Chapter 41: Liver, Gallbladder, and Pancreatic Disorders
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. For which complication should a nurse be careful to monitor a patient after a liver biopsy?
a.
Headache
b.
Muscle cramps
c.
Bleeding
d.
Respiratory distress
2. What is pruritus related to in the patient diagnosed with hepatitis?
a.
Decreased fat intake
b.
Poor appetite and therefore poor protein intake
c.
Accumulation of bile salts under the skin
d.
Altered urinary output of bile
3. A young woman with severe jaundice has a nursing diagnosis of “Altered body image, related
to jaundice.” The patient says, “Will I always be this horrible color?” What is the best
response by the nurse?
a.
“Yes, but your sclera will return to their previous white color.”
b.
“No. The color will fade gradually as liver inflammation decreases.”
c.
“Yes, but cosmetics can disguise the color.”
d.
“No. The color will change to freckles.”
4. What action should a nurse implement to prevent complications in a patient with hepatitis
who has been prescribed bedrest?
a.
Raise the knee gatch to prevent the patient from sliding down in bed.
b.
Provide undisturbed periods of 6 hours to encourage rest.
c.
Restrict fluids.
d.
Encourage turning, coughing, and deep breathing every 2 hours.
5. Which sign indicates that the need for increased fluid intake would be contraindicated in a
patient diagnosed with a hepatic disorder?
a.
Low blood pressure
b.
Increased urinary output
c.
Signs of edema
d.
Bradycardia
6. What intervention should a nurse implement when assessing a patient with jaundice who has
been given the nursing diagnosis of impaired skin integrity?
a.
Sedate the patient.
b.
Apply mittens or socks to the hands.
c.
Restrain the hands.
d.
Distract the patient with conversation.
7. Which vaccination does the Occupational Health and Safety Administration (OSHA) require
all health care providers to receive?
a.
Hepatitis A
b.
Hepatitis B
c.
Hepatitis C
d.
All strains of hepatitis
8. What is the meaning of a dropping bilirubin level in a patient diagnosed with hepatitis?
a.
Red blood cell destruction is decreasing.
b.
Liver function is improving.
c.
Kidneys are compensating for liver dysfunction.
d.
Kupffer cell damage is continuing.
9. A goal of medical treatment for patients with cirrhosis is to prevent complications and limit
cell damage. A major approach is to promote rest. What rationale supports this approach?
a.
Allows time for a transplant
b.
Allows the liver to regenerate
c.
Prevents red cell destruction
d.
Decreases the risk of trauma
10. What is necessary to restrict when the ammonia level of a patient diagnosed with cirrhosis
continues to rise?
a.
Protein
b.
Carbohydrates
c.
Fats
d.
Water-soluble vitamins
11. What actions should a nurse implement to correctly assess the progress of ascites on a daily
basis?
a.
Daily weights and abdominal girth measurements
b.
Intake-output and electrolyte levels
c.
Blood pressure and pulse
d.
Daily temperatures and oxygen levels
12. A patient with ascites is scheduled for a LeVeen peritoneal-venous shunt. The patient asks
why this needs to be done instead of a paracentesis. What is the best response by the nurse?
a.
“It helps the kidneys retain needed sodium.”
b.
“It will decrease the need for analgesics.”
c.
“This procedure will prevent the loss of protein.”
d.
“The risk of infection is lessened with this procedure.”
13. A high ammonia level contributes to hepatic encephalopathy. Which nursing implementation
needs to be added to the nursing care plan as this level continues to increase?
a.
Mouth care
b.
Increased frequency of neurologic checks
c.
Oxygen saturation monitoring
d.
Intake and output
14. A nurse is educating a patient diagnosed with hepatitis A. What should the nurse instruct this
patient to avoid sharing?
a.
Food
b.
Bodies
c.
Needles
d.
Housing
15. Which dietary selection should lead the nurse to conclude that the dietary teaching is
successful for a patient on a low-sodium diet?
a.
Bologna sandwich with tomato juice
b.
Hotdog on a bun with pickle relish and skim milk
c.
Baked chicken, white rice, and apple juice
d.
Peanut butter and jelly sandwich with tomato soup
16. Which nursing measure takes priority in relation to the care of a patient with a
gastroesophageal balloon tube?
a.
Deflate the balloon periodically.
b.
Advance the tube as instructed.
c.
Monitor respiratory status.
d.
Withhold medications that could decrease restlessness.
17. Which instruction should be given to a patient with portal hypertension to reduce the threat of
hemorrhage?
a.
Eat bland foods.
b.
Avoid straining to have a bowel movement.
c.
Increase fluid intake.
d.
Use an electric razor to shave.
18. What precaution should a nurse initiate when caring for a patient with hepatitis B?
a.
Reverse isolation
b.
Standard precautions
c.
Respiratory precautions
d.
Enteric precautions
19. A patient was positive for hepatitis B virus, although she had the disease 4 years ago and now
is symptom free. What is the nurse aware is true regarding this patient?
a.
Is likely to have hepatitis B again
b.
Now has noninfectious hepatitis
c.
Is an infectious carrier and always will be
d.
Is at risk for hepatitis E
20. A nurse is providing information on the medication Pancrease (lipase, protease, amylase) to a
patient diagnosed with pancreatitis. Which important instruction should the nurse be sure to
include?
a.
Taken before meals
b.
Sprinkled on warm food
c.
Mixed with juice
d.
Taken 1 hour after eating
21. A patient in acute pain is admitted with pancreatitis. A nurse reviews a laboratory report
showing an elevation that is diagnostic for acute pancreatitis. Which laboratory report did the
nurse most likely review?
a.
Serum bilirubin
b.
Serum calcium
c.
Serum lipids
d.
Serum amylase
22. What is the highest nursing priority outcome when planning the care for the patient with
pancreatitis?
a.
Patient claims satisfaction with pain control.
b.
Patient states an understanding of medications needed on discharge.
c.
Patient’s activity level tolerance shows an increase.
d.
Patient can maintain a normal bowel pattern.
23. What should a nurse often find in the medical history of a patient diagnosed with pancreatic
disease?
a.
Liver disorders
b.
Drug abuse
c.
Alcohol abuse
d.
Excessive sugar intake
24. Which observation by a nurse would indicate blocked flow of bile from the liver to the
intestine?
a.
Clay-colored stools
b.
Jaundice
c.
High blood pressure
d.
Tachycardia
25. Which chronic condition is related to the presence of chronic pancreatitis?
a.
Chronic obstructive pulmonary disease (COPD)
b.
Urinary tract infection (UTI)
c.
Diabetes mellitus (DM)
d.
Arteriosclerotic heart disease (ASD)
26. Which risk is significantly increased in patients diagnosed with liver disease?
a.
Urinary infections
b.
Systemic infection
c.
Drug toxicity
d.
Drug allergy
27. What should a nurse include in the discharge teaching for a patient after a laparoscopic
procedure for cholelithiasis?
a.
Take water-soluble vitamins.
b.
Follow a low-fat diet.
c.
Expect light-colored stools for several days.
d.
Keep dressing over the T-tube dry.
MULTIPLE RESPONSE
28. Which drugs and herbal remedies are considered harmful to the liver? (Select all that apply.)
a.
Comfrey (herbal remedy)
b.
Promethazine (Phenergan)
c.
Acetaminophen (Tylenol)
d.
Oral contraceptive (Yaz)
e.
Lavender (herbal remedy)
COMPLETION
29. A nurse reminds a patient with liver disease that the level of _____ in the blood is an indicator
of the how well the liver is functioning.
30. A nurse explains to a patient that when the blood sugar level drops, the liver is capable of
converting the stored glycogen to glucose by the process of _____.
31. A nurse is alert for bleeding in a patient with hepatic disorders because the inflamed liver may
not be able to synthesize two clotting factors, which are _____ and _____.
32. In assessing a dark-skinned patient for jaundice, the nurse would assess the _____ for a
yellow color.
