Chapter 44: Nursing Management: Liver, Pancreas, and Biliary Tract Problems
Test Bank
MULTIPLE CHOICE
1. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric)
phase of the patient’s illness, the nurse would expect serologic testing to reveal
a. antibody to hepatitis D (anti-HDV).
b. hepatitis B surface antigen (HBsAg).
c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
ANS: D
Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears
during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or
antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.
DIF: Cognitive Level: Apply (application) REF: 1007 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
2. Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when
a specimen of the patient’s blood reveals
a. HBsAg.
b. anti-HBs.
c. anti-HBc IgG.
d. anti-HBc IgM.
ANS: B
The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the
vaccine. The other laboratory values indicate current infection with HBV.
DIF: Cognitive Level: Analyze (analysis) REF: 1008 TOP: Nursing Process:
Evaluation MSC: NCLEX: Health Promotion and Maintenance
3. A 36-year-old male patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV)
infection. Which action by the nurse is appropriate?
a. Schedule the patient for HCV genotype testing.
b. Administer the HCV vaccine and immune globulin.
c. Teach the patient about ribavirin (Rebetol) treatment.
d. Explain that the infection will resolve over a few months.
ANS: A
Genotyping of HCV has an important role in managing treatment and is done before drug
therapy is initiated. Because most patients with acute HCV infection convert to the chronic
state, the nurse should not teach the patient that the HCV will resolve in a few months.
Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV
infection.
, DIF: Cognitive Level: Apply (application) REF: 1010
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse will plan to teach the patient diagnosed with acute hepatitis B about
a. side effects of nucleotide analogs.
b. measures for improving the appetite.
c. ways to increase activity and exercise.
d. administering a-interferon (Intron A).
ANS: B
Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon
and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute
hepatitis B infection. Rest is recommended.
DIF: Cognitive Level: Apply (application) REF: 1015
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
5. The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis
C will plan to monitor for
a. leukopenia.
b. hypokalemia.
c. polycythemia.
d. hypoglycemia.
ANS: A
Therapy with ribavirin and a-interferon may cause leukopenia. The other problems are not
associated with this drug therapy.
DIF: Cognitive Level: Apply (application) REF: 1013
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. Which information given by a 70-year-old patient during a health history indicates to the
nurse that the patient should be screened for hepatitis C?
a. The patient had a blood transfusion in 2005.
b. The patient used IV drugs about 20 years ago.
c. The patient frequently eats in fast-food restaurants.
d. The patient traveled to a country with poor sanitation.
ANS: B
Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions
given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk
for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by
contaminated food or by traveling in underdeveloped countries.
DIF: Cognitive Level: Apply (application) REF: 1009 TOP: Nursing Process:
Assessment MSC: NCLEX: Health Promotion and Maintenance
, 7. A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver
function studies but serologic testing is negative for viral causes of hepatitis. Which question
by the nurse is most appropriate?
a. “Is there any history of IV drug use?”
b. “Do you use any over-the-counter drugs?”
c. “Are you taking corticosteroids for any reason?”
d. “Have you recently traveled to a foreign country?”
ANS: B
The patient’s symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms
suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as
acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk
factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.
DIF: Cognitive Level: Apply (application) REF: 1027 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
8. Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient
with cirrhosis?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level
ANS: D
The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in
the development of edema. The other parameters should also be monitored, but they are not
directly associated with the patient’s current symptoms.
DIF: Cognitive Level: Apply (application) REF: 1019 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
9. Which topic is most important to include in patient teaching for a 41-year-old patient
diagnosed with early alcoholic cirrhosis?
a. Maintaining good nutrition
b. Avoiding alcohol ingestion
c. Taking lactulose (Cephulac)
d. Using vitamin B supplements
ANS: B
The disease progression can be stopped or reversed by alcohol abstinence. The other
interventions may be used when cirrhosis becomes more severe to decrease symptoms or
complications, but the priority for this patient is to stop the progression of the disease.
DIF: Cognitive Level: Apply (application) REF: 1015-1016
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Test Bank
MULTIPLE CHOICE
1. A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric)
phase of the patient’s illness, the nurse would expect serologic testing to reveal
a. antibody to hepatitis D (anti-HDV).
b. hepatitis B surface antigen (HBsAg).
c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
ANS: D
Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears
during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or
antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.
