NSG 231 Exam #2-Questions with Correct Answers/
Verified/ Latest Update
Etiology of Jaundice - ✔✔results from an alteration in normal bilirubin metabolism or flow
of bile into the hepatic/ biliary duct system
Structure and function of gallbladder - ✔✔pear-shaped sac located below the liver.
Concentrates and stores bile
Diagnositic studies for gallbladder - ✔✔Hx and physical exam, ultrasound, ERCP,
percutaneous transhepatic cholangiography, liver function studies, WBC count, serum
bilirubin
Manifestations of obstructed bile flow - ✔✔Obstructive jaundice, dark amber urine, no
urobilinogen in urine, clay-colored stools, pruritis, intolerance for fatty foods, bleeding
tendencies, statorrhea
Chronic cholecystitis - ✔✔May be asymptomatic or hx of fat intolerance, dyspepsia,
heartburn, flatulence, spasms result when a stone gets stuck (biliary colic).
Cholelithiasis - ✔✔Gallstones, unknown cause upsets balance between cholesterol, bile
salts, and calcium in solution.
Cholecystitis - ✔✔acute or chronic inflammation of the gallbladder, usually caused by
obstruction, or trauma, extensive burns, recent surgery, prolonged immobility, fasting, DM,
bacteria.
S/S of Cholecystitis - ✔✔indigestion, moderate to sever pain, fever, jaundice, tenderness
RUQ possible referred to R shoulder/ scapula. Possible N&V, restlessness, diaphoresis,
leukocytosis, fever.
Functions of the Liver - ✔✔Metabolic: Carb/ prot/ fat, Detox, steroid metabolism, bile
synthesis, fat soluble vitamin storage, mononuclear phagocyte system
,Biilirubin - ✔✔Pigment derived from breakdown of hemoglobin. Insoluble in water/ bound
to protein. Unconjugated: bound to albumin => go to liver. Conjugated by liver: gluuronic
acid = soluble, excreted in bile.
Liver metabolic functions Carbs - ✔✔glycogenesis (glucose to glycogen), glycogenolysis
(glycogen to glucose), gluconeogenesis (glucose FROM amino/ fatty acids)
Liver protein function - ✔✔synthesis: non-essential aminos, plasma proteins, clotting
factors. Urea formation from ammonia.
Liver function Fat - ✔✔Synthesis: lipoproteins, fatty acids, cholesterol. Breakdown:
triglycerides, cholesterol. Formation of ketone bodies
Other liver functions - ✔✔Detox: inactivation of drugs/ harmful substances. Steroids:
conjugation and excretion of corticosteroid hormones
Hemolytic Jaundice - ✔✔Increased breakdown in RBCs, which produces more unconjugated
bilirubin in the blood, liver unable to handle increased load. Cause: transfusion reactions,
sickle cell, hemolytic anemia
Hepatocellular Jaundice - ✔✔Liver's ability to take up bilirubin, conjugate it, or excrete it is
altered. Hepatocytes are damages and leak bilirubin = Increased levels CONJUGATED. Cause:
hepatitis, cirrhosis, hepatocellular carcinoma.
Obstructive Jaundice - ✔✔decreased or obstructed flow through the liver or biliary duct
system. Cause: damage from liver tumors, hepatitis, cirrhosis, bile stones, strictures,
sclerosing cholangitis, pancreatic cancer.
Types of hepatitis - ✔✔Viral: A,B,C,D,E,G, cytomegalovirus, Epstein-Barr, herpes, cocksackie,
rubella. Non-infectious: exposure to chemicals or drugs
Effects of hepatitis on liver - ✔✔Widespread inflammation, cell degeneration and necrosis,
proliferation/ enlargement of Kupffer cells
,Systemic effects: hepatitis - ✔✔Circulating immune complexes, rash, angioedema, arthritis,
fever, malaise, can be asymptomatic, RUQ tenderness, hepatomegaly, splenomegaly
Diagnostic findings in acute hepatitis - ✔✔Increased: AST, ALT, serum bilirubin (liver cell
injury), Urinary bilirubin, prothrombin time, GGT, alkaline phosphotase. Decreased: serum
albumin
Collabo care for acute and chronic hepatitis - ✔✔Well-balanced diet, Vitamin supplements,
Rest, avoid alcohol intake and drugs which are detoxed by the liver
Collabo care for chronic HBV - ✔✔Intron-A, Epivir, Hepsera, Baraclude, Tyzeka, Viread
Drugs: decrease viral load, liver enzymes, rate of dz progress, rate of drug-resistance.
Collabo care for chronic HCV - ✔✔Pegasys, Rebetol, Copegus
Nursing Diagnoses for Hepatitis - ✔✔Imbalanced nutrition, activity intolerance, risk for
impaired liver function
Overall nursing goals/ interventions vira Hep - ✔✔relief of discomfort, be able to resume
normal activities, return to normal liver function without complications, prevention, control,
patient ed, follow up is very important!
