Liver, Biliary Tract, and Pancreas Problems Lewis Ch 48
UPDATED ACTUAL Questions and CORRECT Answers
The nurse teaches a patient about cholestyramine to “The medication is a powder and needs to be mixed with milk or juice.”
reduce pruritus caused by gallbladder disease. Which
statement indicates understanding of the instructions? Rationale:
For treatment of pruritus, cholestyramine may provide relief. This is a resin that
“This medication will help me digest fats and fat-soluble binds bile salts in the intestine, increasing their excretion in the feces.
vitamins.” Cholestyramine is in powder form and should be mixed with milk or juice before
“I will apply the medicated lotion sparingly to the areas oral administration.
where I itch.”
“The medication is a powder and needs to be mixed with
milk or juice.”
“I should take this medication on an empty stomach at the
same time each day.”
The family of a patient newly diagnosed with hepatitis A “An immunoglobulin injection will be given to prevent infection or limit
asks the nurse what they can do to prevent becoming symptoms.”
ill. How would the nurse respond?
Rationale:
“You will need to be tested first; then treatment can be Immunoglobulin provides temporary (1 to 2 months) passive immunity and is
determined.” effective for preventing hepatitis A if given within 2 weeks after exposure. It may
“The hepatitis vaccine will provide immunity from this and not prevent infection in all persons, but it will at least modify the illness to a
future exposures.” subclinical infection. The hepatitis vaccine is only used for preexposure
“There is nothing you can do since the patient was prophylaxis.
infectious before admission.”
“An immunoglobulin injection will be given to prevent
infection or limit symptoms.”
The health care provider orders lactulose for a patient Decreased ammonia levels
with hepatic encephalopathy. Which finding indicates
the medication has been effective? Rationale:
Hepatic encephalopathy is a complication of liver disease and is associated with
Relief of constipation elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its
Relief of abdominal pain laxative effect then expels the ammonia from the colon, resulting in decreased
Decreased liver enzymes serum ammonia levels and correction of hepatic encephalopathy. An additional
Decreased ammonia levels finding may be an improvement in level of consciousness.
, The nurse is caring for a patient with acute pancreatitis Nausea and vomiting
from gallstones. Which clinical manifestations would Left upper abdominal pain
the nurse expect? (Select all that apply.) Temperature 99.3°F (37.4°C)
Hematochezia Rationale:
Nausea and vomiting Abdominal pain (usually in the left upper quadrant) is the predominant
Hyperactive bowel sounds manifestation of acute pancreatitis. Other manifestations include nausea and
Left upper abdominal pain vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice.
Ascites and peripheral edema Abdominal tenderness with muscle guarding is common. Bowel sounds may be
Temperature 99.3°F (37.4°C) decreased or absent. Ileus may occur and causes marked abdominal distention.
Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal
wall may occur. Other areas of ecchymoses are the flanks (Grey Turner’s spots or
sign, a bluish flank discoloration) and the periumbilical area (Cullen’s sign, a bluish
periumbilical discoloration).
A patient with cirrhosis has increased abdominal girth Portal hypertension causes leaking of protein and water into the peritoneal cavity.
from ascites. Which statements describe the Aldosterone is released to stabilize intravascular volume by saving salt and water.
pathophysiology of ascites? (Select all that apply.) Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.
Hepatocytes are unable to convert ammonia to urea. Rationale:
Osmoreceptors in the hypothalamus stimulate thirst. Ascites related to cirrhosis is caused by decreased colloid oncotic pressure. The
An enlarged spleen removes blood cells from the liver does not produce albumin that holds fluid in the vascular space, so fluid
circulation. shifts into interstitial and third spaces. Portal hypertension causes back pressure in
Portal hypertension causes leaking of protein and water the vessels, shifting protein and fluids into the peritoneal cavity. Decreased
into the peritoneal cavity. intravascular volume stimulates the release of aldosterone, which increases
Aldosterone is released to stabilize intravascular volume sodium and fluid retention. Oral intake of fluids and removal of blood cells by the
by saving salt and water. spleen do not directly contribute to ascites.
Inability of the liver to synthesize albumin reducing
intravascular oncotic pressure.
After teaching the patient with acute hepatitis C (HCV), “I will need to be monitored for chronic HCV and other liver problems.”
which statement demonstrates understanding of the
disease process? Rationale:
Many patients who acquire HCV develop chronic infection, which may lead to
“I will use care when kissing my wife to prevent giving it cirrhosis or liver cancer. HCV is not transmitted via saliva but by blood exposures
to her.” such as sharing needles and high-risk sexual activity. The treatment for acute viral
“I will need to take adefovir (Hepsera) to prevent chronic hepatitis focuses on resting the body and adequate nutrition for liver
HCV.” regeneration. Adefovir (Hepsera) is taken for severe hepatitis B (HBV) with liver
“Now that I have had HCV, I will have immunity and not failure. HCV is treated with oral direct-acting antivirals (DAAs). Immunity with HCV
get it again.” does not occur as it does with HAV and HBV, so the patient may be reinfected
“I will need to be monitored for chronic HCV and other with another type of HCV.
liver problems.”
When caring for a patient with a biliary obstruction, the Vitamin A
nurse will anticipate administering which vitamin Vitamin D
supplements? (Select all that apply.) Vitamin E
Vitamin K
Vitamin A
Vitamin B Rationale:
Vitamin D Biliary obstruction prevents bile from entering the small intestine and thus
Vitamin E prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-
Vitamin K soluble and thus would need to be supplemented in a patient with biliary
obstruction.
UPDATED ACTUAL Questions and CORRECT Answers
The nurse teaches a patient about cholestyramine to “The medication is a powder and needs to be mixed with milk or juice.”
reduce pruritus caused by gallbladder disease. Which
statement indicates understanding of the instructions? Rationale:
For treatment of pruritus, cholestyramine may provide relief. This is a resin that
“This medication will help me digest fats and fat-soluble binds bile salts in the intestine, increasing their excretion in the feces.
vitamins.” Cholestyramine is in powder form and should be mixed with milk or juice before
“I will apply the medicated lotion sparingly to the areas oral administration.
where I itch.”
“The medication is a powder and needs to be mixed with
milk or juice.”
“I should take this medication on an empty stomach at the
same time each day.”
The family of a patient newly diagnosed with hepatitis A “An immunoglobulin injection will be given to prevent infection or limit
asks the nurse what they can do to prevent becoming symptoms.”
ill. How would the nurse respond?
Rationale:
“You will need to be tested first; then treatment can be Immunoglobulin provides temporary (1 to 2 months) passive immunity and is
determined.” effective for preventing hepatitis A if given within 2 weeks after exposure. It may
“The hepatitis vaccine will provide immunity from this and not prevent infection in all persons, but it will at least modify the illness to a
future exposures.” subclinical infection. The hepatitis vaccine is only used for preexposure
“There is nothing you can do since the patient was prophylaxis.
infectious before admission.”
“An immunoglobulin injection will be given to prevent
infection or limit symptoms.”
The health care provider orders lactulose for a patient Decreased ammonia levels
with hepatic encephalopathy. Which finding indicates
the medication has been effective? Rationale:
Hepatic encephalopathy is a complication of liver disease and is associated with
Relief of constipation elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its
Relief of abdominal pain laxative effect then expels the ammonia from the colon, resulting in decreased
Decreased liver enzymes serum ammonia levels and correction of hepatic encephalopathy. An additional
Decreased ammonia levels finding may be an improvement in level of consciousness.
, The nurse is caring for a patient with acute pancreatitis Nausea and vomiting
from gallstones. Which clinical manifestations would Left upper abdominal pain
the nurse expect? (Select all that apply.) Temperature 99.3°F (37.4°C)
Hematochezia Rationale:
Nausea and vomiting Abdominal pain (usually in the left upper quadrant) is the predominant
Hyperactive bowel sounds manifestation of acute pancreatitis. Other manifestations include nausea and
Left upper abdominal pain vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice.
Ascites and peripheral edema Abdominal tenderness with muscle guarding is common. Bowel sounds may be
Temperature 99.3°F (37.4°C) decreased or absent. Ileus may occur and causes marked abdominal distention.
Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal
wall may occur. Other areas of ecchymoses are the flanks (Grey Turner’s spots or
sign, a bluish flank discoloration) and the periumbilical area (Cullen’s sign, a bluish
periumbilical discoloration).
A patient with cirrhosis has increased abdominal girth Portal hypertension causes leaking of protein and water into the peritoneal cavity.
from ascites. Which statements describe the Aldosterone is released to stabilize intravascular volume by saving salt and water.
pathophysiology of ascites? (Select all that apply.) Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.
Hepatocytes are unable to convert ammonia to urea. Rationale:
Osmoreceptors in the hypothalamus stimulate thirst. Ascites related to cirrhosis is caused by decreased colloid oncotic pressure. The
An enlarged spleen removes blood cells from the liver does not produce albumin that holds fluid in the vascular space, so fluid
circulation. shifts into interstitial and third spaces. Portal hypertension causes back pressure in
Portal hypertension causes leaking of protein and water the vessels, shifting protein and fluids into the peritoneal cavity. Decreased
into the peritoneal cavity. intravascular volume stimulates the release of aldosterone, which increases
Aldosterone is released to stabilize intravascular volume sodium and fluid retention. Oral intake of fluids and removal of blood cells by the
by saving salt and water. spleen do not directly contribute to ascites.
Inability of the liver to synthesize albumin reducing
intravascular oncotic pressure.
After teaching the patient with acute hepatitis C (HCV), “I will need to be monitored for chronic HCV and other liver problems.”
which statement demonstrates understanding of the
disease process? Rationale:
Many patients who acquire HCV develop chronic infection, which may lead to
“I will use care when kissing my wife to prevent giving it cirrhosis or liver cancer. HCV is not transmitted via saliva but by blood exposures
to her.” such as sharing needles and high-risk sexual activity. The treatment for acute viral
“I will need to take adefovir (Hepsera) to prevent chronic hepatitis focuses on resting the body and adequate nutrition for liver
HCV.” regeneration. Adefovir (Hepsera) is taken for severe hepatitis B (HBV) with liver
“Now that I have had HCV, I will have immunity and not failure. HCV is treated with oral direct-acting antivirals (DAAs). Immunity with HCV
get it again.” does not occur as it does with HAV and HBV, so the patient may be reinfected
“I will need to be monitored for chronic HCV and other with another type of HCV.
liver problems.”
When caring for a patient with a biliary obstruction, the Vitamin A
nurse will anticipate administering which vitamin Vitamin D
supplements? (Select all that apply.) Vitamin E
Vitamin K
Vitamin A
Vitamin B Rationale:
Vitamin D Biliary obstruction prevents bile from entering the small intestine and thus
Vitamin E prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat-
Vitamin K soluble and thus would need to be supplemented in a patient with biliary
obstruction.
