Chapter 31: Care of Patients with Disorders of the Gallbladder, Liver, and Pancreas My Nursing Test Banks

Chapter 31: Care of Patients with Disorders of the Gallbladder, Liver, and Pancreas

MULTIPLE CHOICE

1. A patient who has had his fifth attack of gallstones is encouraged to have a cholecystectomy to prevent the threat of:

a.

further attacks.

b.

nutritional compromise.

c.

cancer of the gallbladder.

d.

hepatitis.

ANS: C

Repeated gallstone attacks with their attendant gallbladder inflammation can lead to cancer of the gallbladder.

DIF: Cognitive Level: Comprehension REF: 694 OBJ: 1 (theory)

TOP: Cholelithiasis: Cholecystectomy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. A patient comes to the emergency department with the complaint of severe vomiting and nausea and a temperature elevation to 101 F. The patient complains of stomach pain that radiates to his right scapula. These assessments suggest:

a.

cholecystitis.

b.

hepatitis.

c.

pancreatitis.

d.

gastroenteritis.

ANS: A

All the symptoms and signs alert the medical staff to the probability of cholecystitis. Hepatitis causes liver dysfunction, including jaundice. Pancreatitis causes abdominal pain that is usually acute, but this can vary among individuals. The pain is steady and is localized to the epigastrium or left upper quadrant. Gastroenteritis causes nausea, vomiting, and diarrhea.

DIF: Cognitive Level: Application REF: 691 OBJ: 2 (theory)

TOP: Cholecystitis: Signs and Symptoms

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

3. The nurse explains to a patient with cholelithiasis that the purpose of the cholescintigraphy (HIDA scan) is to:

a.

visualize the location of the gallstones.

b.

assess the amount of inflammatory swelling.

c.

diagnose abnormal contraction of the gallbladder.

d.

assess composition of the gallstones.

ANS: C

The HIDA scan can diagnose abnormal contractions of the gallbladder, which occur in the presence of gallstones or a gallbladder that is not functioning properly.

DIF: Cognitive Level: Comprehension REF: 692 OBJ: 1 (theory)

TOP: Cholelithiasis: HIDA Scan KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

4. The nurse is caring for a patient diagnosed with gallstones. The patients medical record indicates the presence of two gallstones less than 1.5 inches. The patient is obese and has a history of insulin-dependent diabetes. The patient asks the nurse why he could not have a lithotripsy. The nurse points out that the criteria for the procedure are rigid and that he failed to meet them because:

a.

he has only two gallstones.

b.

the gallstones are all less than 1.5 inches.

c.

he is obese.

d.

he is diabetic.

ANS: C

Lithotripsy is not effective on obese persons. The three criteria are as follows: the gallstones must be fewer than three, of no more than 1.5 inches in diameter, and the patient must not be obese.

DIF: Cognitive Level: Application REF: 693 OBJ: 1 (theory)

TOP: Lithotripsy: Criteria KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

5. A patient who had a laparoscopic cholecystectomy 4 hours ago complains of fullness in the abdomen and mild discomfort. Because his vital signs are stable, the nurse should:

a.

ambulate the patient to reduce gas.

b.

notify the charge nurse of possible hemorrhage.

c.

position the patient in high Fowlers.

d.

give the ordered PRN analgesic.

ANS: A

Ambulation helps relieve gas. After a laparoscopic procedure, retained CO2 causes free air pain. The stable vital signs indicate no threat of hemorrhage.

DIF: Cognitive Level: Analysis REF: 692 OBJ: 2 (theory)

TOP: Laparoscopic Surgery: Free Air KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

6. In a patient who had a cholecystectomy 3 days ago, the nurse assesses that the bile is no longer obstructed from entering the bowel by the appearance of:

a.

excessive flatus.

b.

dark brown stool.

c.

dark urine.

d.

increased appetite.

ANS: B

Darkening of stools back to the normal color indicates that the bile has reached the duodenum.

DIF: Cognitive Level: Application REF: 693 OBJ: 1 (clinical)

TOP: Assessment of Bile Flow: Dark Stool

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. The nurse explains that the jaundice observed in a person with hepatitis is related to the:

a.

ischemia of the liver.

b.

increased bile production by the enlarged Kupffer cells.

c.

destruction of RBCs by the hepatitis virus.

d.

congestion in the liver obstructing bile flow.

ANS: D

Congestion from the inflammation obstructs the bile from entering the duodenum and keeps it in the circulating volume.

DIF: Cognitive Level: Analysis REF: 693 OBJ: 4 (theory)

TOP: Hepatitis: Jaundice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse reading the laboratory reports for a patient with acute hepatitis is aware that an indicator supporting this diagnosis is:

a.

elevated aspartate aminotransferase (AST).

b.

decreased alanine aminotransferase (ALT).

c.

decreased g-glutamyl transpeptidase (GGT).

d.

increased prothrombin time.

ANS: D

During the acute phase of hepatitis the patient will likely have an elevation of aspartate aminotransferase (AST). Levels of alanine aminotransferase and g-glutamyl transpeptidase will be elevated. Prothrombin times will be prolonged.

DIF: Cognitive Level: Analysis REF: 696 OBJ: 4 (theory)

TOP: Hepatitis B: Diagnostic Tests KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse recommends that he get immediate protection by acquiring:

a.

a prescription for a broad-spectrum antibiotic.

b.

a prescription for an antiviral agent.

c.

the first of the three immunizations for HBV.

d.

an injection of hepatitis B immune globulin (HBIG).

ANS: D

HBIG will give immediate passive immunity. Immunization for HBV takes too long for immediate coverage. Oral medications are of little value at this stage.

DIF: Cognitive Level: Application REF: 698 OBJ: 3 (theory)

TOP: HBV: Immune Globulin KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

10. In caring for a patient with hepatitis B, the nurse would follow:

a.

Standard Precautions.

b.

strict isolation.

c.

Contact Precautions.

d.

surgical asepsis.

ANS: A

Standard Precautions are needed to care for a patient with hepatitis B. Isolation and Contact Precautions are not indicated for this diagnosis. There are no reports of treatments needing surgical asepsis.

DIF: Cognitive Level: Application REF: 698 OBJ: 3 (theory)

TOP: HBV: Standard Precautions KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

11. The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of a(n):

a.

liver biopsy.

b.

elevated aspartate aminotransferase (AST).

c.

elevated alanine aminotransferase (ALT).

d.

elevated lactate dehydrogenase (LDH).

ANS: A

Liver biopsy is the definitive test. The other tests will be elevated, but they are not specific for cirrhosis.

DIF: Cognitive Level: Comprehension REF: 702 OBJ: 5 (theory)

TOP: Cirrhosis: Diagnosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

12. The nurse assesses that a patient with cirrhosis is deteriorating when there is evidence of:

a.

an increase in urine output related to the effect of the diuretics.

b.

a decrease in total bilirubin.

c.

confusion related to rising ammonia levels.

d.

a decrease in jaundice.

ANS: C

The rising ammonia level indicates that the various therapies have not been effective and the patient continues to deteriorate.

DIF: Cognitive Level: Application REF: 703 | 707 OBJ: 5 (theory)

TOP: Cirrhosis: Signs of Deterioration KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. A patient with cirrhosis complains of the blandness of the low-protein diet and questions its effectiveness. The nurse reminds the patient that the low-protein diet helps his condition by:

a.

decreasing the production of ammonia.

b.

decreasing the production of urea.

c.

supporting the manufacture of clotting factors.

d.

decreasing the production of albumin.

ANS: A

The low-protein diet reduces the production of ammonia, the metabolic toxin that can cause hepatic coma. Protein is broken down in the bowel, and one of its metabolites is ammonia.

DIF: Cognitive Level: Application REF: 703 OBJ: 5 (theory)

TOP: Cirrhosis: Low-Protein Diet KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

14. The physician has prescribed neomycin enemas for a patient with cirrhosis. The patient questions why they are being used. Which response by the nurse is most appropriate?

a.

These enemas help prevent infection.

b.

These enemas help reduce straining during a bowel movement.

c.

These enemas kill intestinal flora.

d.

These enemas aid in reducing ascites.

ANS: C

Neomycin is occasionally given orally or by enema to decrease the colonic bacteria that break down protein. This treatment lowers the formation of ammonia. The bowel is cleansed by enemas to decrease ammonia production further.

DIF: Cognitive Level: Application REF: 703 OBJ: 5 (theory)

TOP: Cirrhosis: Neomycin KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

15. A patient with esophageal varices is receiving potent vasoconstrictors to help prevent hemorrhage. The nurse will be concerned if the patient complains of pain in the:

a.

chest.

b.

flank area.

c.

lower legs.

d.

back.

ANS: A

With the use of potent vasoconstrictors such as vasopressin (Pitressin), which constricts all vessels, the possibility of it causing an MI is a very real concern.

DIF: Cognitive Level: Analysis REF: 707 OBJ: 5 (theory)

TOP: Vasoconstrictors: Possible Myocardial Infarction (MI)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

16. The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patients umbilicus. This finding is best reported as:

a.

effect of increased amylase.

b.

indication of retroperitoneal hemorrhage.

c.

inflammatory response to a possible pseudocyst.

d.

abdominal distention related to ascites.

ANS: B

A bluish tinge around the umbilicus or in the flank area indicates a retroperitoneal hemorrhage.

DIF: Cognitive Level: Analysis REF: 709 OBJ: 10 (theory)

TOP: Pancreatitis: Retroperitoneal Hemorrhage

KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance

17. The nurse is caring for a patient diagnosed with hepatitis during the posticteric phase of the condition. When planning care, which intervention should be of the highest priority?

a.

Encouraging frequent rest periods

b.

Monitoring intake and output

c.

Taking a daily weight

d.

Encouraging compliance with a low-sodium diet

ANS: A

The posticteric phase begins when jaundice is disappearing. Convalescence may take 2 to 4 months. Major complaints are malaise and fatigue.

DIF: Cognitive Level: Application REF: 695-696 OBJ: 2 (clinical)

TOP: Hepatitis: Signs and Symptoms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

18. The nurse is caring for a patient being treated for recurrent gallstones. The patient questions the need to have the stones removed, voicing a concern about the condition causing cancer. What statement by the nurse is most correct?

a.

The presence of gallstones is not linked to the development of cancer.

b.

Only those patients with gallstones having multiple health concerns are at risk for the development of cancer.

c.

Gallstones cause an irritation which is linked to an increase in the incidence of cancer.

d.

The pathological analysis of gallstones will tell if they are the type linked to cancer.

ANS: C

Constant irritation of the gallbladder may lead to cancer of the gallbladder.

DIF: Cognitive Level: Comprehension REF: 694 OBJ: 1 (clinical)

TOP: Gallbladder: Complications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate?

a.

If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A.

b.

Hepatitis A is not transmitted as a result of close contact with an infected individual.

c.

Hepatitis A transmission is associated with contact with infected body fluids.

d.

Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries.

ANS: B

Hepatitis A and hepatitis E viruses are transmitted primarily by the fecal-oral route. They are responsible for the epidemic forms of viral hepatitis. Hepatitis A virus can be transmitted by food handlers to customers or by mollusk shellfish from contaminated waters. Hepatitis B is transmitted via infected blood and body fluids. Hepatitis E virus infection is primarily seen in less developed countries.

DIF: Cognitive Level: Application REF: 694 OBJ: 3 (theory)

TOP: Hepatitis: Etiology and Pathophysiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

20. The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (Select all that apply.)

a.

Obesity

b.

Daily exercise regimen

c.

Diabetes mellitus

d.

Taking cholesterol-lowering drugs

e.

Mexican American ethnicity

ANS: A, C, D, E

Cholelithiasis is the presence of gallstones within the gallbladder or in the biliary tract. All options listed are risk factors for the development of gallstones except a daily exercise regimen. A sedentary lifestyle is a risk factor for cholelithiasis.

DIF: Cognitive Level: Comprehension REF: 691 OBJ: 1 (theory)

TOP: Cholelithiasis: Risk Factors KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21. The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found not only in blood but also in: (Select all that apply.)

a.

semen.

b.

vaginal secretions.

c.

sweat.

d.

breast milk.

e.

human feces.

ANS: A, B, D, E

Hepatitis B, C, and D viruses may cause chronic inflammation and necrosis of the tissue. Hepatitis B and C viruses are transmitted by parenteral routes and sexually as they are present in semen, vaginal secretions, and saliva of carriers, as well as breast milk and human feces. HBV is not transmitted through sweat. Sexual partners of patients who are carriers of hepatitis B or C virus are at high risk for contracting the virus.

DIF: Cognitive Level: Comprehension REF: 694 OBJ: 3 (theory)

TOP: HBV: Body Fluids KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis blocks the blood flow through the liver, the result is: (Select all that apply.)

a.

portal hypertension.

b.

decrease in metabolic processes of the liver.

c.

decrease in clotting factors.

d.

increase in ascites.

e.

decrease in aldosterone.

ANS: A, B, C, D

Cirrhosis is a progressive, chronic disease of the liver. The destruction of normal hepatic structures and their replacement with necrotic tissue occur. Fibrous bands of connective tissue develop in the organ. The bands eventually constrict and partition the liver tissue into irregular nodules. If this process is halted before too much liver tissue is damaged, the liver tissue will regenerate. Late cirrhosis is considered irreversible. The outcomes of cirrhosis of the liver are failure of its cells to perform their functions and the development of portal hypertension. Aldosterone levels are increased rather than decreased.

DIF: Cognitive Level: Comprehension REF: 703-704 OBJ: 6 (theory)

TOP: Cirrhosis: Pathophysiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

23. The nurse plans for the skin care of the patient with ascites, which would include: (Select all that apply.)

a.

bathing in tepid water.

b.

applying emollients to decrease itching.

c.

cutting the patients fingernails short.

d.

changing the patients position every 1 to 2 hours.

e.

coaching in deep-breathing exercises.

ANS: A, B, C, D

Deep breathing, although a good intervention in certain situations, has nothing to do with skin care.

DIF: Cognitive Level: Application REF: 706 OBJ: 5 (theory)

TOP: Cirrhosis: Skin Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. A patient with advanced cirrhosis develops esophageal varices as a direct result of portal hypertension. The nurse anticipates that this complication will be addressed by: (Select all that apply.)

a.

insertion of a Blakemore-Sengstaken tube.

b.

administration of IV vasopressin (Pitressin).

c.

administration of vitamin B.

d.

lactulose to empty swallowed blood in colon.

e.

vasoconstrictors to reduced portal blood flow.

ANS: A, B, D, E

All treatment modalities are appropriate to intervene for esophageal varices except administration of vitamin B. The nurse can expect to administer vitamin K.

DIF: Cognitive Level: Application REF: 703-704 OBJ: 5 (theory)

TOP: Esophageal Varices: Treatment KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse caring for a patient with acute pancreatitis will include in the daily assessments: (Select all that apply.)

a.

auscultation of bowel sounds to detect paralytic ileum.

b.

amount of food eaten each meal.

c.

abdominal girth to detect ascites.

d.

effectiveness of pain control.

e.

urine output.

ANS: A, B, D, E

People with pancreatitis are NPO.

DIF: Cognitive Level: Application REF: 709-710 OBJ: 3 (clinical)

TOP: Pancreatitis: Essential Assessments

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

26. The nurse explains that bile salts deposited in the skin cause jaundice and also cause _____.

ANS:

pruritus

Bile salts deposited in the skin cause both jaundice and pruritus.

DIF: Cognitive Level: Comprehension REF: 694 OBJ: 4 (theory)

TOP: Jaundice: Pruritus KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27. The nurse reinforces that the immunization for HBV is believed to provide _____ immunity.

ANS: lifelong

DIF: Cognitive Level: Comprehension REF: 698 OBJ: 3 (theory)

TOP: HBV Immunization: Effectiveness KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MATCHING

Match the hepatitis virus (HV) with the characteristics that best describe it.

a.

HAV

b.

HBV

c.

HCV

d.

HDV

e.

HEV

28. Transmission by contact with blood and body fluids, perinatal transmission from mother to infant

29. Prevalent in less developed countries

30. Most likely to lead to cirrhosis

31. Coexists with HBV

32. Fecal-oral transmission, acute onset

28. ANS: B DIF: Cognitive Level: Analysis REF: 695

OBJ: 3 (theory) TOP: Hepatitis Differences

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

29. ANS: E DIF: Cognitive Level: Analysis REF: 695

OBJ: 3 (theory) TOP: Hepatitis Differences

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

30. ANS: C DIF: Cognitive Level: Analysis REF: 695

OBJ: 3 (theory) TOP: Hepatitis Differences

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

31. ANS: D DIF: Cognitive Level: Analysis REF: 695

OBJ: 3 (theory) TOP: Hepatitis Differences

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

32. ANS: A DIF: Cognitive Level: Analysis REF: 695

OBJ: 3 (theory) TOP: Hepatitis Differences

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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