Question 1

Patients with hepatitis A, B, C, D, or E typically are instructed to

Accepted Answer

If the patient is dehydrated, intravenous fluids will be given, with supplements of vitamin C for healing, vitamin B complex to assist with the damaged liver's ability to absorb fat-soluble vitamins, and vitamin K to combat prolonged coagulation time.

Question 2

In preparation for a cholecystography, the nurse asks if the patient has eaten since midnight. This is done to determine

Accepted Answer

The following factors are necessary for adequate dye concentration: ingestion of the correct number of dye tablets, adequate absorption of the dye, abstinence from food the morning of the exam, uptake for the portal system and excretion of the dye by the liver, patency of the cystic duct, and concentration of the dye within the gallbladder.

Question 3

The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n)

Accepted Answer

The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder.

Question 4

The nurse can prevent the transmission of hepatitis A by avoiding

Accepted Answer

Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material (called fecal-oral transmission). Teach patients the importance of good hand washing after the bathroom or changing a diaper, as well as proper food preparation, to prevent the spread of HAV.

Question 5

Which abnormal lab value would be found in a patient with a pathological condition of the liver?

Accepted Answer

Liver enzyme tests are AST, ALT, LDH, alkaline phosphatase, and gamma GT.

Question 6

When a patient has hepatic encephalopathy, medications often administered to relieve toxic blood chemistry include:

Accepted Answer

The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Preventing the buildup of ammonia will prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestine.

Question 7

Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated?

Accepted Answer

The cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII, IX, and X. This causes the patient with cirrhosis to have bleeding tendencies. Prothrombin time measures clotting time.

Question 8

The patient, age 56, has cirrhosis of the liver with severe ascites. The nurse is assisting the physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an

Accepted Answer

Paracentesis is a temporary method of removing fluid by withdrawing fluid from the abdominal cavity by either gravity or vacuum.

Question 9

A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purpose of the T-tube is to

Accepted Answer

If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves.

Question 10

The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign?

Accepted Answer

Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema.

Question 11

Flapping tremor (asterixis) is seen in a patient with

Accepted Answer

Asterixis is a hand flapping tremor in which the patient stretches out an arm and hyperextends the wrist with the fingers separated, relaxed, and extended. This occurs in the patient with hepatic encephalopathy.

Question 12

As a result of cirrhosis of the liver, the patient's condition deteriorates and he slips into a hepatic coma. The nurse would anticipate increasing levels of:

Accepted Answer

Hepatic encephalopathy is a type of brain damage caused by liver disease and consequent ammonia intoxication. Ammonia is the breakdown product of protein.

Question 13

The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic?

Accepted Answer

It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area.

Question 14

After the physician has performed a liver biopsy, the nursing interventions would usually include

Accepted Answer

Keep the patient lying on the right side for minimum of 2 hours to splint puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak.

Question 15

Which findings would the nurse expect in a patient with acute pancreatitis?

Accepted Answer

This pain is usually decreased by flexing the trunk, by leaning forward from a sitting position, or by assuming the fetal position. It is increased by eating or lying down. Low-grade fever may be present.

Question 16

If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to

Accepted Answer

The nurse will be responsible for the care of the T-tube if one is placed. The drainage bag for the T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated.

Question 17

An essential nursing measure to prevent peritonitis after a paracentesis is

Accepted Answer

An incision is made in the skin, and a hollow trocar cannula, or catheter, is passed through the incision and into the cavity. Thoroughly cleansing the skin of the abdominal wall is done prior to the procedure.

Question 18

The nurse realizes that the patient requires additional teaching about an esophagoscopy after the patient states

Accepted Answer

After the procedure, keep the patient NPO until the gag reflex returns.

Question 19

Infection control is necessary in all areas of the health care setting. Which would be most appropriate in the prevention of hepatitis B in high-risk health workers?

Accepted Answer

People identified as being at high risk for developing hepatitis B should be vaccinated if they are not already immune. These people include health care personnel.

Question 20

The patient's cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of:

Accepted Answer

Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension.

Quiz 6: Care of the Patient With a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder