Hepatic Biliary NCLEX Questions

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NCLEX Questions: Liver, Pancreas, a...

Teacher 31 terms rebecca_bowman2 Preview Nursing 49 terms gra The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

• Ascites and orthopnea
• Dyspnea and fatigue
• Purpura and petechiae
• Gynecomastia and testicular atrophy
• Purpura and petechiae

A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.A client with a history of alcohol abuse comes to the emergency department and complains of abdominal pain. Laboratory studies help confirm a diagnosis of acute pancreatitis. The client's vital signs are stable, but the client's pain is worsening and radiating to his back. Which intervention takes priority for this client?

• Maintaining nothing-by-mouth (NPO) status
• Providing mouth care
• Administering morphine I.V. as ordered
• Placing the client in a semi-Fowler's position
• Administering morphine I.V. as ordered

The nurse should address the client's pain issues first by administering morphine I.V. as ordered. Placing the client in a Semi-Fowler's position, maintaining NPO status, and providing mouth care don't take priority over addressing the client's pain issues.

A client with pancreatitis is admitted to the medical intensive care unit. Which nursing intervention is most appropriate?

• Providing the client with plenty of P.O. fluids
• Reserving an antecubital site for a peripherally inserted central catheter (PICC)
• Limiting I.V. fluid intake according to the physician's order
• Providing generous servings at mealtime
• Reserving an antecubital site for a peripherally inserted central catheter (PICC)

Pancreatitis treatment typically involves resting the GI tract by maintaining nothing-by-mouth status. The nurse should reserve the antecubital site for a PICC, which enables the client to receive long-term total parenteral nutrition. Clients in the acute stages of pancreatitis also require large volumes of I.V. fluids to compensate for fluid loss.A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

• Portal hypertension
• Asterixis
• Cirrhosis
• Hepatic encephalopathy
• Hepatic encephalopathy

Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.Which enzyme aids in the digestion of fats?

• Amylase
• Secretin
• Lipase
• Trypsin
• Lipase

Lipase is a pancreatic enzyme that aids in the digestion of fats. Amylase aids in the digestion of carbohydrates. Secretin is responsible for stimulating secretion of pancreatic juice. Trypsin aids in the digestion of protein.When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?

• Provide the client with nonprescription laxatives.
• Ask the client about food intake.
• Measure abdominal girth according to a set routine.
• Report the condition to the physician immediately.
• Measure abdominal girth according to a set routine.

If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

A client being treated for pancreatitis faces the risk of atelectasis. Which of the following interventions would be important to implement to minimize this risk?

• Reposition the client every 2 hours.
• Withhold oral feedings for the client.
• Monitor pulse oximetry every hour.
• Instruct the client to avoid coughing.
• Reposition the client every 2 hours.

Repositioning the client every 2 hours minimizes the risk of atelectasis in a client who is being treated for pancreatitis. The client should be instructed to cough every 2 hours to reduce atelectasis. Monitoring the pulse oximetry helps show changes in respiratory status and promote early intervention, but it would do little to minimize the risk of atelectasis. Withholding oral feedings limits the reflux of bile and duodenal contents into the pancreatic duct.A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.

• Enlarged liver size
• Excess storage of vitamin C
• Hemorrhoids
• Accelerated behaviors and mental processes
• Ascites
• Enlarged liver size
• Hemorrhoids
• Ascites

Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures.These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

• lavage
• gavage
• decompression
• instillation
• decompression

Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns.Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

A client comes to the ED with severe abdominal pain, nausea, and vomiting. The physician plans to rule out acute pancreatitis. The nurse would expect the diagnosis to be confirmed by an elevated result on which laboratory test?

• Serum bilirubin
• Serum calcium
• Serum potassium
• Serum amylase
• Serum amylase

Serum amylase and lipase concentrations are used to make the diagnosis of acute pancreatitis. Serum amylase and lipase concentrations are elevated within 24 hours of the onset of symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but the serum lipase concentration may remain elevated for a longer period, often days longer than amylase. Urinary amylase concentrations also become elevated and remain elevated longer than serum amylase concentrations.The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client?

• Teaching the client to choose low-fat foods from the menu
• Assisting the client to turn, cough, and deep breathe every 2 hours
• Assisting the client to ambulate the evening of the operative day
• Performing range-of-motion (ROM) leg exercises hourly while the client is awake
• Assisting the client to turn, cough, and deep breathe every 2 hours

Assessment should focus on the client's respiratory status. If a traditional surgical approach is planned, the high abdominal incision required during surgery may interfere with full respiratory excursion. The other nursing actions are also important, but are not as high a priority as ensuring adequate ventilation.The physician has written the following orders for a new client admitted with pancreatitis: bed rest, nothing by mouth (NPO), and administration of total parenteral nutrition (TPN) . Which does the nurse attribute as the reason for NPO status?

• To aid opening up of pancreatic duct
• To drain the pancreatic bed
• To prevent the occurrence of fibrosis
• To avoid inflammation of the pancreas
• To avoid inflammation of the pancreas

Pancreatic secretion is increased by food and fluid intake and may cause inflammation of the pancreas.A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal?

• Relieving the client's anxiety
• Controlling bleeding
• Maintaining fluid volume
• Maintaining the airway
• Maintaining the airway

Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.