The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing and what serum bilirubin results would be expected?
a. Hemolytic jaundice with normal conjugated bilirubin
b. Posthepatic icteris with
c. Gallstones cause obstructive or posticteric jaundice and may elevate both conjugated and unconjugated bilirubin.
The patient experienced a blood transfusion reaction. How should the nurse explain to the patient the cause of the hemolytic jaundice that occurred?
a. Results from hepatocellular disease
b. Due to a malaria parasite breaking apart red blood cells (RBCs)
. d. Hemolytic jaundice from a blood transfusion reaction is from increased breakdown of RBCs producing increased unconjugated bilirubin in the blood. Hepatocellular jaundice results from hepatocellular disease. Hemolytic jaundice occurs with malaria. Obs
The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted?
a. Hepatitis B (HBV) c. Hepatitis D (HDV)
b. Hepatitis C (HCV
d. Hepatitis E virus (HEV) is associated with poor sanitation and contaminated water in developing countries.
Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?
a. Hepatitis A (HAV) c. Hepatitis C (HCV
b. Hepatitis B virus (HBV) is a DNA virus that is transmitted via infectious blood and body products and is required for hepatitis D virus (HDV) replication, and
Copyright � 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
chronic HBV along
Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination?
a. Anti-HBcIgG c. Surface antibody An
c. Immunization to HBV after vaccination is identified with the hepatitis B surface antibody Anti-HBs. Anti-HBcIgG indicates previous or ongoing HBV infection. Surface antigen HBsAg is present in acute and chronic infection. Core antigen Anti-HBcIgM indic
The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best rationale for the nurse to explain the test to the patient?
a. Indicates ongoing infection with HBV
b. Indicates co-infection with HBV and HDV
c. Indicates pre
d. HBV DNA quantitation is the best indicator of viral replication and effectiveness of therapy for chronic
HBV. HBsAg is present in acute or chronic infection. HBeAg indicates high infectivity and can also be used to determine clinical management of pati
Although HAV antigens are not tested in the blood, they stimulate specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies. Which antibody indicates there is acute HAV infection?
a. Anti-HBc IgG c. Anti-HAV IgG
b. Anti-HBc IgM d. Anti-HAV IgM
d. Anti-HAV immunoglobulin M (IgM) indicates acute
HAV infection. Anti-HBc immunoglobulin G (IgG) indicates previous or ongoing infection with HBV. Anti- HBc IgM indicates acute HBV infection. Anti-HAV IgG indicates previous infection with HAV.
What test will be done before prescribing treatment for the patient with positive testing for HCV? Nursing Management: Liver, Pancreas, and Biliary Tract Problems a. Anti-HCV
b. HCV genotyping c. HCV RNA quantitation
d. Recombinant immunoblot assay (RIBA)
b. HCV genotyping is done to predict HCV response to drug therapy. Anti-HCV and HCV RNA quantitation are tests completed to diagnose HCV. Recombinant immunoblot assays are used to confirm anti-HCV reactivity.
What causes the systemic effects of viral hepatitis? a. Cholestasis b. Impaired portal circulation c. Toxins produced by the infected liver d. Activation of the complement system by antigen-antibody complexes
d. The systemic manifestations of rash, angioedema, arthritis, fever, and malaise in viral hepatitis are caused
by the activation of the complement system by circulating immune complexes. Liver manifestations include jaundice from hepatic cell damage and
During the incubation period of viral hepatitis, what should the nurse expect the patient to report? a. Pruritus and malaise
b. Dark urine and easy fatigability
c. Anorexia and right upper quadrant discomfort
d. Constipation or diarrhea with light-colored
c. Incubation symptoms occur before the onset of jaundice and include a variety of gastrointestinal (GI) symptoms as well as discomfort and heaviness in the upper right quadrant of the abdomen. Pruritus, dark urine, and light-colored stools occur with the
The occurrence of acute liver failure is most common in which situation?
a. An individual with hepatitis A c. Antihypertensive medication use
b. An individual with hepatitis C d. Use of acetaminophen with alcohol abuse
d. The most common cause of acute liver failure is drugs, usually acetaminophen in combination with alcohol abuse. HBV is the second most common cause.
