NCLEX Questions: Liver, Pancreas, and Biliary Problems

NCLEX Questions: Liver, Pancreas, and Biliary Problems

4.9 (30 reviews) Students also studied Terms in this set (31) Lander UniversityNURN 304 Save Hepatic & Biliary NCLEX Questions 113 terms A_NonamePreview Med Surg Gastrointestinal NCLEX Q...86 terms Jasmine_Lawson4 Preview Endocrine NCLEX questions 121 terms awebstePreview NCLEX 20 terms JLT8 A 54-year-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. To what diagnosis does the nurse attribute these findings?

• Malnutrition
• Osteomyelitis
• Alcohol abuse
• Diabetes mellitus
• Alcohol Use

The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal 30-122 U/L) and serum lipase (normal 31-186 U/L) levels as shown.The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this patient by assessing what?

• Relief of constipation
• Relief of abdominal pain
• Decreased liver enzymes
• Decreased ammonia levels
• Decreased ammonia levels.

Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is most appropriate?

• "The hepatitis vaccine will provide immunity from this

exposure and future exposures."

• "I am afraid there is nothing you can do since the

patient was infectious before admission."

• "You will need to be tested first to make sure you don't

have the virus before we can treat you."

• "An injection of immunoglobulin will need to be given

to prevent or minimize the effects from this exposure."

• "An injection of immunoglobulin will need to be given to prevent or minimize

the effects from this exposure." Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?

• Impaired skin integrity related to edema, ascites, and

pruritus

B. Imbalanced nutrition: less than body requirements

related to anorexia

• Excess fluid volume related to portal hypertension and

hyperaldosteronism

• Ineffective breathing pattern related to pressure on

diaphragm and reduced lung volume

• Ineffective breathing pattern related to pressure on diaphragm and reduced

lung volume Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome (select all that apply)?

• Use smallest gauge needle possible when giving

injections or drawing blood.

• Teach patient to avoid straining at stool, vigorous

blowing of nose, and coughing.

• Advise patient to use soft-bristle toothbrush and avoid

ingestion of irritating food.

• Apply gentle pressure for the shortest possible time

period after performing venipuncture.

• Instruct patient to avoid aspirin and NSAIDs to prevent

hemorrhage when varices are present.

• Use smallest gauge needle possible when giving injections or drawing blood.
• Teach patient to avoid straining at stool, vigorous blowing of nose, and

coughing.

• Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating

food.

• Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when

varices are present.Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply)?

• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K
• Vitamin B
• Vitamin A
• Vitamin D
• Vitamin E
• Vitamin K

Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat- soluble and thus would need to be supplemented in a patient with biliary obstruction.

A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic complications?

• Tramadol
• Hydromorphone
• Oxycodone with aspirin
• Hydrocodone with acetaminophen
• Hydrocodone with acetaminophen (Vicodin)

The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function.Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What should the nurse expect to do for this patient?

• Prevent all oral intake.
• Control abdominal pain.
• Provide enteral feedings.
• Avoid dietary cholesterol.
• Control abdominal pain.

Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication for a cholecystectomy?

• Low-grade fever of 100° F and dehydration
• Abscess in the right upper quadrant of the abdomen
• Activated partial thromboplastin time (aPTT) of 54

seconds

• Multiple obstructions in the cystic and common bile

duct

• Activated partial thromboplastin time (aPTT) of 54 seconds

An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration; the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?

• "I will use care when kissing my wife to prevent giving

it to her."

• "I will need to take adofevir (Hepsera) to prevent

chronic HCV."

• "Now that I have had HCV, I will have immunity and not

get it again."

• "I will need to be checked for chronic HCV and other

liver problems."

• "I will need to be checked for chronic HCV and other liver problems."

The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.

The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdomen for which reasons (select all that apply)?

• There is decreased colloid oncotic pressure from the

liver's inability to synthesize albumin.

• Hyperaldosteronism related to damaged hepatocytes

increases sodium and fluid retention.

• Portal hypertension pushes proteins from the blood

vessels, causing leaking into the peritoneal cavity.

• Osmoreceptors in the hypothalamus stimulate thirst,

which causes the stimulation to take in fluids orally.

• Overactivity of the enlarged spleen results in increased

removal of blood cells from the circulation, which decreases the vascular pressure.

• There is decreased colloid oncotic pressure from the liver's inability to

synthesize albumin.

• Hyperaldosteronism related to damaged hepatocytes increases sodium and

fluid retention.

• Portal hypertension pushes proteins from the blood vessels, causing leaking

into the peritoneal cavity.The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the removal of blood cells by the spleen do not directly contribute to ascites The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

• "If I notice a fast heart rate or irregular beats, this is

normal for cirrhosis."

• "I need to take good care of my belly and ankle skin

where it is swollen."

• "A scrotal support may be more comfortable when I

have scrotal edema."

• "I can use pillows to support my head to help me

breathe when I am in bed."

• "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis."

If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a contraindication for liver transplantation?

• Has completed a college education
• Has been able to stop smoking cigarettes
• Has well-controlled type 1 diabetes mellitus
• The chest x-ray showed another lung cancer lesion.
• The chest x-ray showed another lung cancer lesion.

Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug and/or alcohol abuse, and the inability to comprehend or comply with the rigorous post- transplant course.The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?

• Immediately start enteral feeding to prevent

malnutrition.

• Insert an NG and maintain NPO status to allow

pancreas to rest.

• Initiate early prophylactic antibiotic therapy to prevent

infection.

• Administer acetaminophen (Tylenol) every 4 hours for

pain relief.

• Insert an NG and maintain NPO status to allow pancreas to rest.

Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.