When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should the nurse include?
Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and
A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the
In the patient with alcohol abuse, liver disease could develop as a complication, increasing the liver function tests above the normal levels. Normal ALT range is 7--56 IU/L and normal AST range is 5--40 IU/L. Diabetes would result in elevated blood sugar
The nurse evaluates the effectiveness of a paracentesis in a patient who has ascites. Which measurement is most important for the nurse to note?
Paracentesis involves the removal of fluid from the abdominal cavity. A large-bore needle connected to tubing is inserted by the healthcare provider into the distended abdomen. The other end of the tubing also has a large-bore needle, which is inserted in
When teaching the male patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?
The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepati
The patient with advanced cirrhosis asks why his or her skin is so yellow. The nurse's response is based on the knowledge that
Jaundice results from the functional derangement of liver cells and compression of bile ducts by connective tissue overgrowth. Jaundice occurs as a result of the decreased ability to conjugate and excrete bilirubin Jaundice is not caused by a build-up of
The parent of a pediatric patient suffering from hepatitis A approaches the nurse and is worried about the spread of infection to other family members through use of the same bathroom. What should the nurse advise the patient's parent? Select all that app
Hepatitis A spreads through the fecal-oral route. Transmission is prevented by maintaining hygiene. Proper hand washing is extremely important in preventing the spread of the virus. Buying a separate commode is unnecessary. Thorough cleaning of the bathro
The nurse provides discharge instructions to a patient with newly diagnosed cirrhosis. Which statement made by the patient indicates the need for further teaching?
Even though a low-protein diet has been questioned in the treatment of patients with cirrhosis, it remains in use. In light of this, it is incorrect for the patient to say that he may eat anything. Patients with cirrhosis must also avoid alcohol. Frequent
What are the precautions that nurses and hospital staff should follow while handling patients suffering from hepatitis infections? Select all that apply.
Hepatitis A spreads through the fecal-oral route, and hepatitis B spreads through blood. Hence the virus can spread through needles and syringes used by the patient. Also, the virus can spread while the nurse is handling the urine or fecal material of the
A patient with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. What is the most important information for the nurse to include in the teaching plan for this patient?
Straining during a bowel movement increases venous pressure and could cause rupture of the varices. Fluid restrictions may be a recommendation for ascites but are not directly associated with esophageal varices. If the patient is able to eat, meals should
The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention should the nurse expect to include in the patient's plan of care?
Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. Enteral feedings
A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess?
Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement
When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?
Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priority. Impaired skin integrity, imbalanced nutrition, and excess fluid volume are all seen in pat
What points should a nurse emphasize while teaching a patient ways to protect oneself from exposure to hepatitis B infection? Select all that apply.
Hepatitis B spreads through sexual contact and through blood. Sharing razors or toothbrushes with an infected person may introduce infection in another person's body. Similarly, a needle used by an infected person can spread the infection. Hepatitis B als
The nurse cares for a patient with advanced cirrhosis. What indicates that the patient is experiencing a serious complication?
The liver produces clotting factors. As cirrhosis becomes more advanced, the production of clotting factors is disrupted and thereby decreased, making the patient more susceptible to bleeding. Increasing frequency and severity of nosebleeds and bruising w
Which clinical manifestation of pain does the nurse expect to identify in a patient who has cholecystitis?
The pain of cholecystitis is in the region of the gallbladder (right upper quadrant), which is inflamed as a result of infection and irritation from bile. The pain may be referred to the right shoulder and scapula. Left flank pain with intermittent exacer
A patient with type 2 diabetes mellitus has been diagnosed with nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include which of the following?
NAFLD can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For those who are overwei
A patient has undergone cholecystectomy. What postoperative care should the nurse perform for this patient? Select all that apply.
After cholecystectomy, it is important to follow dietary restrictions. A diet low in fat decreases the workload of the liver. Bleeding is a complication after the procedure; hence the nurse should monitor it. It is important to position the patient in Sim
A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?