Following a needle stick, what is used as prophylaxis against HBV?
a. Interferon c. Hepatitis B immune globulin (HBIG) b. HBV vaccine d. HBV vaccine and HBIG
d. HBV vaccine and hepatitis B immune globulin (HBIG) are used together prophylactically after a needle stick. Interferon is used to treat chronic HBV.
The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?
a. "No immunization is available for hepatitis A, nor are you likely to get the disease.
c. Individuals who have been exposed to hepatitis A through household contact or foodborne outbreaks should be given immune globulin within 1 to 2 weeks of exposure to prevent or modify the illness. Hepatitis A vaccine is used to provide preexposure immun
A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?
a. "Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon."
b. "There are no
c. Nucleoside and nucleotide analogs (e.g., lamivudine), ribavirin, and pegylated interferon are used to treat chronic
hepatitis B or C. Protease inhibitors are also used to treat chronic hepatitis C. No specific drugs are effective in treating acute vira
The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement? a. "I should avoid alcohol completely for as long as a year."
b. "I must avoid all physical contact with my family until the jaundice is gone."
c. "I
b. The patient with hepatitis B is infectious for 4 to 6 months and precautions to prevent transmission through percutaneous and sexual contact should be maintained
until tests for HbsAg or Anti-HBcIgM are negative. Close contact does not have to be avoid
What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis? a. Providing adequate nutritional intake
b. Promoting strict bed rest during the icteric phase
c. Providing pain relief without using liver-m
a. Adequate nutrition is especially important in promoting regeneration of liver cells but the anorexia of viral hepatitis is often severe, requiring creative and innovative nursing interventions. Strict bed rest is not usually required, and the patient u
When caring for a patient with autoimmune hepatitis, the nurse understands that what in this patient is different from the patient who has viral hepatitis?
a. Does not manifest hepatomegaly or jaundice
b. Experiences less liver inflammation and damage
c.
c. Immunosuppressive agents are indicated in hepatitis associated with immune disorders to decrease liver damage caused by autoantibodies. Autoimmune hepatitis is similar to viral hepatitis in presenting signs and symptoms and may become chronic and lead
. The patient has been newly diagnosed with Wilson's disease and D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect?
a. Pruritus c. Corneal Fleischer rings
b. Acute kidney injury d. Elevated serum iron
c. Corneal Fleischer rings, brownish red rings in the cornea near the limbus, are the hallmark of Wilson's disease. Pruritus (not seen with Wilson's disease) is commonly seen with jaundice or primary biliary cirrhosis. Renal failure associated with hepato
The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What diagnosis should the nurse expect for this patient?
a. Cirrhosis c. Hepatorenal syndrome
b. Acute live
d. The majority of patients with primary sclerosing cholangitis (PSC) also have ulcerative colitis. The manifestations are otherwise similar to cirrhosis and PSC may lead to cirrhosis, liver failure, and liver cancer
. A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?
a. Weight loss
b. Diabetes management
c. Ulcerative colitis dietary changes
d. Dieta
a, c, d. The anemia of cirrhosis is related to overactivity of the enlarged spleen that removes blood cells from circulation. Vitamin B deficiencies from altered intake and metabolism of nutrients and decreased prothrombin production can increase bleeding
A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?
a. Weight loss
b. Diabetes management
c. Ulcerative colitis dietary changes
d. Dietary
. a, b, d. There is no treatment for nonalcoholic fatty liver disease (NAFLD) except to control the other diseases
that are frequently diagnosed in these individuals. These measures include weight loss for obesity, control of blood glucose for diabetes, c
Which manifestations may be seen in the patient with cirrhosis related to esophageal varices?
a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction
b. Loss of the small bile ducts and cholestasis and cirrhosis in
c. Esophageal varices occur when collateral channels of circulation develop inelastic fragile veins as a result of portal hypertension. Portal hypertension is from scarring and nodular changes in the liver leading to compression of the veins and sinusoids
Which conditions contribute to the formation of abdominal ascites?