Interventions for Hep A - ✔✔vaccination, hand washing, Twinrix: HAV + HAB over 18 yrs.
immune globulin,
Interventions for Hep B - ✔✔prevention, patient ed, good hygiene, vaccination, infection
control precautions
Interventions for Hep C - ✔✔No vaccine. Control high-risk behavior, screening blood etc,
testing after exposure.
, Interventions for Jaundice - ✔✔comfort measures to relieve pruritis, headache, arthralgias,
adequate nutrition, rest, psychological/ emotional support
Primary Biliary Cirrhosis - ✔✔chronic inflammatory condition of liver, possibly due to
genetic and environmental factors. Generalizes pruritis, hepatomegaly, hyper skin
pigmentation, fatigue.
Stressors of Primary Biliary Cirrhosis - ✔✔asymptomatic early stages, then fatigue, pruritis,
jaundice, osteoporosis, fat malabsorption
Interventions for Primary Biliary Cirrhosis - ✔✔ursodiol (Actigal), focus on malabsorption,
skin disorders, hyperlipidemia, vit deficiency, anemia, fatigue, monitored for progression to
cirrhosis, liver transplant.
Cirrhosis - ✔✔chronic progressive dz. Extensive degeneration of liver parenchymal cells;
cells regenerate in a disorganized pattern with fibrous connective tissue = abnormal blood
vessel, bile ducts, lobular structure, and blood flow
Causes of cirrhosis - ✔✔long-term liver dz, excessive alcohol ingestion, extreme dieting,
malabsorption, obesity, hep C, hep B, primary biliary cirrhosis, primary sclerosing cholangitis
(chronic inflammatory condition)
Stressors of Cirrhosis - ✔✔Insidious. GI disturbances, anorexia, dyspepsia, flatulence, N&V,
ab pain, fever, weight loss, palpable liver, liver failure, portal HTN, jaundice, edema, ascites,
skin lesions, endocrine/ hematologic disorders, peripheral neuropathies
Cirrhosis Patient teaching - ✔✔Chronic = continuous care. What complications, and when to
seek treatment. Hepatotoxic drugs. Avoiding alcohol, spicy/ rough foods, and anything that
increases portal pressure.
Collabo care for Cirrhosis - ✔✔Rest, B vitamins, avoid alcohol, minimize aspirin and NSAIDs,
treat major complications with diet and drugs
Verified/ Latest Update
Etiology of Jaundice - ✔✔results from an alteration in normal bilirubin metabolism or flow
of bile into the hepatic/ biliary duct system
Structure and function of gallbladder - ✔✔pear-shaped sac located below the liver.
Concentrates and stores bile
Diagnositic studies for gallbladder - ✔✔Hx and physical exam, ultrasound, ERCP,
percutaneous transhepatic cholangiography, liver function studies, WBC count, serum
bilirubin
Manifestations of obstructed bile flow - ✔✔Obstructive jaundice, dark amber urine, no
urobilinogen in urine, clay-colored stools, pruritis, intolerance for fatty foods, bleeding
tendencies, statorrhea
Chronic cholecystitis - ✔✔May be asymptomatic or hx of fat intolerance, dyspepsia,
heartburn, flatulence, spasms result when a stone gets stuck (biliary colic).
Cholelithiasis - ✔✔Gallstones, unknown cause upsets balance between cholesterol, bile
salts, and calcium in solution.
Cholecystitis - ✔✔acute or chronic inflammation of the gallbladder, usually caused by
obstruction, or trauma, extensive burns, recent surgery, prolonged immobility, fasting, DM,
bacteria.
S/S of Cholecystitis - ✔✔indigestion, moderate to sever pain, fever, jaundice, tenderness
RUQ possible referred to R shoulder/ scapula. Possible N&V, restlessness, diaphoresis,
leukocytosis, fever.
Functions of the Liver - ✔✔Metabolic: Carb/ prot/ fat, Detox, steroid metabolism, bile
synthesis, fat soluble vitamin storage, mononuclear phagocyte system
,Biilirubin - ✔✔Pigment derived from breakdown of hemoglobin. Insoluble in water/ bound
to protein. Unconjugated: bound to albumin => go to liver. Conjugated by liver: gluuronic
acid = soluble, excreted in bile.
Liver metabolic functions Carbs - ✔✔glycogenesis (glucose to glycogen), glycogenolysis
(glycogen to glucose), gluconeogenesis (glucose FROM amino/ fatty acids)
Liver protein function - ✔✔synthesis: non-essential aminos, plasma proteins, clotting
factors. Urea formation from ammonia.
