Content Refresher: Hepatobiliary

Sophia, a nurse, is caring for a client who has just been admitted with severe abdominal pain and a history suggestive of acute pancreatitis. During her assessment, which finding best supports the diagnosis of acute pancreatitis?

• Right lower-quadrant cramping

• Left upper-quadrant pain that radiates to the back

• Hyperactive bowel sounds

• Hemoglobin 18 g/dL

Answer explanation

The finding of left upper-quadrant pain that radiates to the back is characteristic of acute pancreatitis, as it often presents with this type of pain due to inflammation of the pancreas.

Aria, a nurse, is assessing a client who has been admitted with suspected pancreatitis. To clarify the character of the client’s pain, which question should Aria ask?

• “Does the pain in your stomach move into your back?”

• “Do you feel aching in your hips?”

• “Is the discomfort sharp in your groin?”

• “Does it spread to your lower abdomen?”

Answer explanation

The correct choice, "Does the pain in your stomach move into your back?", is significant as pancreatitis pain often radiates to the back, helping to clarify the nature of the client's pain.

During morning rounds, Maya, a nurse, observes that a cirrhotic client’s hands begin to flap when the arms are extended. Which action is priority?

• Check the last INR result

• Measure abdominal girth

• Notify the provider of possible hepatic encephalopathy

• Assess skin for spider angiomas

Answer explanation

The flapping of hands indicates asterixis, a sign of hepatic encephalopathy. This condition requires immediate attention, so notifying the provider is the priority action to ensure timely intervention.

Tags

NGSS.HS-LS1-3

Samuel has recently been diagnosed with advanced cirrhosis and is learning how to manage his condition at home. During a follow-up visit, the nurse asks Samuel to share what he has learned about self-management. Which statement from Samuel signals the need for more teaching about advanced cirrhosis self-management?

• “I’ll weigh myself every morning.”

• “I can take acetaminophen if I get a headache.”

• “Carbohydrates are okay for me to eat.”

• “Getting plenty of rest will help my liver.”

Answer explanation

Samuel's statement about taking acetaminophen indicates a misunderstanding. Patients with advanced cirrhosis should avoid acetaminophen due to the risk of liver damage, signaling the need for more teaching on medication safety.

Anika has just returned to her hospital room after undergoing a cholecystectomy. As her nurse, which assessment should you prioritize first?

• Inspecting the incision dressing

• Auscultating bowel sounds

• Recording temperature

• Obtaining oxygen saturation

Answer explanation

Obtaining oxygen saturation is the priority as it assesses the patient's respiratory status post-surgery. Ensuring adequate oxygenation is critical before addressing other assessments like incision or bowel sounds.

Anika, a client with cirrhosis, is prescribed lactulose 30 mL PO Q6H. Besides treating constipation, the nurse knows lactulose is given to:

• Promote diuresis

• Prevent GI bleeding

• Reduce elevated serum ammonia

• Replace lost electrolytes

Answer explanation

Lactulose is primarily used to reduce elevated serum ammonia levels in patients with liver disease, such as cirrhosis. It helps prevent hepatic encephalopathy by promoting the excretion of ammonia through the stool.

Emma has been diagnosed with hepatic encephalopathy. Her healthcare provider discusses dietary changes to help manage her condition. Which diet change will best help lower ammonia production for Emma?

• Limiting daily protein intake

• Increasing sodium to 4 g/day

• Adding fat-free milkshakes

• Doubling complex carbohydrates

Answer explanation

Limiting daily protein intake is crucial for managing hepatic encephalopathy, as it reduces ammonia production from protein metabolism, helping to alleviate symptoms and improve overall liver function.

After administering an IM injection to a client with hepatitis C, Aria is preparing to dispose of the used needle. What is the safest action for her to take?

• Recap using one-hand scoop

• Remove needle with extractor

• Wrap needle in gauze first

• Drop the uncapped device straight into a sharps container

Answer explanation

The safest action is to drop the uncapped device straight into a sharps container. This minimizes the risk of needle-stick injuries and ensures proper disposal of hazardous materials.

Nora is a nurse who is planning menus for a client suffering from biliary colic due to chronic cholecystitis. Which instruction should Nora give?

• Emphasize high-protein foods

• Select whole-milk dairy products

• Avoid foods that are high in fat

• Include extra dietary fiber

Answer explanation

Biliary colic and chronic cholecystitis require a low-fat diet to reduce gallbladder stimulation and prevent pain. Therefore, avoiding high-fat foods is crucial for managing the client's condition.

Nora recently enjoyed a meal that included raw shellfish at a local restaurant. A few days later, she visits the clinic. Which early manifestation should the nurse expect if Nora has contracted hepatitis A?

• Malaise

• Black, tarry stools

• Unintentional weight gain

• Left upper-quadrant discomfort

Answer explanation

Malaise is an early symptom of hepatitis A, often presenting as general discomfort or fatigue. Other options like black stools or weight gain are not typical early signs of this viral infection.