N3 Final Study Guide Chapter 51 Hepatic, Biliary Tract, and Pancreatic Dysfunction: Nursing Management

1.A child care worker complains of flu-like symptoms. On further assessment, hepatitis is suspected. The nurse realizes that this individual is at risk for which type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D ANS: 1 Hepatitis A virus (HAV) is spread through the fecal-oral route. Child care workers are at greater risk because of potentially poor hygiene practices. Child care workers are not at the same risk for contracting hepatitis B, C, or D. 2. An older male is diagnosed with cirrhosis of the liver. The nurse knows that the most likely cause of this problem is: being in the military. traveling to a foreign country. drinking excessive alcohol. eating bad food. ANS: 3 The destruction to the liver from alcohol often progresses from fatty liver to alcoholic hepatitis and culminates in alcoholic cirrhosis. Alcoholic cirrhosis accounts for a great number of individuals diagnosed with this disease. Cirrhosis is not associated with being in the military, traveling to a foreign country, or eating bad food. 3. When the liver is seriously damaged, ammonia levels can rise in the body. One of the treatments for this is: administering intravenous (IV) neomycin. giving vitamin K. MICHE 1 lOMoARcPSD| 3. giving lactulose. 4. starting the patient on insulin. ANS: 3 Lactulose is a laxative that works by pulling water into the stool. It also helps pull ammonia from the blood into the colon for expulsion. IV antibiotics do not reduce serum ammonia levels. Vitamin K controls bleeding, but it does not reduce ammonia levels. Insulin is not used to reduce ammonia levels. 4.A client is scheduled for a liver biopsy. The nurse realizes that the most important sign to assess for is: 1. infection. 2. bleeding. 3. pain. 4. nausea and vomiting. ANS: 2 After a liver biopsy, the client is monitored for bleeding or hemorrhage. Infection and pain are of concern, but they are not the most important signs to be monitored. Nausea and vomiting are not typically associated with a liver biopsy. 5. The nurse realizes that the organ which is a major site for metastases, harboring and growing cancerous cells that originated in some other part of the body, is the: 1. spleen. 2. gallbladder. 3. liver. 4. stomach. ANS: 3 In most developed countries, this secondary type of liver cancer is more common than cancer that originates in the liver itself. The spleen, gallbladder, and stomach are not major sites for metastases. lOMoARcPSD| 1. cirrhosis due to hepatitis C. 2. biliary atresia. 3. diabetes. 4. Crohns disease. Preicteric . Icteric . 6. A school age child is placed on a waiting list for a liver transplant. The nurse knows that the most common reason for children to need this type of transplant is because of: ANS: 2 Biliary atresia is the most common reason for children to have a liver transplant. Cirrhosis due to hepatitis C is the reason for most adults to have a transplant. Children do not typically need a liver transplant for diabetes or Crohns disease. 7. Because health care workers are at a greater risk of hepatitis B infection, it is recommended that all health care workers: 1. wash their hands often. 2. avoid foreign travel. 3. become vaccinated. 4. drink bottled water only. ANS: 3 Because of the risk of blood and body fluid exposure, it is recommended that all health care workers be vaccinated against hepatitis B virus. All health care workers should engage in frequent handwashing, but handwashing is not the primary mechanism to prevent the onset of hepatitis B. Avoiding foreign travel and drinking bottled water only will not reduce the risk of hepatitis B. 8. A client who usually smokes a pack of cigarettes a day tells the nurse that he cannot stand the smell of smoke. The nurse realizes that this client is in which phase of hepatitis? lOMoARcPSD| Hyperkalemia . Hypercalcemia . Hypernatremia . 3 Posticteric . 4 Recovery . ANS: 1 In the preicteric phase of hepatitis, some smokers will have an aversion to smoking as a first sign of the disease. Smoking is not affected with the icteric or posticteric phases of the disease. Recovery is not a phase of hepatitis. 9. A female client is surprised to learn that she has been diagnosed with hemochromatosis. Which of the following should the nurse respond to this client? 1 It doesnt affect people until they are in their 50s. . 2 I would ask the doctor if hes sure about the diagnosis. . 3 Females often do not experience the effects of the disease until menopause. . 4 All women have the disorder but not the symptoms. . ANS: 3 Women do not experience the effects of hemochromatosis until menopause when the regular loss of blood stops. This disorder is a genetic disorder and can affect individuals of all ages. The nurse should not doubt the physicians diagnosis. All women do not have this disorder. 10. A client is diagnosed with liver disease. Which of the following is one impact of this disorder on a clients fluid and electrolyte status? lOMoARcPSD| 4 Hyponatremia . ANS: 4 Liver disease effects the fluid and electrolyte status by causing ascites, edema, hypokalemia, hypocalcemia, and hyponatremia. Liver disease does not cause hyperkalemia, hypercalcemia, or hypernatremia. 11. The nurse, caring for a client recovering from the placement of a shunt to treat portal hypertension, should assess the client for which of the following complications associated with this surgery? 1 Myocardial infarction . 2 Pulmonary emboli . 3 Pulmonary edema . 4 Decreased peripheral . pulses ANS: 3 Complications after shunt surgery include the development of pulmonary edema. Myocardial infarction, pulmonary emboli, and decreased peripheral pulses are not complications associated with this type of surgery. 12. A client is diagnosed with macrovesicular fatty liver. Which of the following should the nurse instruct this client? Expect to develop jaundice. Avoid all alcohol. Increase exercise. Treatment includes antibiotic therapy. lOMoARcPSD| 1. Fluid restriction 2. Low-sodium diet 3. Increased exercise 4. Diuretic therapy 5. Pain medication 6. Bed rest ANS: 2 The client diagnosed with macrovesicular fatty liver should be instructed to avoid all alcohol. Jaundice is a symptom of microvesicular fatty liver. The client should be instructed to rest. Antibiotic therapy is not indicated for macrovesicular fatty liver. MULTIPLE RESPONSE 1.A client diagnosed with cirrhosis is experiencing the complication of ascites. Which of the following would be considered treatment for this complication? (Select all that apply.) ANS: 1, 2, 4 Ascites is the accumulation of fluid in the peritoneal cavity. Treatment strategies include fluid restriction (1000 to 1500 mL/day), low-sodium diet (200 to 500 mg/day), and diuretic therapy to remove the excessive fluid. Increased exercise, pain medication, and bed rest are not included as treatments for this complication. 2.A client is recovering from an endoscopic retrograde cholangiopancreatogram (ERCP). Which of the following should the nurse assess as possible complications from this procedure? (Select all that apply.) 1. Perforation of the stomach 2. Perforated duodenum 3. Pancreatitis 4. Aspiration of gastric contents 5. Anaphylactic reaction to the contrast dye lOMoARcPSD| 6. Perforated bladder ANS: 1, 2, 3, 4, 5 Potential complications of an ERCP are perforated stomach and duodenum, pancreatitis, anaphylactic reaction to the contrast diet, aspiration of gastric contents, and reaction to anesthesia. A perforated bladder is a possible complication from a paracentesis. 3.A client is demonstrating yellow pigmentation of the skin and sclera. Which of the following can be used to describe this clients symptoms? (Select all that apply.) 1 Jaundice . 2 Dyspepsia . 3 Icterus . 4 Sclerosis . 5 Kernicterus . 6 Cirrhosis . ANS: 1, 3, 5 Terms used to describe yellow pigmentation of the skin and sclera include jaundice, icterus, and kernicterus. Dyspepsia, sclerosis, and cirrhosis are not terms used to describe the yellow pigmentation of the skin and sclera. 4. The nurse is providing dietary instruction to a client diagnosed with Wilsons disease. Which of the following should be included in these instructions? (Select all that apply.) 1. Avoid liver. 2. Avoid shellfish. 3. Eat soy products. lOMoARcPSD| 4. Use avocados in salads. 5. Avoid nectarines. 