hepatic and billary

Ch. 43 Hepatic Disorders and Ch. 44 Biliary Disorders

1. A nurse is caring for a client with liver failure and is performing an assessment of the client's increased risk of bleeding. The nurse recognizes that this risk is related to the client's inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

A. Alterations in glucose metabolism

B. Retention of bile salts

C. Inadequate production of albumin by hepatocytes

D. Inability of the liver to use vitamin K

D. Inability of the liver to use vitamin K

2. A nurse is performing an admission assessment of a client with a diagnosis of cirrhosis. What technique should the nurse use to palpate the client's liver?

A. Place hand under the right lower abdominal quadrant and press down lightly with the other hand.

B. Place the left hand over the abdomen and behind the left side at the 11th rib.

C. Place hand under right lower rib cage and press down lightly with the other hand.

D. Hold hand 90 degrees to right side of the abdomen and push down firmly.

C. Place hand under right lower rib cage and press down lightly with the other hand.

3. A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments?

A. Assessment of blood pressure and assessment for headaches and visual changes

B. Assessments for signs and symptoms of venous thromboembolism

C. Daily weights and abdominal girth measurement

D. Blood glucose monitoring q4h

A. Assessment of blood pressure and assessment for headaches and visual changes

4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.

A. Immunization

B. Use of standard precautions

C. Consumption of a vitamin-rich diet

D. Annual vitamin K injections

E. Annual vitamin B12 injections

A. Immunization

B. Use of standard precautions

5. A client who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

A. The client will obtain measurement of drainage from the T-tube.

B. The client will exercise three times a week.

C. The client will take immunosuppressive agents as required.

D. The client will monitor for signs of liver dysfunction.

C. The client will take immunosuppressive agents as required.

6. A triage nurse in the emergency department is assessing a client who presented with reports of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this client's presentation?

A. "How many alcoholic drinks do you typically consume in a week?"

B. "To the best of your knowledge, are your immunizations up to date?"

C. "Have you ever worked in an occupation where you might have been exposed to toxins?"

D. "Has anyone in your family ever experienced symptoms similar to yours?"

A. "How many alcoholic drinks do you typically consume in a week?"

7. A nurse is participating in the emergency care of a client who has just developed variceal bleeding. What intervention should the nurse anticipate?

A. Infusion of intravenous heparin

B. IV administration of albumin

C. STAT administration of vitamin K by the intramuscular route

D. IV administration of octreotide

D. IV administration of octreotide

8. A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the client has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?

A. Asterixis

B. Constructional apraxia

C. Fetor hepaticus

D. Palmar erythema

A. Asterixis

9. A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

A. The hepatitis A vaccine

B. Albumin infusion

C. The hepatitis A and B vaccines

D. An immune globulin injection

D. An immune globulin injection

10. What health promotion teaching should the nurse prioritize to prevent drug-induced hepatitis?

A. Finish all prescribed courses of antibiotics, regardless of symptom resolution.

B. Adhere to dosing recommendations of over-the-counter analgesics.

C. Ensure that expired medications are disposed of safely.

D. Ensure that pharmacists regularly review drug regimens for potential interactions.

B. Adhere to dosing recommendations of over-the-counter analgesics.

11. Diagnostic testing has revealed that a client's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this client's plan of care will focus on what intervention?

A. Cryosurgery

B. Liver transplantation

C. Lobectomy

D. Laser hyperthermia

C. Lobectomy

12. A client has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the client may have developed liver metastases?

A. Persistent fever and cognitive changes

B. Abdominal pain and hepatomegaly

C. Peripheral edema unresponsive to diuresis

D. Spontaneous bleeding and jaundice

B. Abdominal pain and hepatomegaly

13. A client is being discharged after a liver transplant and the nurse is performing discharge education. When planning this client's continuing care, the nurse should prioritize what risk diagnosis?

