Chapter 51 Hepatic, Biliary Tract, and Pancreatic Dysfunction: Nursing Management My Nursing Test Banks

Chapter 51 Hepatic, Biliary Tract, and Pancreatic Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A child care worker complains of flu-like symptoms. On further assessment, hepatitis is suspected. The nurse realizes that this individual is at risk for which type of hepatitis?

1.

Hepatitis A

2.

Hepatitis B

3.

Hepatitis C

4.

Hepatitis D

ANS: 1

Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater risk because of potentially poor hygiene practices. Child care workers are not at the same risk for contracting hepatitis B, C, or D.

PTS: 1 DIF: Analyze REF: Table 51-1 Comparison of the Types of Hepatitis

2.An older male is diagnosed with cirrhosis of the liver. The nurse knows that the most likely cause of this problem is:

1.

being in the military.

2.

traveling to a foreign country.

3.

drinking excessive alcohol.

4.

eating bad food.

ANS: 3

The destruction to the liver from alcohol often progresses from fatty liver to alcoholic hepatitis and culminates in alcoholic cirrhosis. Alcoholic cirrhosis accounts for a great number of individuals diagnosed with this disease. Cirrhosis is not associated with being in the military, traveling to a foreign country, or eating bad food.

PTS: 1 DIF: Analyze REF: Cirrhosis

3.When the liver is seriously damaged, ammonia levels can rise in the body. One of the treatments for this is:

1.

administering intravenous (IV) neomycin.

2.

giving vitamin K.

3.

giving lactulose.

4.

starting the patient on insulin.

ANS: 3

Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia levels.

PTS:1DIF:Analyze

REF: Hepatic Encephalopathy: Planning and Implementation

4.A client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess for is:

1.

infection.

2.

bleeding.

3.

pain.

4.

nausea and vomiting.

ANS: 2

After a liver biopsy, the client is monitored for bleeding or hemorrhage. Infection and pain are of concern, but they are not the most important signs to be monitored. Nausea and vomiting are not typically associated with a liver biopsy.

PTS: 1 DIF: Analyze REF: Nursing Strategy: Complications of a Liver Biopsy

5.The nurse realizes that the organ which is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, is the:

1.

spleen.

2.

gallbladder.

3.

liver.

4.

stomach.

ANS: 3

In most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases.

PTS: 1 DIF: Analyze REF: Cancer of the Liver: Secondary Liver Cancer

6.A school age child is placed on a waiting list for a liver transplant. The nurse knows that the most common reason for children to need this type of transplant is because of:

1.

cirrhosis due to hepatitis C.

2.

biliary atresia.

3.

diabetes.

4.

Crohns disease.

ANS: 2

Biliary atresia is the most common reason for children to have a liver transplant. Cirrhosis due to hepatitis C is the reason for most adults to have a transplant. Children do not typically need a liver transplant for diabetes or Crohns disease.

PTS: 1 DIF: Analyze REF: Liver Transplantation: Etiology

7.Because health care workers are at a greater risk of hepatitis B infection, it is recommended that all health care workers:

1.

wash their hands often.

2.

avoid foreign travel.

3.

become vaccinated.

4.

drink bottled water only.

ANS: 3

Because of the risk of blood and body fluid exposure, it is recommended that all health care workers be vaccinated against hepatitis B virus. All health care workers should engage in frequent handwashing, but handwashing is not the primary mechanism to prevent the onset of hepatitis B. Avoiding foreign travel and drinking bottled water only will not reduce the risk of hepatitis B.

PTS: 1 DIF: Analyze REF: Table 51-1 Comparison of the Types of Hepatitis

8.A client who usually smokes a pack of cigarettes a day tells the nurse that he cannot stand the smell of smoke. The nurse realizes that this client is in which phase of hepatitis?

1.

Preicteric

2.

Icteric

3.

Posticteric

4.

Recovery

ANS: 1

In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign of the disease. Smoking is not affected with the icteric or posticteric phases of the disease. Recovery is not a phase of hepatitis.

PTS: 1 DIF: Analyze REF: Box 51-3 Phases of Hepatitis

9.A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which of the following should the nurse respond to this client?

1.

It doesnt affect people until they are in their 50s.

2.

I would ask the doctor if hes sure about the diagnosis.

3.

Females often do not experience the effects of the disease until menopause.

4.

All women have the disorder but not the symptoms.

ANS: 3

Women do not experience the effects of hemochromatosis until menopause when the regular loss of blood stops. This disorder is a genetic disorder and can affect individuals of all ages. The nurse should not doubt the physicians diagnosis. All women do not have this disorder.

PTS: 1 DIF: Apply REF: Hereditary Diseases of the Liver

10.A client is diagnosed with liver disease. Which of the following is one impact of this disorder on a clients fluid and electrolyte status?

1.

Hyperkalemia

2.

Hypercalcemia

3.

Hypernatremia

4.

Hyponatremia

ANS: 4

Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia, hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or hypernatremia.