6. Avoid mushrooms. ANS: 1, 2, 5, 6 Dietary instruction for a client diagnosed with Wilsons disease include reducing the intake of foods high in copper. This includes avoiding liver, shellfish, soy products, avocado, nectarines, and mushrooms. 5. A client is diagnosed with a disorder of the liver. The nurse realizes this client might experience which of the following? (Select all that apply.) 1. Low vitamin A levels 2. Increased bleeding 3. Poor digestion of fats 4. Insulin resistance 5. Elevated levels of vitamin E 6. Nerve damage ANS: 1, 2, 3, 4, 6 Effects of a liver disorder on a client are many. Some of the functions affected by this disorder include low levels of fat soluble vitamins, including A and E; poor synthesis of clotting factors, leading to increased bleeding; poor digestion of fats; insulin resistance; and nerve damage. 6.A client is diagnosed with portal hypertension. The nurse should assess the client for which of the following disorders associated with this diagnosis? (Select all that apply.) 1 Esophageal varices . 2 Splenomegaly . lOMoARcPSD| 3 Hemorrhoids . 4 Caput medusae . 5 Gastritis . 6 Gallstone formation . ANS: 1, 2, 3, 4 Portal hypertension can lead to the development of esophageal varices, splenomegaly, hemorrhoids, and caput medusae. Portal hypertension does not lead to gastritis or gallstone formation. lOMoARcPSD| Chapter 60Musculoskeletal Trauma: Nursing Management MULTIPLE CHOICE 1.A client tells the nurse that he has pain, swelling, fatigue, and numbness of his hands. The nurse should assess the client for which of the following occupations? 1. Retail store clerk 2. Lifeguard 3. Computer keyboard operator 4. Bus driver ANS: 3 Some occupations, sports, and tasks can create repetitive motion injuries or cumulative trauma. A computer keyboard operator is an occupation with a high incidence of overuse syndrome. 2.A client who plays baseball on the weekends is experiencing an arm injury. The nurse realizes this client needs to be evaluated for: 1. a rotator cuff tear. 2. lateral epicondylitis. 3. dislocation of the shoulder. 4. patellar tendinopathy. ANS: 1 A rotator cuff tear can be caused by extensive overhead movements found in sports and activities such baseball, softball, tennis, swimming, and volleyball. A dislocation of the shoulder is most commonly caused by a fall on an outstretched hand and arm. Lateral epicondylitis, or tennis elbow, is an overuse injury that involves the extensor/supinator muscles that attach to the distal humerus. Patellar tendinopathy, also known as jumpers knee, is seen in athletes who participate in activities that require a lot of jumping such as basketball. 3.A client, diagnosed with an ankle sprain, is prescribed ibuprofen to control pain and inflammation. What instruction should the client receive concerning this medication? 1 Bleeding is not a problem with this medication. . lOMoARcPSD| Calling physical therapy for a sling Checking capillary refill time Giving pain medication Starting discharge teaching 2 Take on an empty stomach to maximize its effect. . 3 Take with food to minimize gastrointestinal irritation. . 4 Wear sunscreen if outside to prevent a burn. . ANS: 3 Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be taken with food to minimize gastrointestinal irritation. Ibuprofen does not increase photosensitivity; however, bleeding can be a problem when taking ibuprofen. 4.A client, experiencing a fractured arm, asks the nurse why the splint is being applied. Which of the following should the nurse respond to this client? 1. It reduces the need for a cast. 2. It reduces bleeding, swelling and pain. 3. It prevents the need for surgery. 4. It immobilizes the muscles and joints. ANS: 2 Splinting of a fractured extremity minimizes bleeding, edema, and pain. Splinting does not reduce the need for a cast nor prevent the need for surgery. A cast immobilizes the muscles and joints. 5. A client has had a cast applied to immobilize a right ulnar fracture. Which of the following nursing interventions is most important? ANS: 2 lOMoARcPSD| Checking the capillary refill time determines that circulation is not compromised. The other options can be completed after ensuring that circulation to the site is still adequate. 6. A client with a right arm cast is experiencing signs of a serious complication. Which of the following would cause the nurse the most concern? 