A. Risk for infection related to immunosuppressant use

B. Risk for injury related to decreased hemostasis

C. Risk for unstable blood glucose related to impaired gluconeogenesis

D. Risk for contamination related to accumulation of ammonia

A. Risk for infection related to immunosuppressant use

14. A nurse is caring for a client with hepatic encephalopathy. The nurse's assessment reveals that the client exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

C. Stage 3

15. A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

A. Two to three soft bowel movements daily

B. Significant increase in appetite and food intake

C. Absence of nausea and vomiting

D. Absence of blood or mucus in stool

A. Two to three soft bowel movements daily

16. A nurse is performing an admission assessment for an 81-year-old client who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

A. Similar liver size and texture as in younger adults

B. A nonpalpable liver

C. A slightly enlarged liver with palpably hard edges

D. A slightly decreased size of the liver

D. A slightly decreased size of the liver

17. A nurse is caring for a client with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

A. Watery, blood-streaked diarrhea

B. Orange and foamy urine

C. Increased abdominal girth

D. Decreased cognition

B. Orange and foamy urine

18. During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?

A. Following proper hand-washing techniques

B. Avoiding chemicals that are toxic to the liver

C. Wearing a condom during sexual contact

D. Limiting alcohol intake

A. Following proper hand-washing techniques

19. A client's health care provider has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.

A. Alanine aminotransferase (ALT)

B. C-reactive protein (CRP)

C. Gamma-glutamyl transferase (GGT)

D. Aspartate aminotransferase (AST)

E. B-type natriuretic peptide (BNP)

A. Alanine aminotransferase (ALT)

C. Gamma-glutamyl transferase (GGT)

D. Aspartate aminotransferase (AST)

20. A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?

A. Increased potassium intake

B. Fluid restriction to 2 L per day

C. Reduction in sodium intake

D. High-protein, low-fat diet

C. Reduction in sodium intake

21. A nurse is amending a client's plan of care in light of the fact that the client has recently developed ascites. What should the nurse include in this client's care plan?

A. Mobilization with assistance at least 4 times daily

B. Administration of beta-adrenergic blockers as prescribed

C. Vitamin B12 injections as prescribed

D. Administration of diuretics as prescribed

D. Administration of diuretics as prescribed

22. A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care?

A. Measurement of abdominal girth and body weight

B. Assessment for variceal bleeding

C. Assessment for signs and symptoms of jaundice

D. Monitoring of results of liver function testing

B. Assessment for variceal bleeding

23. A client with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the client's treatment?

A. Decisional conflict

B. Deficient knowledge

C. Death anxiety

D. Disturbed thought processes

C. Death anxiety

24. A client with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?

A. Keep client NPO until the results of test are known.

B. Keep client NPO until the client's gag reflex returns.

C. Administer analgesia until post-procedure tenderness is relieved.

D. Give the client a cold beverage to promote swallowing ability.

B. Keep client NPO until the client's gag reflex returns.

25. A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr infusing. The nurse should also anticipate what intervention?

A. Positioning the client supine

B. Administering diuretics

C. Oxygen by nasal cannula

D. Administering volume expanders

D. Administering volume expanders

26. A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's treatment, the nurse should anticipate what intervention?

A. Administration of immune globulins

B. A regimen of antiviral medications

C. Rest and watchful waiting

D. Administration of fresh-frozen plasma (FFP)

B. A regimen of antiviral medications

27. A group of nurses have attended an in-service on the prevention of occupationally acquired diseases that affect health care providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace?

A. Disposing of sharps appropriately and not recapping needles

B. Performing meticulous hand hygiene at the appropriate moments in care

C. Adhering to the recommended schedule of immunizations

D. Wearing an N95 mask when providing care for clients on airborne precautions

A. Disposing of sharps appropriately and not recapping needles

28. A client has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the client's care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence.

1. Fever rises.

2. Hematemesis.

3. Clotting abnormalities.

4. Vascular collapse.

5. Coma.

A. 1, 2, 5, 4, 3

B. 1, 2, 3, 4, 5

C. 2, 3, 1, 4, 5

D. 3, 1, 2, 5, 4

B. 1, 2, 3, 4, 5

29. A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response?

A. Ensure that the client's sodium intake does not exceed recommended levels.

B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy.

C. Inform the primary provider that the client should be assessed for alcoholic hepatitis.

D. Implement interventions aimed at ensuring a calm and therapeutic care environment.

B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy.

30. A client with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the client's fluid volume excess? Select all that apply.

A. Administering diuretics

B. Administering calcium channel blockers

C. Implementing fluid restrictions

E. Implementing a 1500 kcal/day restriction

D. Enhancing client positioning

A. Administering diuretics

C. Implementing fluid restrictions

D. Enhancing client positioning

31. A client with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the client's family how to safely perform which of the following actions?