PTS: 1 DIF: Analyze REF: Box 51-7 Clinical Manifestations of Liver Disease

11.The nurse, caring for a client recovering from the placement of a shunt to treat portal hypertension, should assess the client for which of the following complications associated with this surgery?

1.

Myocardial infarction

2.

Pulmonary emboli

3.

Pulmonary edema

4.

Decreased peripheral pulses

ANS: 3

Complications after shunt surgery include the development of pulmonary edema. Myocardial infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated with this type of surgery.

PTS: 1 DIF: Apply REF: Red Flag: Shunt Surgery

12.A client is diagnosed with macrovesicular fatty liver. Which of the following should the nurse instruct this client?

1.

Expect to develop jaundice.

2.

Avoid all alcohol.

3.

Increase exercise.

4.

Treatment includes antibiotic therapy.

ANS: 2

The client diagnosed with macrovesicular fatty liver should be instructed to avoid all alcohol. Jaundice is a symptom of microvesicular fatty liver. The client should be instructed to rest. Antibiotic therapy is not indicated for macrovesicular fatty liver.

PTS: 1 DIF: Apply REF: Fatty Liver: Planning and Implementation

MULTIPLE RESPONSE

1.A client diagnosed with cirrhosis is experiencing the complication of ascites. Which of the following would be considered treatment for this complication? (Select all that apply.)

1.

Fluid restriction

2.

Low-sodium diet

3.

Increased exercise

4.

Diuretic therapy

5.

Pain medication

6.

Bed rest

ANS: 1, 2, 4

Ascites is the accumulation of fluid in the peritoneal cavity. Treatment strategies include fluid restriction (1000 to 1500 mL/day), low-sodium diet (200 to 500 mg/day), and diuretic therapy to remove the excessive fluid. Increased exercise, pain medication, and bed rest are not included as treatments for this complication.

PTS: 1 DIF: Apply REF: Cirrhosis: Planning and Implementation

2.A client is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which of the following should the nurse assess as possible complications from this procedure? (Select all that apply.)

1.

Perforation of the stomach

2.

Perforated duodenum

3.

Pancreatitis

4.

Aspiration of gastric contents

5.

Anaphylactic reaction to the contrast dye

6.

Perforated bladder

ANS: 1, 2, 3, 4, 5

Potential complications of an ERCP are perforated stomach and duodenum, pancreatitis, anaphylactic reaction to the contrast diet, aspiration of gastric contents, and reaction to anesthesia. A perforated bladder is a possible complication from a paracentesis.

PTS:1DIF:ApplyREFiagnostic Tests

3.A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be used to describe this clients symptoms? (Select all that apply.)

1.

Jaundice

2.

Dyspepsia

3.

Icterus

4.

Sclerosis

5.

Kernicterus

6.

Cirrhosis

ANS: 1, 3, 5

Terms used to describe yellow pigmentation of the skin and sclera include jaundice, icterus, and kernicterus. Dyspepsia, sclerosis, and cirrhosis are not terms used to describe the yellow pigmentation of the skin and sclera.

PTS: 1 DIF: Analyze REF: Box 51-1 Bilirubin Labels

4.The nurse is providing dietary instruction to a client diagnosed with Wilsons disease. Which of the following should be included in these instructions? (Select all that apply.)

1.

Avoid liver.

2.

Avoid shellfish.

3.

Eat soy products.

4.

Use avocados in salads.

5.

Avoid nectarines.

6.

Avoid mushrooms.

ANS: 1, 2, 5, 6

Dietary instruction for a client diagnosed with Wilsons disease include reducing the intake of foods high in copper. This includes avoiding liver, shellfish, soy products, avocado, nectarines, and mushrooms.

PTS:1DIF:Apply

REF: Box 51-1 Dietary Recommendations for People with Wilsons Disease

5.A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience which of the following? (Select all that apply.)

1.

Low vitamin A levels

2.

Increased bleeding

3.

Poor digestion of fats

4.

Insulin resistance

5.

Elevated levels of vitamin E

6.

Nerve damage

ANS: 1, 2, 3, 4, 6

Effects of a liver disorder on a client are many. Some of the functions affected by this disorder include low levels of fat soluble vitamins, including A and E; poor synthesis of clotting factors, leading to increased bleeding; poor digestion of fats; insulin resistance; and nerve damage.

PTS: 1 DIF: Analyze REF: Cirrhosis: Pathophysiology

6.A client is diagnosed with portal hypertension. The nurse should assess the client for which of the following disorders associated with this diagnosis? (Select all that apply.)

1.

Esophageal varices

2.

Splenomegaly

3.

Hemorrhoids

4.

Caput medusae

5.

Gastritis

6.

Gallstone formation

ANS: 1, 2, 3, 4

Portal hypertension can lead to the development of esophageal varices, splenomegaly, hemorrhoids, and caput medusae. Portal hypertension does not lead to gastritis or gallstone formation.

PTS:1DIF:ApplyREFortal Hypertension

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