Liver function Fat - ✔✔Synthesis: lipoproteins, fatty acids, cholesterol. Breakdown:
triglycerides, cholesterol. Formation of ketone bodies
Other liver functions - ✔✔Detox: inactivation of drugs/ harmful substances. Steroids:
conjugation and excretion of corticosteroid hormones
Hemolytic Jaundice - ✔✔Increased breakdown in RBCs, which produces more unconjugated
bilirubin in the blood, liver unable to handle increased load. Cause: transfusion reactions,
sickle cell, hemolytic anemia
Hepatocellular Jaundice - ✔✔Liver's ability to take up bilirubin, conjugate it, or excrete it is
altered. Hepatocytes are damages and leak bilirubin = Increased levels CONJUGATED. Cause:
hepatitis, cirrhosis, hepatocellular carcinoma.
Obstructive Jaundice - ✔✔decreased or obstructed flow through the liver or biliary duct
system. Cause: damage from liver tumors, hepatitis, cirrhosis, bile stones, strictures,
sclerosing cholangitis, pancreatic cancer.
Types of hepatitis - ✔✔Viral: A,B,C,D,E,G, cytomegalovirus, Epstein-Barr, herpes, cocksackie,
rubella. Non-infectious: exposure to chemicals or drugs
Effects of hepatitis on liver - ✔✔Widespread inflammation, cell degeneration and necrosis,
proliferation/ enlargement of Kupffer cells
,Systemic effects: hepatitis - ✔✔Circulating immune complexes, rash, angioedema, arthritis,
fever, malaise, can be asymptomatic, RUQ tenderness, hepatomegaly, splenomegaly
Diagnostic findings in acute hepatitis - ✔✔Increased: AST, ALT, serum bilirubin (liver cell
injury), Urinary bilirubin, prothrombin time, GGT, alkaline phosphotase. Decreased: serum
albumin
Collabo care for acute and chronic hepatitis - ✔✔Well-balanced diet, Vitamin supplements,
Rest, avoid alcohol intake and drugs which are detoxed by the liver
Collabo care for chronic HBV - ✔✔Intron-A, Epivir, Hepsera, Baraclude, Tyzeka, Viread
Drugs: decrease viral load, liver enzymes, rate of dz progress, rate of drug-resistance.
Collabo care for chronic HCV - ✔✔Pegasys, Rebetol, Copegus
Nursing Diagnoses for Hepatitis - ✔✔Imbalanced nutrition, activity intolerance, risk for
impaired liver function
Overall nursing goals/ interventions vira Hep - ✔✔relief of discomfort, be able to resume
normal activities, return to normal liver function without complications, prevention, control,
patient ed, follow up is very important!
Interventions for Hep A - ✔✔vaccination, hand washing, Twinrix: HAV + HAB over 18 yrs.
immune globulin,
Interventions for Hep B - ✔✔prevention, patient ed, good hygiene, vaccination, infection
control precautions
Interventions for Hep C - ✔✔No vaccine. Control high-risk behavior, screening blood etc,
testing after exposure.
, Interventions for Jaundice - ✔✔comfort measures to relieve pruritis, headache, arthralgias,
adequate nutrition, rest, psychological/ emotional support
Primary Biliary Cirrhosis - ✔✔chronic inflammatory condition of liver, possibly due to
genetic and environmental factors. Generalizes pruritis, hepatomegaly, hyper skin
pigmentation, fatigue.
Stressors of Primary Biliary Cirrhosis - ✔✔asymptomatic early stages, then fatigue, pruritis,
jaundice, osteoporosis, fat malabsorption
Interventions for Primary Biliary Cirrhosis - ✔✔ursodiol (Actigal), focus on malabsorption,
skin disorders, hyperlipidemia, vit deficiency, anemia, fatigue, monitored for progression to
cirrhosis, liver transplant.
Cirrhosis - ✔✔chronic progressive dz. Extensive degeneration of liver parenchymal cells;
cells regenerate in a disorganized pattern with fibrous connective tissue = abnormal blood
vessel, bile ducts, lobular structure, and blood flow
Causes of cirrhosis - ✔✔long-term liver dz, excessive alcohol ingestion, extreme dieting,
malabsorption, obesity, hep C, hep B, primary biliary cirrhosis, primary sclerosing cholangitis
(chronic inflammatory condition)
Stressors of Cirrhosis - ✔✔Insidious. GI disturbances, anorexia, dyspepsia, flatulence, N&V,
ab pain, fever, weight loss, palpable liver, liver failure, portal HTN, jaundice, edema, ascites,
skin lesions, endocrine/ hematologic disorders, peripheral neuropathies
Cirrhosis Patient teaching - ✔✔Chronic = continuous care. What complications, and when to
seek treatment. Hepatotoxic drugs. Avoiding alcohol, spicy/ rough foods, and anything that
increases portal pressure.
Collabo care for Cirrhosis - ✔✔Rest, B vitamins, avoid alcohol, minimize aspirin and NSAIDs,
treat major complications with diet and drugs