A. Aspirating bile from the catheter using a syringe

B. Removing the catheter when output is 15 mL in 24 hours

C. Instilling antibiotics into the catheter

D. Assessing the patency of the drainage catheter

D. Assessing the patency of the drainage catheter

32. A client with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the client's prioritization for receiving a donor liver be determined?

A. By considering the client's age and prognosis

B. By objectively determining the client's medical need

C. By objectively assessing the client's willingness to adhere to post-transplantation care

D. By systematically ruling out alternative treatment options

B. By objectively determining the client's medical need

33. A nurse has entered the room of a client with cirrhosis and found the client on the floor. The client reports falling when transferring to the commode. The client's vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse's most appropriate action?

A. Remove the client's commode and supply a bedpan.

B. Complete an incident report and submit it to the unit supervisor.

C. Have the client assessed by the primary provider due to the risk of internal bleeding.

D. Perform a focused abdominal assessment in order to rule out injury.

C. Have the client assessed by the primary provider due to the risk of internal bleeding.

34. A client with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following?

A. Continuous monitoring for portal hypertension

B. Administration of immunosuppressive drugs during the first weeks after transplantation

C. Real-time monitoring of vascular changes in the hepatic system

D. Delivery of a continuous chemotherapeutic dose

D. Delivery of a continuous chemotherapeutic dose

35. A nurse on a solid organ transplant unit is planning the care of a client who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority?

A. Implementation of infection-control measures

B. Close monitoring of skin integrity and color

C. Frequent assessment of the client's psychosocial status

D. Administration of antiretroviral medications

A. Implementation of infection-control measures

36. A 55-year-old female client with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

A. Destruction of the client's liver tumor

B. Restoration of portal vein patency

C. Destruction of a liver abscess

D. Reversal of metastasis

A. Destruction of the client's liver tumor

37. A nurse is caring for a client with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL (408 mmol/L). For what complication is this client at risk?

A. Chronic jaundice

B. Pigment stones in portal circulation

C. Central nervous system damage

D. Hepatomegaly

C. Central nervous system damage

38. The nurse's review of a client's most recent laboratory results indicates a bilirubin level of 3.0 mg/dL (51 mmol/L). The nurse assesses the client for:

A. jaundice.

B. bleeding.

C. malnutrition.

D. hypokalemia.

A. jaundice.

ch. 44

1. A nurse is assessing a client who has been diagnosed with cholecystitis, and is experiencing localized abdominal pain. When assessing the characteristics of the client's pain, the nurse should anticipate that it may radiate to what region?

A. Left upper chest

B. Inguinal region

C. Neck or jaw

D. Right shoulder

D. Right shoulder

ch. 44

2. A client has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse explain the pathophysiology of this client's health problem?

A. "Toxins have accumulated and inflamed your pancreas."

B. "Bacteria likely migrated from your intestines and became lodged in your pancreas."

C. "A virus that was likely already present in your body has begun to attack your pancreatic cells."

D. "The enzymes that your pancreas produces have damaged the pancreas itself."

D. "The enzymes that your pancreas produces have damaged the pancreas itself."

ch. 44

3. A client's abdominal ultrasound indicates cholelithiasis. When the nurse is reviewing the client's laboratory studies, what finding is most closely associated with this diagnosis?

A. Increased bilirubin

B. Decreased serum cholesterol

C. Increased blood urea nitrogen (BUN)

D. Decreased serum alkaline phosphatase level

A. Increased bilirubin

ch. 44

4. A nurse who provides care in a community clinic assesses a wide range of individuals. The nurse should identify which client as having the highest risk for chronic pancreatitis?

A. A 45-year-old obese woman with a high-fat diet

B. An 18-year-old man who is a weekend binge drinker

C. A 39-year-old man with chronic alcoholism

D. A 51-year-old woman who smokes one-and-a-half packs of cigarettes per day

C. A 39-year-old man with chronic alcoholism

ch. 44

5. A 37-year-old client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's spouse states that the client was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem?

A. Severe pancreatitis with possible peritonitis

B. Acute cholecystitis

C. Chronic pancreatitis

D. Acute appendicitis with possible perforation

A. Severe pancreatitis with possible peritonitis

ch. 44

6. A client has been scheduled for an ultrasound of the gallbladder the following morning. What should the nurse do in preparation for this diagnostic study?

