353 Quiz 4 - Nurse Sarah

A patient had a cholecystectomy and has a t-tube in place. You’re helping the nursing student understand how to care for the t-tube. The nursing student asks you where the t-tube is located in the body. Your response is the:

Bile duct

The nurse helps the patient with a t-tube get up from the bed and sit in the bedside chair. Where will the nurse make it priority to position the tubing and drainage bag of the t-tube?

At or below the waist

Which position is best for a patient with a t-tube?

Semi-Fowler’s

A patient is post-op day 4 from a t-tube placement. Which finding below requires you to notify the physician?

Drainage from the t-tube within the past 24 hours is approximately 925 cc.

. The physician orders a patient’s t-tube to be clamped 1 hour before and 1 hour after meals. You clamp the t-tube as prescribed. While the tube is clamped which finding requires immediate nursing intervention?

The patient reports nausea and abdominal pain.

You’re assessing a patient’s t-tube and note that it is not draining bile. The patient is reporting nausea. The nurse will first?

Assess if the tubing from the t-tube is kinked or clamped.

The gallbladder is found on the __________ side of the body and is located under the ____________. It stores __________.

right; liver; bile

You’re providing a community in-service about gastrointestinal disorders. During your teaching about cholecystitis, you discuss how cholelithiasis can lead to this condition. What are the risk factors for cholelithiasis that you will include in your teaching to the participants? Select all that apply:

• female

• Older age

• Native American

• Pregnant

• Family History

• Obesity

A patient is being transferred to your unit with acute cholecystitis. In report the transferring nurse tells you that the patient has a positive Murphy’s Sign. You know that this means:

The patient stops breathing in when the examiner palpates under the ribs on the right upper side of the abdomen at the midclavicular line.

Your recent admission has acute cholecystitis. The patient is awaiting a cholecystostomy. What signs and symptoms are associated with this condition? Select all that apply:

• Epigastric pain that radiates to the right scapula

• Pain and fullness that increases after a greasy or spicy meal

• Fever

• Tachycardia

• Nausea

A patient in the emergency room has signs and symptoms associated with cholecystitis. What testing do you anticipate the physician will order to help diagnose cholecystitis? Select all that apply:

• Abdominal ultrasound

• HIDA Scan (Hepatobiliary Iminodiacetic AciD scan)

Your patient is unable to have a cholecystectomy for the treatment of cholecystitis. Therefore, a cholecystostomy tube is placed to help treat the condition. Which statement about a cholecystostomy (C-Tube) is TRUE?

The C-Tube is placed through the abdominal wall and directly into the gallbladder where it will drain infected bile from the gallbladder.

A patient, who has recovered from cholecystitis, is being discharged home. What meal options below are best for this patient?

Baked chicken with steamed carrots and rice

Your patient is diagnosed with acute cholecystitis. The patient is extremely nauseous. A nasogastric tube is inserted with GI decompression. The patient reports a pain rating of 9 on 1-10 scale and states the pain radiates to the shoulder blade.  Select all the appropriate nursing interventions for the patient

• Administered IV fluids per MD order.

• Provide mouth care routinely.

• Keep the patient NPO.

• Administer analgesic as ordered.

• Maintain low intermittent suction to NG tube.

The liver receives blood from two sources. The _____________ is responsible for pumping blood rich in nutrients to the liver

hepatic portal vein

   Which statements are INCORRECT regarding the anatomy and physiology of the liver? Select all that apply:

A.     The liver has 3 lobes and 8 segments.

C.     The liver turns urea, a by-product of protein breakdown, into ammonia.

You’re providing an in-service on viral hepatitis to a group of healthcare workers. You are teaching them about the types of viral hepatitis that can turn into chronic infections. Which types are known to cause ACUTE infections ONLY? Select all that apply:

• hepatitis a

• hepatitis e

Which patients below are at risk for developing complications related to a chronic hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:

B.     An infant who contracted Hepatitis B at birth.

C.     A 32-year-old female with Hepatitis C who reports using IV drugs.

D.     A 50-year-old male with alcoholism and Hepatitis D.

A patient is diagnosed with Hepatitis A. The patient asks how a person can become infected with this condition. You know the most common route of transmission is?

Fecal-oral

Which of the following is NOT a common source of transmission for Hepatitis A? Select all that apply:

• semen

• blood

A 36-year-old patient’s lab work show anti-HAV and IgG present in the blood. As the nurse you would interpret this blood work as

The patient has recovered from a previous Hepatitis A infection and is now immune to it

TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and symptoms appear and 1-3 weeks after the symptoms appear.

true

A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week ago. What education is important to provide to this patient?

   Inform the patient to promptly go to the local health department to receive immune globulin.

Select all the ways a person can become infected with Hepatitis B:

• During the birth process

• IV drug use

• Hemodialysis

• Sexual intercourse

   A patient has completed the Hepatitis B vaccine series. What blood result below would demonstrate the vaccine series was successful at providing immunity to Hepatitis B?

Positive anti-HBs

   A patient has lab work drawn and it shows a positive HBsAg. What education will you provide to the patient?

Avoid sexual intercourse or intimacy such as kissing until blood work is negative.

A patient with Hepatitis A asks you about the treatment options for this condition. Your response is?

Supportive care

  A patient was exposed to Hepatitis B recently. Postexposure precautions include vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be given as soon as possible, preferably ___________ after exposure to be effective.

24 hours

You’re providing education to a patient with an active Hepatitis B infection. What will you include in their discharge instructions? Select all that apply:

C.     “Follow a diet low in fat and high in carbs.”

D.     “Do not share toothbrushes, razors, utensils, drinking cups, or any other type of personal hygiene product.”

What is the MOST common transmission route of Hepatitis C?

IV drug use

A patient is diagnosed with Hepatitis D. What statement is true about this type of viral Hepatitis? Select all that apply:

A.     The patient will also have the Hepatitis B virus.

B.     Hepatitis D is most common in Southern and Eastern Europe, Mediterranean, and Middle East.

Select all the signs and symptoms associated with Hepatitis?

A.     Arthralgia

D.     Dark urine

F.      Yellowing of the sclera

G.     Fever

H.     Loss of appetite

A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this lab result? Select all that apply:

B.     Yellowing of the skin and sclera

C.     Clay-colored stools

E.      Dark urine

A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic Encephalopathy. What lab result would correlate with this mental status change?

Ammonia 100 mcg/dL

The physician writes an order for the administration of Lactulose. What lab result indicates this medication was successful?

Ammonia 16 mcg/dL

How is Hepatitis E transmitted?

  Fecal-oral

  Which patient below is at MOST risk for developing a complication related to a Hepatitis E infection?

A 26-year-old female in the 3rd trimester of pregnancy.

What is the BEST preventive measure to take to help prevent ALL types of viral Hepatitis?

  Hand hygiene

Select all the types of viral Hepatitis that have preventive vaccines available in the United States?

Hepatitis A

Hepatitis B

A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this medication what route?

Subcutaneous

  A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they now have yellowing of the skin and sclera along with dark urine. Based on this finding, this is what phase of Hepatitis?

Icteric

During the posticteric phase of Hepatitis the nurse would expect to find? Select all that apply:

• Decreased liver enzymes and bilirubin level

• Resolved jaundice and dark urine

. Which condition is NOT a known cause of cirrhosis?

All are known causes of Cirrhosis

The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.

hepatic portal vein, high, low

. A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:

B. Ascites

C. Splenomegaly

E. Esophageal varices

Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply:

A.Thrombocytopenia

C. Increased PT/INR

D. Leukopenia

A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?

Beef tips and broccoli rabe

During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient’s hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?

Increased ammonia level

You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient’s bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:

B. Dark brown urine

C. Yellowing of the sclera

E. Jaundice of the skin

A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because?

The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.

You’re providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply

A. Excessive coughing

D. Alcohol consumption

E. Straining during a bowel movement

F. Vomiting

While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:

Fetor Hepaticus

The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply:

B. Decrease in Fetor Hepaticus
D. Decreased ammonia blood level

________ reside in the liver and help remove bacteria, debris, and old red blood cells.

Kupffer cells

Which of the following is NOT a role of the liver?

