Chapter 38: Disorders of Hepatobiliary and Exocrine Pancreas Function PrepU

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?

1. Pain in the left lower quadrant, radiating to the back

2. Pain in the right upper quadrant referred to the same shoulder

3. Pain in the back, radiating to the groin

4. Pain that starts as a diffuse ache and localizes over 24 to 48 hours

2

The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding?

1. Increased levels of vitamin K

2. Decreased number of red blood cells

3. Increased prothrombin time

4. Increased platelet count

3

A client tells the nurse that they are concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The client is at risk for which infection?

1. hepatitis D

2. hepatitis C

3. hepatitis A

4. hepatitis B

3

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?

1. Gallstones related to inability to digest fat

2. Bleeding related to lack of clotting factors

3. Nutritional imbalance due to inability to synthesize protein

4. Hyperglycemia due to inability to synthesize insulin

4

When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:

1. stones will develop in the common bile duct, resulting in acute jaundice.

2. the pancreas is irreversibly damaged and will not recover to normal functioning (chronic).

3. activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.

4. the pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction.

3

When educating the public about hepatitis A, the nurse will stress which accurate teaching points? Select all that apply.

1. Be careful if traveling to a foreign country since many countries do not require vaccination of their workers.

2. The incubation period averages 25 to 26 weeks following exposure.

3. Hepatitis is only transmitted via blood; therefore, just don't touch anything that looks like it contains blood.

4. The onset of symptoms include high fever, malaise, abdominal pain, and jaundice.

5. Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after going to the toilet.

1,4,5

The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?

1. "Something in your home causes them to 'carry' the virus to their body."

2. "A carrier state means the individual is at risk for sudden death."

3. "Your loved one may not look ill, but the virus is present in their blood."

4. "The tests your loved one took show they have had hepatitis B in the past."

3

The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?

1. Carbohydrates

2. Protein

3. Amino acids

4. Fats

4

A client with chronic hepatitis B is undergoing diagnostic testing for possible liver cancer. The nurse can correlate which clinical manifestations with development of liver cancer? Select all that apply.

1. Client states, "I feel like my head is pounding all the time."

2. Client reports "abdominal fullness and bloating."

3. Client states, "My abdomen is getting larger and I can no longer get my belt buckled."

4. Client reports "skin is crawling with bugs."

5. Client reports that "blood sugar has been higher than normal all week."

2,3

A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The health care provider anticipates that the client will have more than 5 L of fluid removed. The health care provider has prescribed intravenous albumin following the procedure. The client asks why they need "more fluids in my vein." The nurse responds:

1. "Albumin works like your diuretics to help you get rid of excess fluid through your kidneys. It's just more potent than your home water pills."

2. "Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."

3. "After the albumin, your potassium level will stay steady and you should keep excess water weight off for several weeks."

4. "Albumin will stay in your blood vessels a long time so that you will not seep out more fluid in your belly for at least a few weeks."

2

A client with a history of excess alcohol consumption for 25 years is admitted with cirrhotic liver disease. To assess the amount of damage to the liver, which lab tests of hepatobiliary function should be monitored? Select all that apply.

1. Alanine aminotransferase (ALT)

2. gamma-glutamyl transferase (GGT)

3. Aspartate aminotransferase (AST)

4. Creatinine

5. Troponin

1,2,3

A 24-year-old client undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for them?

1. Corticosteroids and immunosuppressant drugs

2. Lamivudine

3. Pegylated interferon and ribavirin

4. Interferon alfa-2b

1

The nurse is caring for a client with advanced liver disease who has ascites. Which treatment will the nurse anticipate being used for the daily management of ascites?

1. desmopressin

2. paracentesis

3. diuretics

4. thoracentesis

3

When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?

1. A viral infection has begun to destroy the liver.

2. Sustained, heavy alcohol use causes this problem.

3. The pregnant parent passes this process along to the fetus in utero.

4. There is autoimmune destruction of the bile ducts.

4

A 16-year-old adolescent is hospitalized after ingesting 20 g of acetaminophen in a suicide attempt. The care team would recognize that this client faces risk for which potential complication?

1. Toxic hepatitis

2. Secondary biliary cirrhosis

3. Hepatitis D virus (HDV) infection

4. Portal hypertension

1

When teaching a group of nursing students about the liver, the nurse relates that Kupffer cells function to remove harmful substances or cells from the portal blood and venous sinusoids through which process?

1. Ultrafiltration

2. Cytotoxic action

3. Phagocytosis

4. Osmosis

3

The nurse is caring for a client with hepatic encephalopathy who is receiving neomycin. Which of these does the nurse monitor to determine if a positive outcome to the medication has resulted?