DIF: Cognitive Level: Apply (application) REF: 1007 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
2. Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when
a specimen of the patient’s blood reveals
a. HBsAg.
b. anti-HBs.
c. anti-HBc IgG.
d. anti-HBc IgM.
ANS: B
The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the
vaccine. The other laboratory values indicate current infection with HBV.
DIF: Cognitive Level: Analyze (analysis) REF: 1008 TOP: Nursing Process:
Evaluation MSC: NCLEX: Health Promotion and Maintenance
3. A 36-year-old male patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV)
infection. Which action by the nurse is appropriate?
a. Schedule the patient for HCV genotype testing.
b. Administer the HCV vaccine and immune globulin.
c. Teach the patient about ribavirin (Rebetol) treatment.
d. Explain that the infection will resolve over a few months.
ANS: A
Genotyping of HCV has an important role in managing treatment and is done before drug
therapy is initiated. Because most patients with acute HCV infection convert to the chronic
state, the nurse should not teach the patient that the HCV will resolve in a few months.
Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV
infection.
, DIF: Cognitive Level: Apply (application) REF: 1010
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse will plan to teach the patient diagnosed with acute hepatitis B about
a. side effects of nucleotide analogs.
b. measures for improving the appetite.
c. ways to increase activity and exercise.
d. administering a-interferon (Intron A).
ANS: B
Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon
and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute
hepatitis B infection. Rest is recommended.
DIF: Cognitive Level: Apply (application) REF: 1015
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
5. The nurse administering a-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis
C will plan to monitor for
a. leukopenia.
b. hypokalemia.
c. polycythemia.
d. hypoglycemia.
ANS: A
Therapy with ribavirin and a-interferon may cause leukopenia. The other problems are not
associated with this drug therapy.
DIF: Cognitive Level: Apply (application) REF: 1013
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. Which information given by a 70-year-old patient during a health history indicates to the
nurse that the patient should be screened for hepatitis C?
a. The patient had a blood transfusion in 2005.
b. The patient used IV drugs about 20 years ago.
c. The patient frequently eats in fast-food restaurants.
d. The patient traveled to a country with poor sanitation.
ANS: B
Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions
given after 1992 (when an antibody test for hepatitis C became available) do not pose a risk
for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by
contaminated food or by traveling in underdeveloped countries.
DIF: Cognitive Level: Apply (application) REF: 1009 TOP: Nursing Process:
Assessment MSC: NCLEX: Health Promotion and Maintenance
, 7. A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has abnormal liver
function studies but serologic testing is negative for viral causes of hepatitis. Which question
by the nurse is most appropriate?
a. “Is there any history of IV drug use?”
b. “Do you use any over-the-counter drugs?”
c. “Are you taking corticosteroids for any reason?”
d. “Have you recently traveled to a foreign country?”
ANS: B
The patient’s symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms
suggest toxic hepatitis, which can be caused by commonly used over-the-counter drugs such as
acetaminophen (Tylenol). Travel to a foreign country and a history of IV drug use are risk
factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.
DIF: Cognitive Level: Apply (application) REF: 1027 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
8. Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient
with cirrhosis?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level
ANS: D
The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in
the development of edema. The other parameters should also be monitored, but they are not
directly associated with the patient’s current symptoms.
DIF: Cognitive Level: Apply (application) REF: 1019 TOP: Nursing
Process: Assessment MSC: NCLEX: Physiological Integrity
9. Which topic is most important to include in patient teaching for a 41-year-old patient
diagnosed with early alcoholic cirrhosis?
a. Maintaining good nutrition
b. Avoiding alcohol ingestion
c. Taking lactulose (Cephulac)
d. Using vitamin B supplements
ANS: B
The disease progression can be stopped or reversed by alcohol abstinence. The other
interventions may be used when cirrhosis becomes more severe to decrease symptoms or
complications, but the priority for this patient is to stop the progression of the disease.
DIF: Cognitive Level: Apply (application) REF: 1015-1016
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