An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration, the abscess can be assesse
A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect?
Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. B
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?
Immunoglobulin provides temporary (one to two months) passive immunity and is effective for preventing hepatitis A if given within two weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclini
A nurse assessing a patient with pancreatitis suspects the presence of Grey Turner sign when the patient exhibits:
The Grey Turner sign includes a bluish discoloration, or ecchymosis, on the left or right flank area, the result of internal bleeding caused by pancreatitis. Jaundice of the sclera is associated with liver disorders and with increased serum bilirubin. Blu
A nurse is collecting data from a patient admitted with hepatitis A. Which information given by the patient may indicate the patient's susceptibility to contract hepatitis A? Select all that apply.
Hepatitis A spreads mainly through the fecal-oral route. People living in slums are also exposed to the virus, as food stuffs may be contaminated. Sewage may harbor this virus; hence sewage cleaners and plumbers may be exposed to it. Working as a waiter,
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient?
Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. Nothing by mouth status may be needed if the patient will have surgery, but will not be used for all patients with cholelithiasis. Entera
A patient with cirrhosis of the liver is admitted to the hospital. What hematologic symptoms might be noted in this patient? Select all that apply.
Hematologic problems include thrombocytopenia, leukopenia, anemia, and coagulation disorders. Anemia, leukopenia, and thrombocytopenia are probably caused by the splenomegaly that results from the backup of blood from the portal vein into the spleen (port
A patient with ascites is admitted to the hospital. What should be the primary nursing actions in this case? Select all that apply.
Management of ascites focuses on sodium restriction, diuretics, and fluid removal. The fluid and electrolytes should be closely monitored; an imbalance may lead to an increase in ascites. An albumin infusion may be used to help maintain intravascular volu
A patient has just undergone a liver transplant and is now in the intensive care unit (ICU). What nursing interventions are appropriate for this patient to prevent respiratory complications? Select all that apply.
The patient who has had a liver transplant requires highly skilled nursing care in an ICU or another specialized unit. To prevent respiratory complications, the patient should be encouraged to use measures such as coughing, deep breathing, and repositioni
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements? Select all that apply.
Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction. Vitamin
The nurse finds that a patient admitted to the hospital with cirrhosis of the liver is disoriented, lethargic, and drowsy and has abnormal reflexes. Based on the patient's signs and symptoms, the nurse understands that the patient is in grade ___ hepatic
Hepatic encephalopathy has 0 to 4 grades based on three factors: level of consciousness, intellectual function, and neurological findings. Grade 2 is characterized by lethargy, drowsiness, and inappropriate behavior (level of consciousness); disorientatio
A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication prescription should the nurse question because it is most likely to cause hepatic complications?
The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in t
A patient with cirrhosis of the liver has ascites and is being prepared for a paracentesis. What instructions should the nurse give the patient?
The nurse should instruct the patient to void prior to the paracentesis to prevent accidental puncture of the bladder. During the procedure, the patient sits on the side of the bed or is placed in high Fowler's position. There is no need to keep the patie
A patient suffering from cholelithiasis underwent a cholecystectomy. What dietary advice will the nurse give this patient? Select all that apply.
Having a high-fiber diet helps in the smoother passage of stools and prevents constipation. Having small and frequent meals helps digestion and prevents nausea. Fats make it harder to digest. After cholecystectomy, it is essential that the patient has an
The health care provider prescribes lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?
Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammon
A patient is diagnosed with acute pancreatitis. When providing dietary teaching, what are the points that a nurse should tell the patient? Select all that apply.
Consuming a low-fat, high-carbohydrate diet is essential in pancreatitis. Fats should be avoided because they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Alcohol is an irritant and must be avoided. Carbohydrates are les
The nurse suspects that a patient has hepatitis A. Which symptom will the patient most likely report developed first?
The preicteric phase of hepatitis is usually marked by severe anorexia, malaise, and fever. Itching and jaundice appear later in the hepatitis disease process in a stage known as the icteric phase. Ascites may develop as a long-term effect of diffuse live
The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons? Select all that apply.
