Chapter 41: Liver, Gallbladder, and Pancreatic Disorders Nursing School Test Banks

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
ANS: C
Liver biopsy places the patient at risk for hemorrhage. Liver disorders make patients especially vulnerable to hemorrhage.

DIF: Cognitive Level: Comprehension REF: p. 854-855 OBJ: 2
TOP: Liver Biopsy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: C
Bile salts accumulate under the skin, causing irritation.

DIF: Cognitive Level: Comprehension REF: p. 858 OBJ: 3
TOP: Hepatitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: B
Jaundice causes patients to be self-conscious and reclusive because of the change in physical appearance. Patients can be reassured that the color improves as liver function improves, usually in 2 to 4 weeks.

DIF: Cognitive Level: Comprehension REF: p. 860 OBJ: 3
TOP: Hepatitis and Jaundice KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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.
ANS: D
The nurse must encourage measures that will prevent pneumonia and improve impaired skin integrity because of the increased risk factors associated with bedrest.

DIF: Cognitive Level: Application REF: p. 859 OBJ: 5
TOP: Bedrest for Hepatitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: C
Edema may indicate fluid overload; therefore, question the intake, as well as electrolyte and cardiac status.

DIF: Cognitive Level: Comprehension REF: p. 859 OBJ: 5
TOP: Fluid Volume and Hepatitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: B
Jaundice causes itching, which can cause the patient to scratching and create a break in the skin. Mittens provide some comfort without causing further skin impairment.

DIF: Cognitive Level: Application REF: p. 859 OBJ: 5
TOP: Jaundice KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: B
OSHA requires that all health care providers be vaccinated against hepatitis B.

DIF: Cognitive Level: Knowledge REF: p. 860 OBJ: 2
TOP: OSHA Requirements KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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.
ANS: B
As liver function improves, the bilirubin level will decrease because of the livers ability to conjugate and excrete the bilirubin. The flow of bile out of the liver increases.

DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 3
TOP: Liver Disease KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: B
With rest, the liver will regenerate healthy tissue and return to normal functioning. Rest must include other measures to promote healing, such as dietary measures and no alcohol.

DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 5
TOP: Cirrhosis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
Ammonia is the waste product of protein breakdown. Decreasing protein intake will decrease the end product.

DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 5
TOP: Cirrhosis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: A
Daily weights and abdominal girth measurements will accurately measure the fluid accumulating in the peritoneal cavity.

DIF: Cognitive Level: Application REF: p. 867 OBJ: 3
TOP: Ascites KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: C
Fluids containing protein are returned to the vascular compartment to retain important elements such as albumin. The retention of albumin reduces fluid accumulation.

DIF: Cognitive Level: Comprehension REF: p. 864 OBJ: 3
TOP: Ascites KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: B
As the ammonia level rises, the patient becomes at greater risk for confusion and hepatic coma related to encephalopathy.

DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 5
TOP: Seizure Precautions KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: A
Hepatitis A is spread from contact with saliva, which can be transmitted by shared food or drinks.

DIF: Cognitive Level: Comprehension REF: p. 856 OBJ: 3
TOP: Hepatitis A KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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
ANS: C
A meal of baked chicken, white rice, and apple juice has the lowest sodium levels.

DIF: Cognitive Level: Comprehension REF: p. 867-868 OBJ: 3
TOP: Nutrition: Low-Sodium Diet KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: C
Because of the close proximity of the esophagus and trachea, any upward movement of the tube could cause airway obstruction.

DIF: Cognitive Level: Application REF: p. 866 OBJ: 4
TOP: Esophageal Balloon KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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.
ANS: B
Straining can increase pressure and may cause the dilated vessels in the gastrointestinal tract to bleed. Shaving with an electric razor does not prevent serious bleeding.

DIF: Cognitive Level: Comprehension REF: p. 862 OBJ: 3
TOP: Portal Hypertension KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: B
Standard precautions protect the nurse from organisms that may be in all body fluids.