A. Have the client refrain from food and fluids after midnight.

B. Administer the contrast agent orally 10 to 12 hours before the study.

C. Administer the radioactive agent intravenously the evening before the study.

D. Encourage the intake of 64 ounces of water 8 hours before the study.

A. Have the client refrain from food and fluids after midnight.

ch. 44

7. A client who had surgery for gallbladder disease has just returned to the postsurgical unit from postanesthetic recovery. The nurse caring for this client knows to immediately report what assessment finding to the health care provider?

A. Decreased breath sounds

B. Drainage of bile-colored fluid onto the abdominal dressing

C. Rigidity of the abdomen

D. Acute pain with movement

C. Rigidity of the abdomen

ch. 44

8. A client with chronic pancreatitis had a pancreaticojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The client has come to the office for a routine postsurgical appointment. The client is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse?

A. "The majority of clients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief."

B. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain."

C. "Your health care provider will likely want to discuss the removal of your gallbladder to achieve pain relief."

D. "You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail."

B. "Pain relief occurs by 6 months in most clients who undergo this procedure, but some people experience a recurrence of their pain."

ch. 44

9. A nurse is caring for a client who has been scheduled for endoscopic retrograde cholangiopancreatography (ERCP) the following day. When providing anticipatory guidance for this client, the nurse should describe what aspect of this diagnostic procedure?

A. The need to protect the incision postprocedure

B. The use of moderate sedation

C. The need to infuse 50% dextrose during the procedure

D. The use of general anesthesia

ANS: B

Rationale: Moderate sedation, not general anesthesia, is used during ERCP. D50 is not given and the procedure does not involve the creation of an incision.

ch. 44

10. A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize what topic?

A. Management of fluid balance in the home setting

B. The need for blood glucose monitoring for the next week

C. Signs and symptoms of intra-abdominal complications

D. Appropriate use of prescribed pancreatic enzymes

C. Signs and symptoms of intra-abdominal complications

ch. 44

11. A nurse is preparing a plan of care for a client with pancreatic cysts that have necessitated drainage through the abdominal wall. What nursing diagnosis should the nurse prioritize?

A. Disturbed body image

B. Impaired skin integrity

C. Nausea

D. Risk for deficient fluid volume

B. Impaired skin integrity

ch. 44

12. A home health nurse is caring for a client discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the client who has had pancreatic surgery?

A. Proteinuria and hyperkalemia

B. Hemorrhage and hypercalcemia

C. Weight loss and hypoglycemia

D. Malabsorption and hyperglycemia

D. Malabsorption and hyperglycemia

ch. 44

13. A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain?

A. Aspirin every 4 to 6 hours as prescribed

B. Application of heat 15 to 20 minutes each hour

C. Application of an ice pack for no more than 15 minutes

D. Application of liniment rub to affected area

B. Application of heat 15 to 20 minutes each hour

ch. 44

14. A client returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the client for signs and symptoms of what serious potential complication of this surgery?

A. Diabetic coma

B. Decubitus ulcer

C. Wound evisceration

D. Bile duct injury

D. Bile duct injury

ch. 44

15. A client has been treated in the hospital for an episode of acute pancreatitis. The client has acknowledged the role that his alcohol use played in the development of his health problem, but has not expressed specific plans for lifestyle changes. What is the nurse's most appropriate response?

A. Educate the client about the link between alcohol use and pancreatitis.

B. Ensure that the client knows the importance of attending follow-up appointments.

C. Refer the client to social work or spiritual care.

D. Encourage the client to connect with a community-based support group.

D. Encourage the client to connect with a community-based support group.

ch. 44

16. A client is being treated for acute pain from an episode of pancreatitis. The nurse has identified a nursing diagnosis of Ineffective Breathing Pattern related to pain secondary to effects of surgery. Which intervention should the nurse perform in order to best address this diagnosis?

A. Position the client supine to facilitate diaphragm movement.

B. Administer corticosteroids by nebulizer as prescribed.

C. Perform oral suctioning as needed to remove secretions.

D. Administer analgesic per orders.

D. Administer analgesic per orders.

ch. 44

17. A client with gallstones has been prescribed ursodeoxycholic acid (UDCA). The nurse understands that additional teaching is needed regarding this medication when the client states:

A. "It is important that I see my health care provider for scheduled follow-up appointments while taking this medication."