1. Prothrombin time

2. Transaminase level

3. Ammonia level

4. Aldosterone levels

3

When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease?

1. Leukopenia

2. Hyperglycemia

3. Hypertension

4. Polyuria

2

The health care provider has completed the assessment on a client with jaundice. The provider determines that which pathophysiologic abnormality could cause the jaundice?

1. Increased conjugation of bilirubin

2. Decreased oxygen demands at birth

3. Impaired uptake of bilirubin by the liver

4. Increased red blood cell development

3

A client presents to the emergency department with suspected pancreatitis. Which manifestations would the nurse assess in this client? Select all that apply.

1. Tenderness

2. Increased urinary output

3. Hypertension

4. Fever

5. Tachycardia

6. Epigastric pain

1,4,5,6

A client has been diagnosed with cholelithiasis. The nurse is aware the client is at risk for developing which manifestations? Select all that apply.

1. Biliary colic

2. Obstruction of bile flow

3. Absence of vitamin B₁₂

4. Chronic cholecystitis

5. Acute cholecystitis

1,2,4,5

A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icterus period. The nurse would expect the client to manifest:

1. severe pruritus and liver tenderness.

2. severe anorexia.

3. chills and fever.

4. disappearance of jaundice.

1

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?

1. Impaired uptake of bilirubin

2. Decreased oxygen at birth

3. Increased red cell development

4. Increased conjugation of bilirubin

1

A client with history of alcohol use disorder is brought to the emergency department after a weekend of heavy drinking, experiencing right upper quadrant pain, anorexia, nausea, jaundice and ascites. The nurse identifies these as manifestations of what disorder?

1. Cholestasis

2. Hepatitis

3. Fatty liver

4. Cancer of the gallbladder

2

The nurse is caring for a client with cholelithiasis. When teaching the client about the disease, the nurse includes which point?

1. "You have an inflammation of your gallbladder caused by an autoimmune process."

2. "Stones in the gallbladder are most common in males. Your case is unusual."

3. "You are unable to store bile in your gallbladder, which inhibits digestion of the foods you eat."

4. "Gallstones have developed, which are typically composed of cholesterol."

4

A client diagnosed with liver cancer asks the health care provider what the best treatment option is. The most appropriate response would be:

1. Chemotherapy to eliminate the cancer

2. Hepatic resection

3. Radiation therapy to shrink the tumor

4. Aggressive treatment for hepatitis C

2

A client presents to the emergency department with acute bleeding from ruptured esophageal varices. Which three actions does the nurse prioritize? Select THREE.

1. Administer vasoactive medication.

2. Administer a beta blocker.

3. Assess STAT ammonia level.

4. Arrange for urgent portosystemic shunt (TIPS).

5. Arrange for urgent endoscopy.

6. Initiate intravenous fluids.

1,5,6

When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?

1. Alcohol use

2. Weight gain

3. Progressive destruction of the organ

4. Easily cured with antibiotic therapy

3

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis?

1. Fatigue and depression

2. Ascites and immunosuppression

3. Nausea and diarrhea

4. Jaundice and pruritus

4

What is considered the normal amount of serum bilirubin found in the blood?

1. 1.7 mg/dL

2. 2 mg/dL

3. >1.8 mg/dL

4. <1.5 mg/dL

4

A nurse reviewing the lab results of a client diagnosed with cholestasis would expect to find which abnormality?

1. Decreased plasma bile salts

2. Decreased serum bilirubin

3. Increased serum glucose level

4. Increased serum alkaline phosphate

4

The client reports something "wrong" with their gallbladder. Which manifestation does the nurse recognize that supports the client's concern?

1. Fluid retention and edema of the hands and feet

2. Craving for carbohydrates

3. Intolerance to greasy food; burping

4. Abrupt onset of right lower quadrant pain and chills

3

An adolescent client has been admitted to the emergency department after ingesting 20 g of acetaminophen in a suicide attempt. The nursing team recognizes this client is at risk for acute fulminant hepatitis, with elevated ammonia levels that can be detected by assessing for which manifestation(s)? Select all that apply.

1. photosensitivity

2. flapping tremor (asterixis)

3. elevated creatinine levels

4. confusion

5. convulsions

2,4,5

When assessing the nutritional intake of a client with generalized pancreatic cancer, which statement by the client is consistent with the disease and food intake?

1. Client states consuming liquids with meals makes the pain worse.

2. Client states eating causes vomiting.

3. Client reports pain is worse 2 hours after eating.

4. Client states pain becomes worse with food intake.

4

A client has been diagnosed with cholestasis and is experiencing pruritus. The nurse caring for this client should be educating the client about reduced bile flow that will interfere with intestinal absorption of which vitamins? Select all that apply.

