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WorksheetsCh 46 Liver
Total questions: 50
Worksheet time: 28mins
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.
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
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.
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
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.
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.
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
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
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.
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.
Which will the nurse point out as a significant advantage of the laparoscopic cholecystectomy?
Slightly more invasive, but there is less pain
Can be performed on all patients of any age
Can be performed even when there are large stones present in the bile duct
Less invasive procedure
Which should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)?
Decompress the stomach.
Control esophageal varices bleeding.
A route for tube feedings.
Obtain specimen for gastric analyzing.
The patient’s cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of which complication?
esophageal varices.
diverticulosis.
Crohn disease.
esophageal reflux (GERD).
The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient's hands flap when the patient stretches out the arm. How will the nurse interpret this?
As an attempt to get the nurse’s attention
As asterixis
As an indication of respiratory obstruction from varices
As spasticity
How does the administration of neomycin reduce the production of ammonia?
By assisting the hepatic cells to regenerate
By reducing ascites
By decreasing the bacteria in the gut
By helping to digest fats and proteins
Which is the most common procedure for the removal of the gallbladder?
Laparoscopic cholecystectomy
Cholangiography
Open cholecystectomy
Choledochostomy
Which assessment is the priority assessment for a patient who will be undergoing intravenous cholangiography?
Patency of the intravenous line
Ensure the patient is fasting prior to the exam
An allergy to the iodine based radiographic dye
Whether or not the patient has signed the consent form
Which is a classic location and radiation of the pain associated with cholecystitis?
Substernal, radiating to the left shoulder and arm
Epigastric, radiating to the back
Right upper abdomen, radiating to the back or right scapula
Left upper abdomen, radiating to the jaw and neck
Which should the nurse avoid contamination from to prevent the transmission of hepatitis A?
Food or water
Blood transfusion
Needles
Sexual contact
Which is the most appropriate method used by high-risk health workers to prevent hepatitis B?
Hepatitis B vaccine
Diligent hand washing
Wearing protective gear
Hb immune globulin injections
The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug has which benefit?
increases the rate of the regeneration of liver cells.
can overcome complications presented by hepatitis C.
increases blood supply to transplant.
does not suppress bone marrow.
A patient returning from a 2-week camping trip a few days ago, reports having nausea, anorexia, and dark urine. Which additional information would assist in diagnosing hepatitis A?
Exposure to blood
Recent ingestion of raw fish
History of intravenous drug use
Multiple sex partners
When caring for an extremely jaundiced patient with cirrhosis, which does the nurse expect to see included in the plan of care?
Encouraging consumption of a high-fat diet
Skin care to relieve pruritus
Offering foods rich in fat-soluble vitamins
Meticulous foot care
The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as how many hours after the onset of pancreatic disease?
2 hours
8 hours
24 hours
36 hours
The 100 lb patient who has been exposed to hepatitis A is to receive an injection of immune serum globulin. What should the dose (0.02mL/kg) be?
0.9 mL
1.4 mL
1.6 mL
1.8 mL
A patient with cirrhosis of the liver will have which blood test results monitored?
Blood urea nitrogen (BUN)
Platelet counts
Aspartate aminotransferase (AST)
Hemoglobin and Hematocrit (HGB and HCT)
The nurse would expect to see a provision in the plan of care for a person who has had a liver transplant to prevent which complication?
fluid congestion.
fatigue.
infection.
urinary retention.
The nurse is aware that the hepatitis A immunization provides immunity in:
5 days.
10 days.
15 days.
30 days.
What is the challenge in encouraging coughing and deep breathing for a postoperative patient who had an open cholecystectomy?
High placement of incision
Excessive nausea
Weakened abdominal muscles
Poor oxygenation
Why is it advantageous for a live person to be a liver donor?
Because the donor is not at risk for any complication.
Because the recipient is more likely to avoid rejection.
Because the donor donates only a part of the liver.
Because the blood supply is more dependable in the donated liver.
Which factors are most commonly associated with pancreatitis?
Coronary artery disease
Alcoholism and biliary tract disease
Cirrhosis
History of myocardial infarction
A patient with pancreatitis is on nothing by mouth status (NPO). The patient asks the nurse “Why am I unable to have anything by mouth?”. Which is the best response?
Diagnostic tests depend on you not eating anything.
The pancreas is stimulated whenever you eat or drink and causes pain.
Eating causes the need for a bowel movement, which excretes your medication too rapidly.
Resting your gastrointestinal tract will cure your pancreatitis.
Why is morphine contraindicated in the patient with pancreatitis?
Meperidine is less expensive.
Tylenol is more effective at managing this type of pain.
Morphine may cause spasms of the sphincter of Oddi.
These patients do not experience pain.
Which factors may increase a patient’s risk of developing cancer of the pancreas?
Diet high in carbohydrates and dairy products
Cardiovascular disease and glaucoma
Tea and cola consumption
Cigarette smoking and having diabetes mellitus
Which assessment indicates possible gallbladder disease?
Dull pain in the right upper quadrant region
Changes in color of urine or stool
Distention of veins in upper part of body
Aching muscles and tenderness in the liver
What should the nurse monitor in caring for the patient undergoing a paracentesis?
The urinary output
Hypervolemia
Fluid removal over at least 30 minutes
Seizure
A patient with a T tube for an open cholecystectomy has resumed oral intake. The T tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. Which intervention is most appropriate?
Notify the health care provider.
Unclamp the tube immediately.
Increase the IV fluids.
Change the T-tube dressing.
The nurse clarifies that deterioration progresses through stages before presenting with liver disease. The first stage is destruction. What is the last stage?
Liver disease
Inflammation
Hepatic insufficiency
Destruction
Fibrotic regeneration
Which is a by-product of protein metabolism?
Urine
Protease
Amylase
Ammonia
Which is an indication for a liver transplant?
Congenital biliary abnormalities
Hepatic malignancy
Chronic hepatitis
Cirrhosis due to alcoholism
Gallbladder disease
Which medical intervention and management system controls the bleeding of esophageal varices?
Sengstaken-Blakemore (S/B) tube
Cryotherapy
Band ligation
Transfusions
Portacaval shunt
Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which food should be avoided?
Peanut butter
Rice and pasta
Whole milk
Glazed chocolate doughnuts
Grilled chicken
Viral hepatitis may be treated at home. Which should be taught to the patient’s family?
Clothes should be laundered separately with hot water.
Personal items and drinking glasses should not be shared.
Articles soiled with feces do not require extra care.
Hands need to be thoroughly washed after toileting.
Contaminated items may be disposed of with regular trash.
The nurse is monitoring which laboratory results that are most closely associated with cirrhosis?
Decreased ammonia levels
Decreased glucose levels
Prolonged prothrombin times
Increased cholesterol levels
Decreased total protein levels
Which action will the nurse take to prepare a patient for an endoscopic retrograde cholangiopancreatography (ERCP)?
Confirm that a recent chest x-ray is on file.
Confirm the presence of a consent form.
Warn patient that the procedure will take about 3 hours.
Confirm the presence of a prothrombin time/INR.
Withhold food and drink for 4 hours.
(a) is a condition characterized by yellowing of the sclera and the skin.
The disease that is on the increase because of the growing obesity population and is associated with coronary artery disease and use of corticosteroids is (a)
The tumor marker that is elevated in patients with pancreatic cancer is (a)
Hepatitis D is usually seen as a coinfection with (a) .
A (a) occurs when the body encapsulates the autodigestive debris in the pancreatic tissue, frequently becoming an abscess.