B. "I will take this medication for 2 weeks and then gradually stop taking it."

C. "If I lose weight, the dose of the medication may need to be changed."

D. "This medication will help dissolve small gallstones made of cholesterol

B. "I will take this medication for 2 weeks and then gradually stop taking it."

ch. 44

18. A nurse is assisting with serving dinner trays on the unit. Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray?

A. Fried chicken

B. Mashed potatoes

C. Dinner roll

D. Tapioca pudding

A. Fried chicken

ch. 44

19. A nurse is assessing an older adult client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what examples?

A. Fever and pain

B. Chills and jaundice

C. Nausea and vomiting

D. Signs and symptoms of septic shock

D. Signs and symptoms of septic shock

ch. 44

20. A nurse is creating a care plan for a client with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan?

A. Bed rest reduces the client's metabolism and reduces the risk of metabolic acidosis.

B. Reduced activity protects the physical integrity of pancreatic cells.

C. Bed rest lowers the metabolic rate and reduces enzyme production.

D. Inactivity reduces caloric need and gastrointestinal motility.

C. Bed rest lowers the metabolic rate and reduces enzyme production.

ch. 44

21. The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client for signs of what complications?

A. Pain and peritonitis

B. Bleeding and perforation

C. Acidosis and hypoglycemia

D. Gangrene of the gallbladder and hyperglycemia

B. Bleeding and perforation

ch. 44

22. A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client should be informed that this procedure will involve the removal of which of the following? Select all that apply.

A. Gallbladder

B. Part of the stomach

C. Duodenum

D. Part of the common bile duct

E. Part of rectum

A. Gallbladder

B. Part of the stomach

C. Duodenum

D. Part of the common bile duct

ch. 44

23. An adult client has been admitted to the medical unit for the treatment of acute pancreatitis. What nursing action should be included in this client's plan of care?

A. Measure the client's abdominal girth daily.

B. Limit the use of opioid analgesics.

C. Monitor the client for signs of dysphagia.

D. Encourage activity as tolerated.

A. Measure the client's abdominal girth daily.

ch 44.

24. A community health nurse is caring for a client whose multiple health problems include chronic pancreatitis. During the most recent home visit, the nurse learns that the client is experiencing severe abdominal pain and has vomited 3 times in the past several hours. What is the nurse's most appropriate action?

A. Administer a PRN dose of pancreatic enzymes as prescribed.

B. Teach the client about the importance of abstaining from alcohol.

C. Arrange for the client to be transported to the hospital.

D. Insert an NG tube, if available, and stay with the client.

C. Arrange for the client to be transported to the hospital.

ch. 44

25. A student nurse is caring for a client who has a diagnosis of acute pancreatitis and who is receiving parenteral nutrition. The student should prioritize which of the following assessments?

A. Fluid output

B. Oral intake

C. Blood glucose levels

D. BUN and creatinine levels

C. Blood glucose levels

ch. 44

26. A client has a recent diagnosis of chronic pancreatitis and is undergoing diagnostic testing to determine pancreatic islet cell function. The nurse should anticipate what diagnostic test?

A. Glucose tolerance test

B. ERCP

C. Pancreatic biopsy

D. Abdominal ultrasonography

A. Glucose tolerance test

ch. 44

27. client has been admitted to the hospital for the treatment of chronic pancreatitis. The client has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize?

A. Educating the client about expectations and care following surgery

B. Educating the client about the management of blood glucose after discharge

C. Educating the client about postdischarge lifestyle modifications

D. Educating the client about the potential benefits of pancreatic transplantation

C. Educating the client about post-discharge lifestyle modifications

ch. 44

28. A client is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in clients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication?

A. Sudden increase in random blood glucose readings

B. Increased abdominal girth accompanied by decreased level of consciousness

C. Fever, increased heart rate and decreased blood pressure

D. Abdominal pain unresponsive to analgesics

C. Fever, increased heart rate and decreased blood pressure

ch. 44

29. A client has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this client?

A. Oral oxycodone

B. IV hydromorphone

C. IM meperidine

D. Oral naproxen

B. IV hydromorphone

ch. 44

30. A client has just been diagnosed with chronic pancreatitis. The client is underweight and in severe pain and diagnostic testing indicates that over 80% of the client's pancreas has been destroyed. The client asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response?