a. Esophageal varices contribute to 80% of variceal hemorrhages
b. Increased colloidal oncotic pressure caused by decreased albumin production
c. Hypoaldosteronism causes increased sodium
. d. Blood flow through the portal system is obstructed and causes portal hypertension that increases the blood pressure in the portal venous system. Decreased albumin production leads to decreased serum colloidal oncotic pressure that contributes to asci
What laboratory test results should the nurse expect to find in a patient with cirrhosis? a. Serum albumin: 7.0 g/dL (70 g/L)
b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L)
c. Serum cholesterol: 260 mg/dL (6.7 mmol/L)
d. Aspartate aminotransferase (AST): 6.0
b. Serum bilirubin, both direct and indirect, would be expected to be increased in cirrhosis. Serum albumin
and cholesterol are decreased and liver enzymes,
such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT), are initially elevate
Malnutrition can be a big problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?
a. Oral hygiene before meals and snacks c. Improve oral intake by feeding the patient
b. Provide all foods the patient likes to
Oral hygiene may improve the patient's taste sensation. Food preferences are important but some foods may be restricted if the patient is on a low-sodium diet. The patient will feel more independent with self-feeding and will be more likely to increase in
The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)? a. GI bleeding d. Body image disturbances
b. Hypokalemia e. Increased clotting tendencies
c. Renal function
b, c. With diuretic therapy, fluid and electrolyte balance must be monitored; serum levels of sodium, potassium, chloride, and bicarbonate must be monitored, especially hypokalemia. Renal function must be monitored with blood urea nitrogen and serum creat
What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy? a. Manifests asterixis c. Has increasing oliguria
b. Becomes unconscious d. Is irritable and lethargic
d. Early signs (grade 1) of this neurologic condition include changes in mentation (e.g., depression, apathy, irritability, confusion, agitation, drowsiness, lethargy).
Loss of consciousness (grade 4) is usually preceded by asterixis (grades 2 and 3), dis
To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give t
c. Ammonia must be reduced to treat hepatic encephalopathy. The laxative, lactulose, decreases ammonia by trapping the ammonia and eliminating it in the feces. A ?-adrenergic blocker will be used to decrease portal venous pressure and decrease variceal bl
Priority Decision: The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
a. Turn the patient every 3 hours. c. Assist the patient to the bathroom.
b. Encourage increasing ambulation. d. Prevent constipat
c. The patient may not be oriented or able to walk to the bathroom alone because of hyperreflexia, asterixis, or decreased motor coordination. Turning should be done every 2 hours to prevent skin breakdown. Activity is
limited to decrease ammonia as a by-
A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient?
a. Peanut butter and salt-free cracke
. b. The patient with advanced, complicated cirrhosis requires a high-calorie, high-carbohydrate diet with moderate
to low fat. Patients with cirrhosis are at risk for edema
and ascites and their sodium intake may be limited. The tomato sandwich with salt
The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?
a. Alcohol intake is now okay.
b. HBIG will be required to prevent rejection.
c. Elevate the head 30 degrees to improve ven
d. Monitoring for viral, fungal, and bacterial infection after the liver transplant is essential, as only fever may be present with an infection. Alcohol will not be any better for the patient after the transplant than it was before the transplant. HBIG i
Priority Decision: During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do?
a. Prepare the patient for immediate portal shunting surgery.
b. Perform guaiac testing on all stools to detect
c. Bleeding esophageal varices are a medical emergency. During an episode of bleeding, management of the airway and prevention of aspiration of blood are critical factors. Occult blood as well as fresh blood from the GI tract would be expected. Vasopressi
A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portacaval shunt. As a result of this procedure, what should the nurse expect the patient to experience?
a. An improved survival rate c. Improved metabolism
d. By shunting fluid sequestered in the peritoneum into the venous system, pressure on esophageal veins is decreased and more volume is returned to the circulation, improving cardiac output and renal perfusion. However, because ammonia is diverted past th
In discussing long-term management with the patient with alcoholic cirrhosis, what should the nurse advise the patient?