1. Vitamin D

2. Vitamin B

3. Vitamin C

4. Vitamin A

5. Vitamin K

1,4,5

A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate?

1. Long-term effects are similar to those seen in cholelithiasis.

2. Clients with chronic pancreatitis develop portal hypertension.

3. Clients can develop signs of diabetes and malabsorption.

4. Chronic pancreatitis can lead to liver failure and cirrhosis.

3

Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid?

1. Opioid analgesics

2. Alcohol

3. Concentrated sweets

4. Fatty foods

2

The community health nurse is offering education about hepatitis. Which of these groups does the nurse relate are at risk for hepatitis C? Select all that apply.

1. Those with jaundice

2. Sexually active gay males

3. Those with autoimmune disorders

4. Individuals diagnosed with pancreatitis

5. Injection drug users

2,5

A newborn is admitted to the hospital with a high bilirubin level of 13 mg/dL (222.35 µmol/L). The assessment data related to this lab value includes:

Select all that apply.

1. Colicky, intermittent pain associated with formula feeding

2. Xanthomas

3. Yellowish discoloration of the skin

4. Dark-colored urine

5. Yellowing of the sclera of the eye

3,4,5

The obstetric nurse is caring for a laboring client in the delivery room who has tested positive for the HBsAg. Which intervention does the nurse recognize is indicated?

1. Vaccination of the client with hepatitis C vaccine

2. Vaccination of the client for hepatitis A

3. Vaccination of the newborn with immunoglobulin

4. Vaccination of the newborn for hepatitis A

3

The nurse is caring for a client with viral hepatitis who has general malaise, easy fatigability, arthralgia, and anorexia. These manifestations correspond with what stage of the disease?

1. Prodromal period

2. Chronic period

3. Convalescent phase

4. Icterus phase

1

Clients with chronic autoimmune hepatitis may display which clinical manifestations upon physical exam? Select all that apply.

1. Enlarged liver

2. Bacterial meningitis

3. Nuchal rigidity

4. Edematous joints

5. Jaundice

1,5

An ultrasound of a client with intermittent pain reveals gallbladder sludge. Which client history items are likely factors in the ultrasound result? Select all that apply.

1. A runner training for a marathon

2. Works in surgery with long periods of standing in one place

3. Had lap band surgery 2 years ago and lost 100 pounds

4. Recent pregnancy with a 6-month-old child at home

5. Current prescription for a medicine to lower cholesterol

3,4,5

Following a needlestick injury, a nurse develops hepatitis C that eventually developed into a chronic infection. The health care provider counsels the nurse to assess for which major complications that can result from this chronic condition? Select all that apply.

1. Liver cancer

2. Biliary stone formation

3. Chronic anemia

4. Progressive liver fibrosis

5. Septicemia

1,4

The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy?

1. Vital signs

2. Prothrombin time

3. Mental status

4. Serum albumin

3

A client presents with epigastric pain, a mild fever, nausea, and vomiting. Their history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely?

1. Hepatitis C virus (HCV)

2. Calculous cholecystitis

3. Cirrhosis

4. Pancreatic cancer

2

When educating a client who has been experiencing some manifestations of liver disease about the lab/diagnostic procedures available, which procedure provides the most information about abdominal masses and possible staging of a liver cancer?

1. Angiography of hepatic artery

2. Computed tomography (CT)

3. Ultrasonography

4. Laparoscopic liver biopsy

4

A decrease in the serum level of which substance is suggestive of liver injury?

1. Alanine aminotransferase (ALT)

2. Gamma-glutamyltransferase (GGT)

3. Alkaline phosphatase

4. Albumin

4

When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session?

1. An infection of the pancreas has occurred.

2. The pancreas has developed inflammation due to ingestion of acetaminophen.

3. Pancreatic enzymes are activated before leaving the pancreas, causing injury.

4. The only way to get pancreatitis is from alcohol use.

3

Primary biliary cirrhosis is an autoimmune disease that destroys the small intrahepatic bile ducts causing cholestasis. It is insidious in onset and is a progressive disease. What are the earliest symptoms of the disease?

1. Pale urine

2. Dark stools

3. Unexplained pruritus

4. Weight gain

3

A client in liver failure asks, “How does the liver process ammonia in healthy individuals?” Which explanation from the health care provider explains the mechanism how ammonia is removed from the blood by the liver?

1. Processes ammonia into urea, releasing it into the circulation

2. Combines ammonia with oxygen to create ammonium oxide

3. Converts ammonia into bilirubin, which is then excreted intestinally

4. Processes ammonia into nitrogen and hydrogen ions for excretion

1

The nurse is caring for a client with liver disease who has elevated serum alpha fetoprotein levels. The nurse recognizes this lab result is consistent with which condition in an adult?