A. "The symptoms of pancreatitis mimic those of much less serious illnesses."

B. "Your body doesn't require pancreatic function until it is under great stress, so it is easy to go unnoticed."

C. "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost."

D. "It's likely that your other organs were compensating for your decreased pancreatic function."

C. "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost."

ch. 44

31. A client has been diagnosed with pancreatic cancer and has been admitted for care. Following initial treatment, the nurse should be aware that the client is most likely to require which of the following situations?

A. Inpatient rehabilitation

B. Rehabilitation in the home setting

C. Intensive physical therapy

D. Hospice care

D. Hospice care

ch. 44

32. A client is admitted to the ICU with acute pancreatitis. The client's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of clients with acute pancreatitis have what health issue?

A. Type 1 diabetes

B. An impaired immune system

C. Undiagnosed chronic pancreatitis

D. An amylase deficiency

C. Undiagnosed chronic pancreatitis

ch. 44

33. A client is admitted to the unit with acute cholecystitis. The health care provider has stated that surgery will be scheduled in 4 days. The client asks why the surgery is being put off for a week when he has a "sick gallbladder." What rationale would underlie the nurse's response?

A. Surgery is delayed until the client can eat a regular diet without vomiting.

B. Surgery is delayed until the acute symptoms subside.

C. The client requires aggressive nutritional support prior to surgery.

D. Time is needed to determine whether a laparoscopic procedure can be used.

B. Surgery is delayed until the acute symptoms subside.

ch. 44

34. A client with a cholelithiasis has been scheduled for a laparoscopic cholecystectomy. Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure?

A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.

B. Laparoscopic cholecystectomy can be performed in a clinic setting, while an open procedure requires an OR.

C. A laparoscopic approach allows for the removal of the entire gallbladder.

D. A laparoscopic approach can be performed under conscious sedation.

A. Laparoscopic cholecystectomy poses fewer surgical risks than an open procedure.

ch. 44

35. A client with ongoing back pain, nausea, and abdominal bloating has been diagnosed with cholecystitis secondary to gallstones. The nurse should anticipate that the client will undergo what intervention?

A. Laparoscopic cholecystectomy

B. Methyl tertiary butyl ether (MTBE) infusion

C. Intracorporeal lithotripsy

D. Extracorporeal shock wave therapy (ESWL)

A. Laparoscopic cholecystectomy

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36. A nurse is caring for a client with gallstones who has been prescribed ursodeoxycholic acid (UDCA). The client asks how this medicine is going to help his symptoms. The nurse should be aware of what aspect of this drug's pharmacodynamics?

A. It inhibits the synthesis of bile.

B. It inhibits the synthesis and secretion of cholesterol.

C. It inhibits the secretion of bile.

D. It inhibits the synthesis and secretion of amylase.

B. It inhibits the synthesis and secretion of cholesterol.

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37. A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods?

A. High-fiber foods

B. Low-purine, nutrient-dense foods

C. Low-fat foods high in proteins and carbohydrates

D. Foods that are low-residue and low in fat

C. Low-fat foods high in proteins and carbohydrates

38. A client presents to the emergency department (ED) reporting severe right upper quadrant pain. The client states that the family doctor said the pain was caused by gallstones. The ED nurse should recognize what possible complication of gallstones?

A. Acute pancreatitis

B. Atrophy of the gallbladder

C. Gallbladder cancer

D. Gangrene of the gallbladder

D. Gangrene of the gallbladder

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39. A client's assessment and diagnostic testing are suggestive of acute pancreatitis.

    When the nurse is performing the health interview, what assessment question(s) addresses likely etiologic factors? Select all that apply.

A. "How many alcoholic drinks do you typically consume in a week?"

B. "Have you ever been tested for diabetes?"

C."Have you ever been diagnosed with gallstones?"

D. "Would you say that you eat a particularly high-fat diet?

E. "Does anyone in your family have cystic fibrosis

A. "How many alcoholic drinks do you typically consume in a week?"

B. "Have you ever been tested for diabetes?"

C."Have you ever been diagnosed with gallstones?"

D. "Would you say that you eat a particularly high-fat diet?

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