Ch 46 Liver

The nurse clarifies that which event happens to unconjugated bilirubin, which is made up of broken-down red cells?

• It is stored in the gallbladder to make bile.

• Water-insoluble bilirubin must be converted by the liver.

• A by-product is excreted directly into the bowel for excretion.

• Red blood cells are necessary for digestion of fats.

Answer explanation

Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel.

The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 to 5 g/dL. Based on these findings, which would the nurse expect the patient to exhibit?

• Jaundice

• Edema

• Copious urine output

• Pallor

Answer explanation

Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema.

Which is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis?

• Have patient sign a permit.

• Pad side rails.

• Check for allergy to contrast media or to shellfish.

• Have patient void immediately before procedure.

Answer explanation

To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis.

Which should the nurse expect of a patient with a malabsorption of vitamin K?

• Anemia

• Excess platelet production

• Increased coagulation time

• Elevated for infection due to diminished white blood cell count

Answer explanation

Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies.

A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and the patient underwent an open cholecystectomy with a T tube inserted into the common bile duct. Which is the purpose of the T tube?

• To decompress the duct and relieve pain caused by stimulation of the sphincter of Oddi.

• To improve diaphragmatic expansion and prevention of atelectasis.

• To shorten postoperative recovery and hasten the healing process.

• To keep the duct open and allow drainage of the bile until edema resolves.

Answer explanation

If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves.

The nurse caring for a patient who has had an open cholecystectomy with a T Tube will take which action?

• open the T tube to the air so that it will drain freely.

• position and secure the drainage bag at mid-chest level.

• place the collection bag so the tube is not kinked.

• irrigate the T tube with normal saline to ensure the free flow of bile.

Answer explanation

The T tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T tubes are not irrigated.

Which nursing intervention should will be completed immediately after the health care provider has performed a needle liver biopsy?

• Assisting to ambulate for the bathroom

• Keeping the patient on the right side for a minimum of 2 hours

• Taking vital signs every 4 hours

• Keeping the patient on the left side for a minimum of 4 hours

Answer explanation

Keep the patient lying on the right side with a rolled towel against the puncture site for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours.

Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. Which will the nurse suspect?

• Peritonitis

• Pneumothorax

• Hemorrhage of the liver

• Pleural effusion

Answer explanation

Pneumothorax is a possible complication of a liver biopsy. These signs and symptoms need to be reported to the health care provider immediately.

Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography?

• Right after the test, I want breakfast with black coffee.

• The instrument will be put down my throat.

• I haven’t had anything to eat or drink since 9 p.m. last night.

• My doctor said I could have medicine to relax me before the test.

Answer explanation

After the procedure, keep the patient at nothing by mouth status (NPO) until the gag reflex returns.

The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for which complication?

• muscular twitching/spasm.

• hematuria.

• macular rash on trunk and arms.

• evidence of cardiac ischemia.

Answer explanation

Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of the varices. Unfortunately it also constricts all vessels and may cause cardiac ischemia.