Absorbing water

Inside the pancreas are special cells that secrete digestive enzymes and hormones. The cells that secrete digestive enzymes are known as ______________ cells.

Acinar

. From the pancreas and gallbladder, the common bile duct and pancreatic duct open into the ____________ where digestive enzymes and bile flow into the duodenum via the major duodenal papilla which is surrounded by a muscular valve that controls the release of digestive enzymes known as the ______________.

ampulla of vater, sphincter of Oddi

Select-ALL-that-apply: In the pancreas, the acinar cells release:

• A. Amylase

• C. Lipase

• D. Protease

You're caring for a 45 year old patient who is admitted with suspected acute pancreatitis. The patient reports having extreme mid-epigastric pain that radiates to the back. The patient states the pain started last night after eating fast food. As the nurse, you know the two most common causes of acute pancreatitis are:

Gallstones and alcohol abuse

Which patient below is at MOST risk for CHRONIC pancreatitis?

A 15 year old female with cystic fibrosis

Your patient with acute pancreatitis is scheduled for a test that will use a scope to assess the pancreas, bile ducts, and gallbladder. The patient asks you, "What is the name of the test I’m going for later today?" You tell the patient it is called:

ERCP

A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called?

Cullen's Sign

While assisting a patient with chronic pancreatitis to the bathroom, you note the patient's stool to be oily/greasy in appearance. In your documentation you note this as:

Steatorrhea

A patient with acute pancreatitis is reporting excessive thirst, excessive voiding, and blurred vision. As the nurse, it is priority you?

Check the patient's blood glucose

A patient who received treatment for pancreatitis is being discharged home. You're providing diet teaching to the patient. Which statement by the patient requires immediate re-education about the diet restrictions?

"It is very important I limit my alcohol intake to no more than 2-3 glasses of wine a week."

The physician orders a patient with pancreatitis to take a pancreatic enzyme. What assessment finding demonstrates the pancreatic enzymes are working properly?

Stools appear formed and solid

During a home health visit, you are assessing how a patient takes the prescribed pancreatic enzyme. The patient is unable to swallow the capsule whole, so they open the capsule and mix the beads inside the capsule with food/drink. Which food or drink is safe for the patient to mix the beads with?

Applesauce

A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY

A. Bitter taste in mouth

B. Dry cough

D. Difficulty swallowing

Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus’ ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, “What is the name of the test I’m having later today?” You tell the patient the name of the test is:

. Esophageal manometry

After dinner time, during hourly rounding, a patient awakes to report they feel like “food is coming up” in the back of their throat and that there is a bitter taste in their mouth. What nursing intervention will you perform next?

Assist the patient into the Semi-Fowler’s position

During a home health visit, you are helping a patient develop a list of foods they should avoid due to GERD. Which items in the patient’s pantry should be avoided? SELECT-ALL-THAT-APPLY:

A. Hot and Spicy Pork Rinds

B. Peppermint patties

D. Tomato Soup

E. Chocolate Fondue

G. Oranges

After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT?

“I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter.”

You’re collecting a patient’s medication history that has GERD. Which medication below is NOT typically used to treat GERD?

Colesevelam “Welchol”

A patient is taking Bethanechol “Urecholine” for treatment of GERD. This is known as what type of drug?

Prokinetic

Which of the following does NOT play a role in the development of GERD?

All the above play a role in GERD

. In the stomach lining, the parietal cells release _________ and the chief cells release __________ which both play a role in peptic ulcer disease.

hydrochloric acid, and pepsinogen

. A patient has developed a duodenal ulcer. As the nurse, you know that which of the following plays a role in peptic ulcer formation. Select ALL that apply:

B. Helicobacter pylori

C. NSAIDs

E. Zollinger-Ellison Syndrome

. You’re educating a group of patients at an outpatient clinic about peptic ulcer formation. Which statement is correct about how peptic ulcers form?

