Question 1

A patient with biliary colic is prescribed an anticholinergic medication to help treat biliary colic.For which medical diagnosis should the nurse question the administration of this medication?

Accepted Answer

Anticholinergic medications are contraindicated in patients with prostatic hypertrophy.A.B.C.Anticholinergic medications are not contraindicated in diabetes,asthma,or psoriasis.

Question 2

The nurse is providing a patient with cholelithiasis the medication ursodiol (Actigall).What should the nurse instruct the patient about this medication?

Accepted Answer

Dissolution of small non-calcified stones (less than 2 centimeters)with the bile acid drugs ursodiol (Actigall)is used for those who are not surgical candidates.Treatment with the dissolution drugs may take months and stones may return.

Question 3

A patient with cholecystitis is prescribed promethazine (Phenergan)for nausea.Which adverse effect of the medication should the nurse instruct the patient to report?

Accepted Answer

Urine retention can be life threatening and should be reported immediately.B.C.Dry mouth and insomnia are not emergencies.A.Constipation,not diarrhea,is more likely to occur.

Question 4

The nurse is identifying care to delegate to unlicensed assistive personnel.Which actions could be safely delegated in the care of a patient with fulminant liver failure?

Accepted Answer

Unlicensed assistive personnel can safely bathe and position a patient in liver failure.A.C.D.Assessment,monitoring,and evaluating are nursing functions and are beyond the scope of practice for unlicensed assistive personnel.

Question 5

A patient has the nursing diagnosis of Deficient Fluid Volume related to anorexia,nausea,vomiting,and excessive T-tube drainage related to cholecystitis.Which interventions should the nurse recommend be included in the plan of care? (Select all that apply.)

Accepted Answer

Daily weights,intake and output,and skin turgor are good measures of fluid balance.Antiemetics will help reduce vomiting and contribute to fluid balance.F.About 500 to 1000 mL of yellowish-green bile is common within the first 24 hours after surgery.C.Clamping the T-tube is inappropriate and may put pressure on the surgical site.E.Use of incentive spirometer contributes to oxygenation status and not deficient fluid volume.

Question 6

A patient with chronic liver disease is prescribed dexlansoprazole (Kapidex).What should the nurse instruct the patient about this medication?

Accepted Answer

This medication is a delayed-release proton pump inhibitor.The medication should be taken whole and not crushed.Milk does not need to be taken with this medication.

Question 7

While collecting data,the nurse becomes concerned that a patient is at risk for developing liver cancer.What information did the nurse use to come to this conclusion? (Select all that apply.)

Accepted Answer

Patients with a history of chronic hepatitis B infection,and heavy alcohol use or smoking have an increased risk for cancer of the liver.A.E.Home setting and employment do not increase the patient's risk for developing liver cancer.

Question 8

A patient with liver failure takes acetaminophen (Tylenol)650 mg tablets by mouth for severe arthritis pain.How many tablets should the nurse instruct that the patient can safely take in one 24 hour period?

Accepted Answer

Acetaminophen (Tylenol)overdose is the most common cause of ALF.Acetaminophen should not exceed 3000 mg in a 24 hour period.If each tablet contains 650 mg,then divide 3000 mg/650 mg = 4.6 tablets.The patient can safely take 4 tablets of the medication in one day.

Question 9

The nurse is contributing to the teaching plan for a patient recovering from a cholecystectomy.Which dietary modification should the nurse recommend for the first few weeks after surgery?

Accepted Answer

Patients are put on high-protein,low-fat diets.Fat should be slowly reintroduced into the diet.Once the duodenum becomes accustomed to constant infusion of bile,the patient's individual tolerance for fat becomes the only restriction for diet.A.Fruits and vegetables are not contraindicated.B.Meat,cheese,and peanut butter are high in fat.D.Pancreatic enzymes are not necessary-the pancreas has not been removed.

Question 10

The nurse is reinforcing teaching provided to a patient recovering from an acute attack of cholecystitis.Which foods should the nurse caution the patient to avoid? (Select all that apply.)

Accepted Answer

Eggs and cheese are high in fat content and will stimulate gallbladder contraction.A,D,E,Fruits,lean meats,and rice are low in fat content and therefore safer for the patient to consume.

Question 11

The nurse is providing education to a patient recovering from a recent cholecystectomy.What should the nurse include in the teaching? (Select all that apply.)

Accepted Answer

Patients are put on high-protein,low-fat diets.Encourage obese patients to lose weight.After a cholecystectomy,fat should be slowly reintroduced into the diet.A.B.E.Once the duodenum becomes accustomed to constant infusion of bile,the patient's individual tolerance for fat becomes the only restriction for diet.