1 Capillary refill time less than 3 seconds . 2 Finger movement . 3 Itching under the cast . 4 Severe pain to the right arm continues after receiving pain medication . ANS: 4 Severe pain that continues after receiving pain medication would be considered as being disproportionate to the injury, can be a sign of compartment syndrome, and should be immediately reported. The other options are expected assessment findings for a client with a cast. 7. A client is unable to pass the chair raise test. The nurse realizes this client is experiencing: 1. carpal tunnel syndrome. 2. rotator cuff tear. 3. fractured arm. 4. lateral epicondylitis. ANS: 4 The chair raise test examines the clients ability to grip and lift. The client stands behind a chair and places the hands on the chair back. The client then attempts to raise the chair. If pain is experienced over the lateral elbows, lateral epicondylitis may be present. The chair raise test is not used to diagnose carpal tunnel syndrome, rotator cuff tear, or a fractured arm. 8. A client has been wearing a splint for carpal tunnel syndrome for 7 weeks. The nurse realizes that which of the following would be the next course of treatment for this client? 1. Surgery lOMoARcPSD| 2. Exercises 3. Corticosteroid injection 4. Casting ANS: 3 If after 2 to 7 weeks of conservative treatment the carpal tunnel syndrome symptoms do not improve, corticosteroid injection is recommended. Surgery is not recommended until after corticosteroid injections have been tried. Exercises are implemented with the use of the splint. Casting is not a treatment for carpal tunnel syndrome. 9. The nurse is planning care for a client recovering from a meniscal injury. Which of the following should be included as strategies to avoid future injuries? Avoid hamstring muscle . exercises. Stretch before and after exercise. . Wear similar shoes for all . activities. Avoid skiing. . ANS: 2 Strategies to prevent future meniscal injuries include having strong thigh and hamstring muscles; stretching before and after exercise; wearing shoes that fit and are appropriate for the activity; and when skiing, having bindings that release the skis with a fall. 10. A client with an ankle sprain is instructed to follow RICE. Which of the following should the nurse instruct the client regarding this process? Maintain your normal level of activity. Apply ice to the ankle once a day. Apply an elastic bandage to the site. Elevate the extremity every day for 20 to 30 minutes. lOMoARcPSD| ANS: 3 The nurse should instruct the client to use crutches to allow for the rest of the ankle joint and relieve pain; apply ice for 20 to 30 minutes 3 to 4 times a day; apply an elastic bandage to the site; and elevate the ankle for the first 48 hours after the injury. 11. The nurse is evaluating the effectiveness of care for a client recovering from an injured Achilles tendon. Which of the following would indicate that care has been effective? Client states steroid injections will be helpful to reduce the amount of pain. . Client plans to participate in rehabilitation for 5 to 6 months after the injury. . Client resumes sports activities as soon as possible. . Client uses heat to decrease the inflammation and swelling from the injury. . ANS: 2 Evidence that care has been effective for a client recovering from an injured Achilles tendon would be that the client plans to participate in rehabilitation for 5 to 6 months after the injury. Steroid injections are not used for this type of injury. Sports activities should be avoided until the injury has healed and rehabilitation is completed. Cryotherapy, not heat, is used to decrease the inflammation and swelling from the injury. 12. The nurse is instructing a client on ways to prevent the onset of stress fractures. Which of the following should be included in these instructions? 1. Avoid overtraining 2. Increase intensity of training 10% each day 3. Limit warm up exercises 4. Avoid shock absorbing footwear ANS: 1 Interventions to prevent the onset of stress fractures include: avoid overtraining; gradually increase the intensity of workouts by 10% each week; perform adequate warm up exercises; and use shock absorbing footwear and insoles.