Ascites related to cirrhosis is caused by decreased colloid oncotic pressure from the lack of albumin due to the liver's inability to synthesize it and the portal hypertension that shifts protein from the blood vessels to the peritoneal cavity, and hypera
A nurse is attending to a patient suffering from cirrhosis of the liver. What clinical manifestations should the nurse expect to find upon physical examination? Select all that apply.
Ecchymoses are small areas of bleeding into the skin or mucous membrane forming blue or purple patches. Because there is decreased synthesis of prothrombin in the liver, the bleeding and clotting time may be deranged. Telangiectasia is a vascular lesion f
A patient with pancreatic cancer is in the outpatient cancer center to receive radiation therapy. The nurse knows that radiation therapy for patients with pancreatic cancer is to:
Radiation therapy alone for pancreatic cancer has little effect on survival, but may be effective for pain relief. Radiation therapy does not reduce ascites, increase survival time, or inhibit tumor metastasis to other areas of the body.
A nurse is attending to a patient with jaundice. The health care provider instructs the nurse to prepare the patient for percutaneous liver biopsy. The nurse understands that presence of certain conditions may need the procedure to be rescheduled. Which c
To do a liver biopsy when a patient has marked ascites increases the risk of leakage of ascitic fluid. The liver biopsy should be postponed. A patient with low hemoglobin levels should not have a liver biopsy because the patient cannot take the risk of th
A patient suffering from ascites is admitted to the hospital. What are the factors that can lead to ascites development? Select all that apply.
Hyperaldosteronism or increased secretion of aldosterone causes ascites. Portal hypertension causes an increase in resistance to blood flow in the liver leading to ascites. When there is decreased serum colloidal oncotic pressure, there is impairment of s
When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome? Select all that apply
Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irr
A patient underwent pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer. What are the instructions that the nurse should include when giving dietary advice to this patient? Select all that apply.
Having a low-fat, high-carbohydrate, and high-protein diet is essential. The diet should be low in fat to decrease the work load of the liver and promote healing. A high-calorie diet should be provided, as more energy is required. High-calorie meals are n
A patient with hepatitis A is in the acute phase. The nurse plans care while anticipating that the patient may be experiencing which symptoms? Select all that apply.
The acute phase of hepatitis usually lasts from one to four months. During the incubation period, symptoms may include malaise, anorexia and weight loss, fatigue, nausea, occasional vomiting, and abdominal (right upper quadrant) discomfort. The patient ma
A patient with cancer of the head of the pancreas is admitted to the hospital. What are the manifestations that a nurse might expect to find in this patient? Select all that apply.
Tumor of the head of the pancreas will obstruct the common bile duct where it passes through the head of the pancreas to join the pancreatic duct and empty at the ampulla of Vater into the duodenum. The stools will be clay-colored when bile is not able to
Following a laparoscopic cholecystectomy, a patient without pre- or postoperative complications is being discharged from the hospital. What instructions should the nurse include in the discharge teaching? Select all that apply.
The patient who undergoes a laparoscopic cholecystectomy without complications may be discharged shortly after surgery. Therefore, it is important to teach the patient about care following discharge. The patient should be informed that he or she may take
A patient who underwent a cholecystectomy is now complaining of pain referred to his right shoulder. What is the most probable cause for this pain? Select all that apply.
The carbon dioxide that is used to inflate the abdomen during surgery may not be released or absorbed by the body and can irritate the phrenic nerve and diaphragm. This is the reason for breathing difficulty and the most common cause of shoulder pain foll
A patient with liver cancer is scheduled to receive radiofrequency ablation (RFA) therapy. The nurse knows that this treatment is appropriate for which of these?
In RFA, a thin needle is inserted into the core of the tumor. The electrical energy is used to create heat in a specific location for a limited time. The end result is destruction of tumor cells. This procedure can be done percutaneously, laparoscopically