Question 12

The nurse is caring for a patient recovering from an incisional cholecystectomy.Which activities should the nurse identify as having the highest priority for this patient? (Select all that apply.)

Accepted Answer

Preventing respiratory complications is the priority as the high incision can be painful with respiration and may make the patient reluctant to cough and clear secretions.Controlling pain so the patient will be willing to deep breathe and cough and use an incentive spirometer are important.Ambulation as soon as ordered promotes lung expansion to prevent respiratory complications.B.E.These actions are important but not the highest priority.

Question 13

The nurse is collecting data for a patient with acute liver failure.Which laboratory test findings should the nurse recognize as supporting this diagnosis? (Select all that apply.)

Accepted Answer

AST and ALT are found in high concentrations in liver cells and are released with death of liver cells.Serum bilirubin and urobilinogen may be elevated.In patients with severe hepatitis,prothrombin time may be elevated because the liver can no longer make prothrombin.A.D.Potassium and platelet counts are not directly affected.

Question 14

A patient with cholelithiasis is having clay-colored stools.What should the nurse realize as the most common cause of clay-colored stools?

Accepted Answer

Obstruction of bile flow (e.g.,from a stone in the duct)may result in stools that are clay-colored,because bile is not present in the stool to give it color.A.B.C.Other liver and gallbladder disorders can also cause clay-colored stools,but in a patient with cholelithiasis,a stone lodged in the duct would be the most common.

Question 15

The nurse is caring for a patient with chronic liver failure.Which medication order should the nurse question?

Accepted Answer

Acetaminophen (Tylenol)overdose is the most common cause of ALF.Acetaminophen should not exceed 3000 mg in a 24 hour period.A.B.C.Multivitamins,Lactulose,and Neomycin are all used to treat symptoms of liver disease.

Question 16

The nurse is caring for a patient diagnosed with chronic hepatitisB.Which medications should the nurse anticipate being prescribed for this patient? (Select all that apply.)

Accepted Answer

To manage chronic hepatitis B infection,the antivirals adefovir (Hepsera)or lamivudine (Epivir)may be used.A.B.Interferon therapy (peginterferon alpha-2b [Peg-Intron] or interferon alpha-2a [Pegasys])along with an antiviral medication (oral ribavirin [Rebetol])is considered to prevent chronic hepatitis C infection.

Question 17

A patient recovering from a cholecystectomy earlier in the day is reluctant to deep breathe and cough.What intervention should the nurse use to assist the patient to cough and breathe?

Accepted Answer

Patients are usually reluctant to cough and deep breathe after cholecystectomy because the high incision makes coughing painful.Medicating for pain and splinting the incision allow the patient to cough without excessive pain.A.D.Simply reminding and teaching do not solve the problem.B.Relaxation is helpful but should be in addition to,not instead of,analgesia.

Question 18

A patient recovering from hepatitis is concerned about liver damage from the infection.What should the nurse instruct the patient to do to prevent long-term liver damage? (Select all that apply.)

Accepted Answer

Recovery varies and depends on the type of hepatitis.Full recovery is measured by the return to normal of all liver function tests and may take as long as 1 year.The effects of hepatitis can be considered reversible if the patient complies with a medical regimen of adequate rest,proper nutrition,and abstinence from alcohol or other liver-toxic agents for at least 1 year after liver function laboratory values return to normal.D.E.Physical activity and dairy products do not need to be restricted.

Question 19

A patient with pancreatitis is receiving care to address the nursing diagnosis Imbalanced Nutrition: Less than required related to pain,NPO,and nasogastric suction.After 10 days of treatment,which findings should indicate to the nurse that the treatment plan has been effective? (Select all that apply.)

Accepted Answer

An albumin level greater than 3.5 mg/dL and return to baseline weight are evidence of improving nutrition.A.D.These are good results but are not directly related to nutrition goals.E.Mild diarrhea and steatorrhea are not desirable outcomes.B.The sodium value is lower than normal and indicates continued electrolyte imbalance.

Question 20

The nurse is instructing the mother of an adolescent with hepatitis on ways to prevent the spread of infection in the home.What should the nurse include in this mother's teaching? (Select all that apply.)

Accepted Answer

At home and if possible,the patient with hepatitis should have a separate bedroom and bathroom.The person cleaning the bathroom should wear disposable gloves or rubber gloves and then clean the gloves with a 10% bleach solution.Contaminated linens used by a patient with hepatitis should be washed separately from household laundry and in hot water.One cup of bleach should be added with the detergent to each load.Rubber gloves should be worn to wash the patient's laundry.A.The family should be advised to use liquid soap instead of bar soap.

Quiz 35: Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders