CH. 38 PrepU: Disorders of Hepatobiiliary and Exocrine Pancreas Function

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?
A) Cytotoxic action
B) Phagocytosis
C) Ultrafiltration
D) Osmosis

B) Phagocytosis

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?
A) Kupffer cells are responsible for regulating blood volume and blood vessel tone
B) The liver synthesizes ADH to retain water during periods of deficiency
C) Stored blood in the liver can shift to general circulation to restore blood volume
D) The liver makes substances which constrict blood vessels to raise BP

C) Stored blood in the liver can shift to general circulation to restore blood volume

The nurse is performing a physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver?
A) Left upper quadrant
B) Left lower quadrant
C) Right lower quadrant
D) Right upper quadrant

D) Right upper quadrant

All diseases have risk factors. What is the most significant environmental risk factor for pancreatic cancer?
A) Heavy metal toxicity
B) Cigarette smoking
C) Air pollution
D) Water pollution

B) Cigarette smoking

A decrease in the serum level of which substance is suggestive of liver injury?
A) Alanine aminotransferase (ALT)
B) Gamma-glutamyltransferase (GGT)
C) Alkaline phosphatase
D) Albumin

D) Albumin

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?
A) Cancer of the gallbladder
B) Cholestasis
C) Fatty liver
D) Hepatitis

D) Hepatitis

While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned?
A) High sodium level in foods and beverages
B) Hypersplenism
C) Neurotoxin accumulation
D) Steroid hormone deficiency

C) Neurotoxin accumulation

Which individual likely faces the highest risk of developing chronic pancreatitis?
A) A client who has become profoundly ill during a tropical vacation
B) A client who has 6-8 alcoholic beverages each evening
C) A client who takes 2 acetaminophen tablets 5-6 times a day
D) An obese client who has a high-fat diet and has a sedentary lifestyle

B) A client who has 6-8 alcoholic beverages each evening

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?
A) Thoracentesis
B) Diuretics
C) Paracentesis
D) Desmopressin

B) Diuretics

The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?
A) Hyperglycemia due to inability to synthesize insulin
B) Gallstones related to inability to digest fat
C) Bleeding related to lack of clotting factors
D) Nutritional imbalance due to inability to synthesize protein

A) Hyperglycemia due to inability to synthesize insulin

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?
A) Corticosteroids and immunosuppressant drugs
B) Interferon alfa-sb
C) Pegylated interferon and ribavirin
D) Lamivudine

A) Corticosteroids and immunosuppressant drugs

A client with chronic pancreatitis is experiencing an episode of recurring epigastric pain. The nurse teaches the client to limit which type of meal to avoid further episodes?
A) Romaine salad with olive oil and vinegar dressing
B) Fruit salad and banana bread
C) Fried chicken and french fries
D) Pancakes and coffee

C) Fried chicken and french fries

One of the jobs the liver performs is to export triglyceride. When the liver’s capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute?
A) Cholelithiasis
B) Alcoholic fatty liver disease
C) Biliary cirrhosis
D) Nonalcoholic fatty liver disease

D) Nonalcoholic fatty liver disease

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?
A) Hep B
B) Hep A
C) Hep D
D) Hep C

B) Hep A

When assessing the client with acute pancreatitis, which of these diagnostic tests—consistent with the disease— does the nurse anticipate will be altered?
A) Glucose values
B) Creatine kinase
C) The transaminases
D) Amylase and lipase

D) Amylase and lipase

Given the fact that acute pancreatitis can result in severe, life-threatening complications, the nurse should be assessing the client for which complication?
A) Complete heart block
B) Acute tubular necrosis
C) Cerebral hemorrhage
D) Bilateral pneumothorax

B) Acute tubular necrosis

Which manifestations will the nurse expect to find in a client with advanced liver failure?
A) Hyperkalemia
B) Halitosis
C) Hemiparesis
D) Hematuria
E) Asterixis

B) Halitosis
D) Hematuria
E) Asterixis

Antibody testing has confirmed that a client is positive for hepatitis A virus (HAV). Which statement does the nurse apply as evidence that the client understands the new diagnosis?
A) “I don’t know why I didn’t bother to get vaccinated against this”
B) “I’m embarrassed that I’ll be a carrier of hepatitis from now on”
C) “I’m still trying to deal with the fact that this will forever change my life”
D) “I guess I’m an example of why you should always use condoms”

A) “I don’t know why I didn’t bother to get vaccinated against this”

The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?
A) “The tests your loved one took show they have had hepatitis B in the past”
B) “A carrier state means the individual is at risk for sudden death”
C) “Your loved one may not look ill, but the virus is present in their blood”
D) “Something in your home causes them to ‘carry’ the virus to their body”

C) “Your loved one may not look ill, but the virus is present in their blood”

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?
A) Hepatitis C virus (HCV)
B) Pancreatic cancer
C) Calculous cholecystitis
D) Cirrhosis

C) Calculous cholecystitis

The nurse recognizes that which individuals are at risk for hepatitis B? Select all that apply.
A) Those who eat sushi
B) Blood donors
C) Injection drug users
D) Those with cirrhosis
E) Those having unprotected sex

C) Injection drug users
E) Those having unprotected sex

A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis?
A) Fatigue and depression
B) Ascites and immunosuppression
C) Jaundice and pruritus
D) Nausea and diarrhea

C) Jaundice and pruritus

When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?
A) Pain in the left lower quad, radiating to the back
B) Pain in the back, radiating to the groin
C) Pain that starts as diffuse ache and localizes over 24 to 48 hours
D) Pain in the right upper quad referred to the same shoulder

D) Pain in the right upper quad referred to the same shoulder

When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding?
A) Increased vitamin K
B) Decreased RBCs
C) Increased prothrombin time
D) Increased platelet count

C) Increased prothrombin time

A client who has been taking acetaminophen 1000 mg every 4 hours presents to the Urgent Care Center with increased abdominal pain, elevated ALT, AST, and bilirubin levels. The nurse suspects the client is experiencing:
A) Cholestatic reaction
B) Idiosyncratic reaction
C) Chronic active hepatitis
D) Direct hepatotoxic reaction

D) Direct hepatotoxic reaction

When caring for the client with Laennec cirrhosis, the nurse recognizes which pathophysiologic finding to be an expected etiology of jaundice?
A) Decreased oxygen at birth
B) Impaired uptake of bilirubin
C) Increased red cell development
D) Increased conjugation of bilirubin

B) Impaired uptake of bilirubin

A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas?
A) Sharp, stabbing pain with each deep breath
B) Abdominal pain following the ingestion of a large meal heavy with fat and protein
C) Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward
D) Severe, intractable headache caused by excess fluid in the CNS causing cerebral edema

C) Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward

The nurse is caring for a client with metastatic pancreatic cancer who is to undergo a surgical resection and radiation therapy. What does the nurse recognize is the goal of these interventions?
A) Palliation of symptoms
B) Removal of the tumor
C) Diagnosis of the tumor
D) Cure of the cancer

A) Palliation of symptoms

The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value?
A) Bilirubin 15 mg/dL (256.56 umol/L) (HIGH)
B) Albumin 2.0 g/dL (20 g/L) (LOW)
C) Serum calcium level 7 mg/dL (1.75 mmol/L) (LOW)
D) Amylase 150 units/L (2.50 ukat/L) (HIGH)

A) Bilirubin 15 mg/dL (256.56 umol/L) (HIGH)

While caring for a client undergoing diagnostic testing for possible liver failure, the nurse asks the student nurse what clinical manifestations of liver failure they should assess for. Which answers are accurate? Select all that apply.
A) Palpable masses located in liver region of the abdomen
B) Dull, epigastric pain accompanied by back pain
C) Multiple bruising noted on body
D) Abdominal peritonitis
E) Sweet, musty breath

C) Multiple bruising noted on body
E) Sweet, musty breath

The nurse is caring for a college student with infectious mononucleosis. For which reason does the nurse teach the client to abstain from alcohol during the acute phase of the disease?
A) Consuming alcohol contributes to alcohol use disorder
B) Alcohol consumption is likely to damage the kidneys in the prodromal phase
C) The likelihood of developing hepatitis A increases with alcohol consumption
D) Alcohol may worsen a mild hepatitis which occurs in the acute phase

D) Alcohol may worsen a mild hepatitis which occurs in the acute phase

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?
A) Decreased prothrombin
B) Elevated cholesterol
C) Elevated ammonia
D) Decreased albumin

D) Decreased albumin

The nurse is teaching a client about surgical treatments available for chronic viral hepatitis. Which of these is appropriate for the nurse to relate?
A) Removal of the diseased portion of the liver
B) Liver transplant
C) Portosystemic shunt
D) Hepatectomy

B) Liver transplant

The nurse is teaching about prevention of hepatitis A. Which group does the nurse suggest will benefit from this vaccine?
A) All children as part of childhood immunization
B) People who live in or travel to areas with high rates of hep A infections
C) People with liver disease who are immunocompromised
D) People who have recently been exposed to hep A

B) People who live in or travel to areas with high rates of hep A infections

The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which factors does the nurse include in the teaching session? Select all that apply.
A) Hypertension
B) Age over 50 years
C) Cigarette smoke
D) Chronic pancreatitis
E) Colon cancer

B) Age over 50 years
C) Cigarette smoke
D) Chronic pancreatitis

When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session?
A) Pancreatic enzymes are activated before leaving the pancreas, causing injury
B) The only way to get pancreatitis is from alcohol use
C) An infection of the pancreas has occurred
D) The pancreas has developed inflammation due to ingestion of acetaminophen

A) Pancreatic enzymes are activated before leaving the pancreas, causing injury

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?
A) Prothrombin time
B) Transaminase level
C) Aldosterone levels
D) Ammonia level

D) Ammonia level

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?
A) Alcohol is a source of calories, but cannot be stored as protein, fat, or carbs
B) Impairment of the CYP P450 system may cause severe hypoglycemia
C) Alcohol consumption enhances susceptibility to effects of drugs and toxins
D) This system prevents rapid metabolism of ethanol and subsequent intoxication

C) Alcohol consumption enhances susceptibility to effects of drugs and toxins

A nurse reviewing the lab results of a client diagnosed with cholestasis would expect to find which abnormality?
A) Increased serum glucose level
B) Increased serum alkaline phosphate
C) Decreased serum bilirubin
D) Decreased plasma bile salts

B) Increased serum alkaline phosphate

A client is admitted to a nursing unit with severe edema. The nursing student caring for this client overhears the health care provider and a medical student talking about the client's albumin level. When discussing the flow of fluids into and out of cells, albumin plays a significant role in which pressure gradient?
A) Hydrostatic
B) Transcellular
C) Diffusion
D) Colloidal osmotic

D) Colloidal osmotic

A client presents to the emergency department with some vague symptoms. After history and physical exam, the health care provider is suspecting the client may have viral hepatitis. Which clinical manifestation leads the nurse to suspect the client is in the prodromal period of viral hepatitis?
A) Muscle aches and pain along with fatigue
B) Liver tenderness on palpation
C) Slight jaundice in the sclera of the eyes
D) Onset of severe itching with skin breakdown

A) Muscle aches and pain along with fatigue