the protein intake in your diet.”
d.
“If you are overweight, it is suggested that you lose weight.”
e.
“There are no dietary restrictions once you leave the hospital.”
f.
“Fat is introduced slowly and adjusted according to individual tolerance.”
- ANS: C, D, F
- Patients are put on high-protein, low-fat diets. Encourage obese patients to lose weight. After a cholecystectomy, fat should be slowly reintroduced into the diet. A. B. E. Once the duodenum becomes accustomed to constant infusion of bile, the patient’s individual tolerance for fat becomes the only restriction for diet.
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The nurse is collecting data for a patient with acute liver failure. Which laboratory test findings should the nurse recognize as supporting this diagnosis? (Select all that apply.)
a.
Elevated platelet count
b.
Elevated prothrombin time
c.
Elevated serum bilirubin level
d.
Elevated serum potassium level
e.
Elevated alanine aminotransferase level (ALT)
f.
Elevated aspartate aminotransferase level (AST)
- ANS: B, C, E, F
- AST and ALT are found in high concentrations in liver cells and are released with death of liver cells. Serum bilirubin and urobilinogen may be elevated. In patients with severe hepatitis, prothrombin time may be elevated because the liver can no longer make prothrombin. A. D. Potassium and platelet counts are not directly affected.
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A patient with pancreatitis is receiving care to address the nursing diagnosis Imbalanced Nutrition: Less than required related to pain, NPO, and nasogastric suction. After 10 days of treatment, which findings should indicate to the nurse that the treatment plan has been effective? (Select all that apply.)
a.
The patient reports pain relief.
b.
The serum sodium is 130 mEq/L.
c.
The patient’s albumin level is 3.8 g/L.
d.
The serum potassium level is 3.7 mEq/L.
e.
The patient has mild diarrhea and steatorrhea.
f.
The patient has returned to baseline body weight.
- ANS: C, F
- An albumin level greater than 3.5 mg/dL and return to baseline weight are evidence of improving nutrition. A. D. These are good results but are not directly related to nutrition goals. E. Mild diarrhea and steatorrhea are not desirable outcomes. B. The sodium value is lower than normal and indicates continued electrolyte imbalance.
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A patient has the nursing diagnosis of Deficient Fluid Volume related to anorexia, nausea, vomiting, and excessive T-tube drainage related to cholecystitis. Which interventions should the nurse recommend be included in the plan of care? (Select all that apply.)
a.
Monitor skin turgor.
b.
Administer antiemetics as ordered.
c.
Clamp T-tube for 2 hours each shift.
d.
Monitor daily weight and intake and output.
e.
Encourage use of incentive spirometer every hour while awake.
f.
Contact the physician if T-tube drainage is greater than 150 mL within 24 hours of surgery.
- ANS: A, B, D
- Daily weights, intake and output, and skin turgor are good measures of fluid balance. Antiemetics will help reduce vomiting and contribute to fluid balance. F. About 500 to 1000 mL of yellowish-green bile is common within the first 24 hours after surgery. C. Clamping the T-tube is inappropriate and may put pressure on the surgical site. E. Use of incentive spirometer contributes to oxygenation status and not deficient fluid volume.
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The nurse is caring for a patient diagnosed with chronic hepatitis B. Which medications should the nurse anticipate being prescribed for this patient? (Select all that apply.)
a.
Interferon alpha-2a
b.
Ribavirin (Rebetol)
c.
Adefovir (Hepsera)
d.
Lamivudine (Epivir)
e.
Peginterferon alpha-2b
- ANS: C, D
- To manage chronic hepatitis B infection, the antivirals adefovir (Hepsera) or lamivudine (Epivir) may be used. A. B. Interferon therapy (peginterferon alpha-2b [Peg-Intron] or interferon alpha-2a [Pegasys]) along with an antiviral medication (oral ribavirin [Rebetol]) is considered to prevent chronic hepatitis C infection.
-
A patient recovering from hepatitis is concerned about liver damage from the infection. What should the nurse instruct the patient to do to prevent long-term liver damage? (Select all that apply.)
a.
Get adequate rest.
b.
Ingest nutritious foods.
c.
Abstain from all alcohol.
d.
Restrict physical activity.
e.
Limit the intake of dairy products.
- ANS: A, B, C
- Recovery varies and depends on the type of hepatitis. Full recovery is measured by the return to normal of all liver function tests and may take as long as 1 year. The effects of hepatitis can be considered reversible if the patient complies with a medical regimen of adequate rest, proper nutrition, and abstinence from alcohol or other liver-toxic agents for at least 1 year after liver function laboratory values return to normal. D. E. Physical activity and dairy products do not need to be restricted.
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The nurse is instructing the mother of an adolescent with hepatitis on ways to prevent the spread of infection in the home. What should the nurse include in this mother’s teaching? (Select all that apply.)
a.
Use bar soap.
b.
Wear rubber gloves when handling the patient’s used laundry.
c.
Wash contaminated linens separately from other family linens.
d.
Identify a separate bedroom and bathroom for the patient to use.
e.
Wash gloves with 10% bleach solution after use for cleaning the bathroom.
- ANS: B, C, D, E
- At home and if possible, the patient with hepatitis should have a separate bedroom and bathroom. The person cleaning the bathroom should wear disposable gloves or rubber gloves and then clean the gloves with a 10% bleach solution. Contaminated linens used by a patient with hepatitis should be washed separately from household laundry and in hot water. One cup of bleach should be added with the detergent to each load. Rubber gloves should be worn to wash the patient’s laundry. A. The family should be advised to use liquid soap instead of bar soap.
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While collecting data, the nurse becomes concerned that a patient is at risk for developing liver cancer. What information did the nurse use to come to this conclusion? (Select all that apply.)
a.
Lives in an urban community
b.
Ingests four six-packs of beer each day
c.
Smokes two packs of cigarettes each day
d.
Has a history of chronic hepatitis B infection
e.
Employed as a remote computer operator
- ANS: B, C, D
- Patients with a history of chronic hepatitis B infection, and heavy alcohol use or smoking have an increased risk for cancer of the liver. A. E. Home setting and employment do not increase the patient’s risk for developing liver cancer.
-
A patient is prescribed to receive 20 mg of metoclopramide (Reglan) intramuscularly (IM). The medication available is 5 mg/ mL. How many mL of the medication should the nurse provide to the patient?
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