a. A daily exercise regimen is important to increase the blood flow through the liver.
b. Cirrhosis can be reversed if the patient foll
c. Abstinence from alcohol is very important in alcoholic cirrhosis and may result in improvement if started when liver damage is limited. Although further liver damage
may be reduced by rest and nutrition, most changes in the liver cannot be reversed. Ex
A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?
a. Chemotherapy is highly successful in the treatment of liver cancer.
b. The patient will undergo surgery to remove the involved
c. Because the prognosis for cancer of the liver is poor and treatment is largely palliative, supportive nursing care is appropriate. The patient exhibits clinical manifestations
of liver failure, as seen in any patient with advanced liver failure. Whethe
A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse?
a. "Liver transplants are indicated only in young people with irreversible liver disease."
b. "If you are interested in a transpla
d. Liver transplantation is indicated for patients with cirrhosis as well as for many adults and children with other irreversible liver diseases. Although health care providers make the decisions regarding the patient's qualifications for transplantation,
Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis? a. Tetany
b. Pseudocyst c. Pleural effusiond. Pancreatic abscess
d. A pancreatic abscess is a collection of pus that must
be drained to prevent infection of adjacent organs and sepsis. Tetany from hypocalcemia is treated with IV calcium gluconate (10%). Although pseudocysts usually resolve spontaneously, they may be tr
When assessing a patient with acute pancreatitis, the nurse would expect to find
a. hyperactive bowel sounds. c. a temperature greater than 102�F (38.9�C).
b. hypertension and tachycardia. d. severe midepigastric or left upper quadrant (LUQ) pain.
d. The predominant symptom of acute pancreatitis is severe, deep abdominal pain that is usually located in the left upper quadrant (LUQ) but may be in the midepigastrium. Bowel sounds are decreased or absent, temperature is elevated only slightly, and the
Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis?
a. Increased serum calcium c. Increased urinary amylase b. Increased serum amylase d. Decreased serum glucose
. Although serum lipase levels and urinary amylase
levels are increased, an increased serum amylase level
is the criterion most commonly used to diagnose acute pancreatitis in the first 24 to 72 hours. Serum calcium levels are decreased.
What treatment measure is used in the management of the patient with acute pancreatitis? a. Surgery to remove the inflamed pancreas
b. Pancreatic enzyme supplements administered with meals
c. Nasogastric (NG) suction to prevent gastric contents from enter
c. Pancreatic rest and suppression of secretions are promoted by preventing any gastric contents from entering the duodenum, which would stimulate pancreatic activity. Surgery is not indicated for acute pancreatitis but may
be used to drain abscesses or c
A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care?
a. Provide diversi
c. Positions that flex the trunk and draw the knees up to the abdomen help to relieve the pain of acute pancreatitis and positioning the patient on the side with the head elevated decreases abdominal tension. Diversional techniques are not as helpful as p
The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement?
a. "I should observe for fat in my stools."
b. "I must not use alcohol to prevent future attacks of pancreatitis."
c. "I shou
c. Sodium restriction is not indicated for patients recovering from acute pancreatitis but the stools should be observed for steatorrhea, indicating that fat digestion is impaired, and glucose levels may be monitored for indication of impaired ?-cell func
What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis?
a. The need to abstain from alcohol c. Malabsorption and diabetes mellitus
b. Experience acute abdominal pain d. Require a high-carbohydrate, high-
c. Chronic damage to the pancreas causes a deficiency of digestive enzymes and insulin resulting in malabsorption and diabetes mellitus. Abstinence from alcohol is necessary in both types of pancreatitis, as is a high-carbohydrate, high-protein, and low-f
The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)?
a. Avoid nicotine.
b. Eat bland foods.
c. Observe stools for steatorrhea.
d. Eat high-fat, lo
a, b, c. Measures to prevent attacks of pancreatitis are
those that decrease the stimulation of the pancreas. Lower fat intake and foods that are less stimulating and irritating (bland) should be encouraged. Higher carbohydrates are less stimulating. Avoi
What is a risk factor associated with cancer of the pancreas?