“Peptic ulcers can form when acid penetrates unprotected stomach mucosa. This causes histamine to be released which signals to the parietal cells to release more hydrochloric acid which erodes the stomach lining further.”

Your patient is diagnosed with peptic ulcer disease due to h.pylori. This bacterium has a unique shape which allows it to penetrate the stomach mucosa. You know this bacterium is:

Spiral shaped

Helicobacter pylori can live in the stomach’s acidic conditions because it secretes ___________  which neutralizes the acid.

urease

The physician orders a patient with a duodenal ulcer to take a UREA breath test. Which lab value will the test measure to determine if h. pylori is present?

Carbon dioxide

A patient arrives to the clinic for evaluation of epigastric pain. The patient describes the pain to be relieved by food intake. In addition, the patient reports awaking in the middle of the night with a gnawing pain in the stomach. Based on the patient’s description this appears to be what type of peptic ulcer?

Duodenal

. A patient with chronic peptic ulcer disease underwent a gastric resection 1 month ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What condition is this patient most likely experiencing?

Dumping Syndrome

Thinking back to the patient in question 8, select ALL the correct statements on how to educate this patient about decreasing their symptoms:

B. “After eating a meal lie down for 30 minutes.”

C. “Eat a diet high in protein, fiber, and low in carbs.”

A patient is recovering from discomfort from a peptic ulcer. The doctor has ordered to advance the patient’s diet to solid foods. The patient’s lunch tray arrives. Which food should the patient avoid eating?

Orange

. Which statement is INCORRECT about Histamine-receptor blockers?

“H2 blockers block histamine which causes the chief cells to decrease the secretion of hydrochloric acid.”

You are providing discharge teaching to a patient taking Sucralfate (Carafate). Which statement by the patient demonstrates they understand how to take this medication?

“I will always take this medication on an empty stomach.”

Select all the medications a physician may order to treat a H. Pylori infection that is causing a peptic ulcer?

A. Proton-Pump Inhibitors

E. Antibiotics

F. H2 Blockers

G. Bismuth Subsalicylates

A physician prescribes a Proton-Pump Inhibitor to a patient with a gastric ulcer. Which medication is considered a PPI?

Pantoprazole

A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On assessment of the abdomen you find bloating and an epigastric mass in the abdomen. Which complication may this patient be experiencing?

Upper gastrointestinal bleeding

Most patients with diverticulosis are most likely to have diverticula located in the?

Sigmoid Colon

You’re providing nursing education to a group of nursing students about diverticulosis versus diverticulitis. Which statement by the nursing students demonstrate they understand the education provided?

“Diverticulitis, if not treated, can lead to abscess formation and peritonitis.”

A patient with a history of diverticulosis is admitted with abdominal pain. The physician suspects diverticulitis. What other findings would correlate with diverticulitis? SELECT-ALL-THAT-APPLY:

B. Unrelenting cramping type pain

D. Blood in stool

E. Fever

F. Reports of constipation

G. Abdominal bloating

A patient asks what type of testing is performed to assess for diverticulosis. As the nurse, you know that which test below is used to assess for diverticulosis?

Colonoscopy

A patient is experiencing an acute episode of diverticulitis. The patient is having abdominal pain, temperature 102.6 ‘F, and elevated WBCs. As the nurse, you know it is important to:

Monitor the patient for peritonitis

In regards to question 5, this patient signs and symptoms are starting to subside. Which of the following food items would be best for the patient to consume?

Chicken broth and Jello

You’re providing discharge teaching to a patient who was hospitalized with diverticulitis. Which statement by the patient requires you to re-educate the patient?

“I will be sure to always cook and skin my fruits and vegetables rather than eating them fresh.”

True or False: Most patients with chronic diverticulitis require surgery at some point, such as a bowel resection. If the healthy bowel cannot be reconnected right away, a permanent colostomy will be created until it can be reconnected.

false

True or False: A patient with Crohn’s Disease can experience inflammation in the large intestine that affects mainly the mucosa (inner layer) of the bowel.

false

A patient with Crohn’s Disease is most likely to have the disease is what part of the GI tract?

Terminal Ileum