DIF: Cognitive Level: Comprehension REF: p. 856-858 OBJ: 5
TOP: Hepatitis B KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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
ANS: C
A certain percentage of persons who have had hepatitis B convert to carriers. They have the live virus, which causes no symptoms in them, but they are able to transmit the disease and always will be infectious.

DIF: Cognitive Level: Comprehension REF: p. 858 OBJ: 3
TOP: Carrier State for Hepatitis B KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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
ANS: C
Pancreatic enzyme medication takes the place of enzymes missing from the damaged pancreas. The drug should be mixed with juice or applesauce or sprinkled on cold food, but it should not be chewed because it will irritate the mouth and lips.

DIF: Cognitive Level: Application REF: p. 882 OBJ: 3
TOP: Administration of Pancreatic Replacement
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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
ANS: D
Serum amylase is the most significant of the diagnostic findings.

DIF: Cognitive Level: Knowledge REF: p. 880 OBJ: 1
TOP: Pancreatitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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. Patients activity level tolerance shows an increase.
d. Patient can maintain a normal bowel pattern.
ANS: A
Pain control is the most important priority.

DIF: Cognitive Level: Analysis REF: p. 882 OBJ: 5
TOP: Pancreatitis KEY: Nursing Process Step: Evaluation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: C
Pancreatic disease is often related to alcohol abuse.

DIF: Cognitive Level: Comprehension REF: p. 877 OBJ: 5
TOP: Pancreatic Disease KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
Bile is unable to get to feces to give it the normal brown color.

DIF: Cognitive Level: Comprehension REF: p. 872 OBJ: 3
TOP: Biliary Disease KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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)
ANS: C
Patients with chronic pancreatitis are at risk for developing DM because of the destruction of the insulin-secreting cells in the pancreas.

DIF: Cognitive Level: Knowledge REF: p. 880 OBJ: 3
TOP: Chronic Pancreatitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

26. Which risk is significantly increased in patients diagnosed with liver disease?
a. Urinary infections
b. Systemic infection
c. Drug toxicity
d. Drug allergy
ANS: C
Because many drugs are metabolized in the liver and a diseased liver does not adequately clear the system of drugs, drug toxicity is an ongoing problem.

DIF: Cognitive Level: Comprehension REF: p. 861 | p. 858
OBJ: 3 TOP: Risk for Drug Toxicity
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: B
After the laparoscopic procedure, the patient is to follow a low-fat diet and take fat-soluble vitamins. Placement of the T-tube is not done with the laparoscopic procedure.

DIF: Cognitive Level: Application REF: p. 875 OBJ: 2
TOP: Laparoscopic Procedure for Cholelithiasis
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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)
ANS: A, C
Herbal remedies of comfrey, borage, coltsfoot, and chaparral can harm the liver. The over-the-counter drug Tylenol is also hepatoxic.

DIF: Cognitive Level: Knowledge REF: p. 850 OBJ: 1
TOP: Hepatoxic Drugs KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.

ANS:
bilirubin
The level of indirect bilirubin indicates the effectiveness of the metabolism of proteins by the liver.

DIF: Cognitive Level: Knowledge REF: p. 852 OBJ: 1
TOP: Bilirubin as an Indicator of Liver Function
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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 _____.

ANS:
glycogenesis
The conversion of glycogen to glucose by the liver is called glycogenesis.

DIF: Cognitive Level: Knowledge REF: p. 849 OBJ: 3
TOP: Glycogenesis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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 _____.

ANS:
prothrombin; fibrinogen
fibrinogen; prothrombin
Prothrombin and fibrinogen, which are necessary components for blood clotting, are deficit in liver disorders, leading to bleeding episodes.

DIF: Cognitive Level: Knowledge REF: p. 850 OBJ: 1
TOP: Liver Production of Prothrombin and Fibrinogen
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

32. In assessing a dark-skinned patient for jaundice, the nurse would assess the _____ for a yellow color.

ANS:
sclera
Jaundice can be assessed by the yellow pigment on the sclera of a dark-skinned person.

DIF: Cognitive Level: Application REF: p. 851 OBJ: 1
TOP: Assessing Jaundice in Dark-Skinned Persons
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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