a. Alcohol intake b. Cigarette smoking
c. Exposure to asbestosd. Increased dietary intake of spoiled milk products
b. Major risk factors for pancreatic cancer are cigarette smoking, high-fat diet, diabetes, and exposure to benzidine. Pancreatic cancer is not directly associated with alcohol intake, as pancreatitis is. Chronic pancreatitis is a risk factor for pancreat
In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?
a. Stomach b. Pancreas c. Common bile duct d. Duodenum adjo
d. In a Whipple procedure the head of the pancreas, gallbladder, part of the duodenum adjacent to the pancreas, and sometimes the pylorus of the stomach
are removed. The duodenum is responsible for the breakdown of food in the small intestine and regulate
Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply).
a. Obesity
b. Age over 40
c. Multiparous female
d. History of excessive alcohol intake
e. Family history of gallbladder disease
a, b, c, e, f. Incidence of cholelithiasis is higher in women, multiparous women, persons over 40 years of age, and those with family history and obesity. Postmenopausal women taking estrogen therapy have a higher incidence than women taking oral contrace
. Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)?
a. Fasting b. Hypothyroidism
c. Parenteral nutrition
d. Prolonged immobility
e. Streptococcus pneumon
a, c, d. Acalculous cholecystitis is associated with prolonged immobility, fasting, prolonged parenteral nutrition, and diabetes mellitus. Hypothyroidism, Streptococcus pneumoniae, and absence of bile in the intestine are unrelated to this condition.
A patient with an obstruction of the common bile duct has clay-colored fatty stools, among other manifestations. What is the pathophysiologic change that causes this clinical manifestation?
a. Soluble bilirubin in the blood excreted into the urine b. Abse
b. Absence of bile salts in the intestine and duodenum lead to clay-colored stools and steatorrhea. Soluble bilirubin
in the blood excreted into the urine leads to dark urine. Contraction of the inflamed gallbladder leads to pain with fatty food intake. O
The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?
a. It is noninvasive and is a very reliable method of detecting gallstones.
b. It is used only
a. Ultrasonography is 90% to 95% accurate in detecting gallstones and is a noninvasive procedure. An IV cholangiogram uses radiopaque dye to outline the gallbladder and the ducts. Liver function tests will be elevated if liver damage has occurred but do n
What treatment for acute cholecystitis will prevent further stimulation of the gallbladder? a. NPO with NG suction c. Administration of antiemetics b. Incisional cholecystectomy d. Administration of anticholinergics
a. NPO and nasogastric (NG) suction prevent gallbladder stimulation by food or fluids moving into the duodenum. Incisional choleycystectomy removes the gallbladder, not its stimulation. Administration of antiemetics decreases nausea and vomiting but does
Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care? a. Return to work in 2 to 3 weeks b. Be hospitalized for 3 to 5 days postoperatively c. Have a T-tube placed in the common bile duct to provide bile dra
d. The laparoscopic cholecystectomy requires one to four small abdominal incisions to visualize and remove the gallbladder and the patient has small dressings placed over these incisions. The patient with an incisional cholecystectomy is usually hospitali
A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse? a. "A low-fat diet will prevent the development of further gallstones and should
c. After removal of the gallbladder, bile drains directly
from the liver into the duodenum and a low-fat diet is recommended until adjustment to this change occurs. Most patients tolerate a regular diet with moderate fats but should avoid excessive fats,
What must the nurse do to care for a T-tube in a patient following a cholecystectomy? a. Keep the tube supported and free of kinks. b. Attach the tube to low, continuous suction. c. Clamp the tube when ambulating the patient. d. Irrigate the tube with 10-
a. The T-tube drains bile from the common bile duct until swelling from trauma has subsided and bile can freely enter the duodenum. The tube is placed to gravity drainage and should be kept open and free from kinks to prevent bile from backing up into the
During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching? a. Keep the incision areas clean and dry for at least a week. b. Report the need to take pain medication for shoulder pain
c. Bile-colored drainage or pus from any incision may indicate an infection and should be reported to the health care provider immediately. The bandages on the puncture sites should be removed the day after surgery, followed by bathing or showering. Refer