1. Pregnancy

2. Hepatocellular cancer

3. Rejection of transplanted liver

4. Toxic hepatitis

2

The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?

1. Elevated cholesterol

2. Decreased albumin

3. Decreased prothrombin

4. Elevated ammonia

2

The nurse teaches the client with acute pancreatitis that the pain is caused by prematurely activated pancreatic enzymes that have leaked into surrounding tissues, causing which outcome?

1. Bowel obstruction

2. Fatty deposits

3. Abscess formation

4. Autodigestion

4

The nurse recognizes that which individuals are at risk for hepatitis B? Select all that apply.

1. Those with cirrhosis

2. Those having unprotected sex

3. Blood donors

4. Injection drug users

5. Those who eat sushi

2,4

A client with ascites from cirrhosis undergoes a large volume paracentesis for refractory ascites. Which intervention(s) will the nurse anticipate being prescribed related to this procedure and the ongoing treatment of the client's ascites? Select all that apply.

1. increasing calcium intake

2. administering intravenous albumin

3. loop diuretic

4. sodium restriction

5. octreotide intravenous infusion

2,3,4

A client's long-standing diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this client most likely experience?

1. Post-hepatic

2. Intrahepatic

3. Prehepatic

4. Infectious

3

The nurse is assessing a client with acute pancreatitis who denies use of alcohol. When teaching the client about additional causes of acute pancreatitis, the nurse includes which of these in the discussion? Select all that apply.

1. Potassium-sparing diuretics

2. Gallstones

3. Abdominal trauma

4. Hypocalcemia

5. Increased cholesterol

2,3,5

Which individual likely faces the highest risk of developing chronic pancreatitis?

1. An obese client who has a high-fat diet and has a sedentary lifestyle

2. A client who takes 2 acetaminophen tablets 5 to 6 times a day

3. A client who has become profoundly ill during a tropical vacation

4. A client who has 6 to 8 alcoholic beverages each evening

4

Which diagnosis causes an increased risk of developing intrahepatic jaundice? Select all that apply.

1. Bile duct malformation

2. Cholelithiasis

3. Cirrhosis

4. Hepatitis

5. Liver cancer

3,4,5

During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response?

1. The liver is very vascular and is always filled with blood to maximum capacity.

2. In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver.

3. Since the heart cannot pump effectively, blood is moving very slowing in both the arterial and venous vessels; therefore, blood cannot move out of the liver very fast.

4. The lobules, which are the functional unit of the liver, cannot move blood very rapidly out of the veins so it just pools there until BP is increased.

2

The nurse is teaching a group of nursing students about alcohol-induced liver disease and the cytochrome P450 system (CYP P450). Which of these is correct for the nurse to include in the lesson?

1. Impairment of the CYP P450 system may cause severe hypoglycemia.

2. Alcohol is a source of calories, but cannot be stored as protein, fat, or carbohydrates.

3. This system prevents rapid metabolism of ethanol and subsequent intoxication.

4. Alcohol consumption enhances susceptibility to effects of drugs and toxins.

4

The nurse is caring for a client with cholestasis. When planning care, which measure should the nurse include to promote comfort?

1. Elevate the head of the bed.

2. Increase the protein in the diet.

3. Do not feed the client by mouth.

4. Provide skin care for itching.

4

Hepatocellular cancer usually has a poor prognosis due in part to which factor?

1. The nonspecific symptomatology of liver cancer leads to a diagnosis at a late stage.

2. Surgical options do not exist because removal of all or part of the liver is a threat to health.

3. Liver tumors are poorly differentiated due to the low density of hepatic tissue.

4. Liver cancer typically metastasizes at a much earlier stage than other cancers.

1

A client with hepatitis B asks the nurse, “How did I get this hepatitis?” Which responses are most accurate regarding the mode of transmission for hepatitis B? Select all that apply.

1. Unprotected sexual intercourse

2. Fecal–oral route

3. Inhalation of airborne droplets

4. Intravenous drug use

5. Sharing oral secretions by kissing

1,4

Which factor is most strongly associated with the pathogenesis of gallstone formation?

1. Abnormalities or stasis of bile

2. Excess serum ammonia and urea levels

3. High-cholesterol diet

4. Portal hypertension

1

The nurse is caring for a client with hypovolemic shock. Which of these does the nurse recognize is the liver's contribution to compensate for shock states?

1. The liver synthesizes ADH to retain water during periods of deficiency.

2. Kupffer cells are responsible for regulating blood volume and blood vessel tone.

3. The liver makes substances which constrict blood vessels to raise blood pressure.

4. Stored blood in the liver can shift to general circulation to restore blood volume.

4