Nursing Care of Clients with Gallbladder, Liver, and

Pancreatic Disorders

1 .       A client is admitted for severe pain in the right

upper quadrant of the abdomen radiating to the
back and right shoulder. Which of the following
admitting orders should the nurse question? [Hint]
  Morphine 2 - 6 mg IVP on admit for relief of pain
  NPO
  Ultrasound of the gallbladder
  CBC, serum bilirubin, amylase, and lipase
2 .       In establishing a plan of care for a client returning
from surgery post cholecystectomy with a T-tube,
which of the following actions does the nurse plan
for maintenance of the T-tube? [Hint]
  Maintain the T-tube at the level of the surgical
wound
  Teach client how to clamp the tube
  Monitor the T-tube drainage for color and
consistency and record results
  Maintain the client in supine position for 24 hours
postoperatively
3 .       A community health nurse is planning a teaching
session on the prevention of the spread of hepatitis.
In planning the teaching program, the nurse knows
that which of the following is transmitted by the
fecal-oral route via contaminated food, water,
shellfish, and direct contact with an infected
person? [Hint]
  Hepatitis A
   Hepatitis B
  Hepatitis C
  Hepatitis Delta
4 .       A nurse sustains a needle stick after a deep
intramuscular injection to a client with known
Hepatitis B. After washing and flushing the injury
site, which of the following is the most appropriate
action? [Hint]
 If the nurse has been vaccinated for Hepatitis B, no
further action is necessary.
 If the nurse has been vaccinated for Hepatitis B,
determine by serum lab if the nurse has immunity to
the virus.
 Administer the Hepatitis B immune globulin
(HBIG) immediately after exposure, even if the
nurse has been vaccinated in the past.
 Administer the Hepatitis A immune globulin (IG)
and the Hepatitis B immune globulin (HBIG).
5 .       A nurse, planning dietary and fluid management for
a client with alcohol-induced cirrhosis and elevated
serum ammonia levels, recognizes that which of
the following is the most appropriate to include in
the plan? [Hint]
  Sodium restriction of 2.5g /day
  Fluid restriction of 1000 mL/day
  Restrict foods high in magnesium
  Protein restriction of 75 to 100 grams per day
6 .       A client with a long history of alcohol-induced
cirrhosis is brought to the emergency room via
ambulance, after the client's wife called 911 to
report her husband was vomiting up large amounts
of blood. The client is diagnosed with bleeding
esophageal varicies. The emergency room
physician plans to insert a Sengstaken-Blakemore
nasogastric tube for balloon tamponade. The
emergency room nurse should anticipate and
prepare for which of the following before the
insertion of the nasogastric tube? [Hint]
  Upper endoscopy
  Gastric lavage
  Endotracheal intubation
  Variceal ligation
7 .       The nurse is preparing a client with ascites for an
abdominal paracentesis. Which of the following
indicates that the client is not properly prepared for
the physician to begin the procedure? [Hint]
  The client is in a sitting position.
  The client has not voided in 2 hours.
  Vital signs were obtained 15 minutes ago.
  The client has signed an informed consent.
8 .       The nurse is evaluating the laboratory values of a
client with cirrhosis. The abnormal laboratory
results include total bilirubin 4.6mg/dL; serum
ammonia 95 mm/dL, platelets 68,000/mm3 and
RBC 4.2 million/mm3. Based on the laboratory
 reports, the nurse recognizes that the client is at
most risk for which of the following? [Hint]
  Seizures
  Anemia
  Infection
  Abnormal bleeding
9 .       A client admitted with acute pancreatitis complains
of severe epigastric and abdominal pain
accompanied by nausea and vomiting. Upon
physical assessment, the nurse notes mild
jaundice. When establishing nursing diagnoses for
this client, which of the following represents the
priority nursing diagnosis? [Hint]
  Pain: related to obstruction of pancreatic ducts and
inflammation
  Imbalanced Nutrition: Less Than Body
Requirements
  Risk for Fluid Volume Deficit
  Self-Care Deficit
10       Which of the following results are expected for a
. client with chronic pancreatitis receiving pancreatic
enzyme supplements? [Hint]
  A decrease in abdominal distention
  A reduction in fatty, frothy, foul-smelling stools
  An increase in appetite
  A decrease in pain
1- Morphine is more likely to cause spasms of the
sphincter of Oddi than meperidine, the drug of choice
for acute pain of cholelithiasis. The client should be
NPO during acute pain. Elevated serum bilirubin may
indicate obstructed bile flow, an elevated WBC may
indicate infection and inflammation, and serum amylase
and lipase are monitored to identify possible
pancreatitis related to common duct obstruction.
Ultrasound of the gallbladder can accurately diagnose
cholelithiasis.

2- After a cholecystectomy, the T-tube maintains patency

of the duct and promotes bile passage, which the
edema decreases. Excess bile is collected in a drainage
bag. The T-tube is positioned below the level of the
surgical wound to promote the flow of bile and to
prevent the backflow of bile or seepage of bile onto the
skin. To promote gravity drainage of bile, the client
should be in the Fowler's position when postoperative
position restrictions are lifted. The T-tube is not
clamped until drainage subsides and stools return to
normal brown color, and is not an immediate
postoperative intervention. T-tube drainage is assessed
for color and consistency, and is recorded as part of the
output.
3- Hepatitis A is transmitted by the fecal-oral route via
contaminated food, water, shellfish, and direct contact
with an infected person. Hepatitis B, Hepatitis C, and
Hepatitis Delta are transmitted through contact with
infected blood and body fluids.

4- Postexposure prophylaxis is recommended for people

exposed to the Hepatitis B virus. However, if the
individual has been vaccinated for Hepatitis B, serum
levels will indicate immunity to the virus. Immunity
should not be assumed. Hepatitis B immune globulin
(HBIG) is given to provide short-term immunity, and
the Hepatitis B vaccine may be given concurrently.
5- Though dietary needs change as hepatic function
fluctuates, sodium is generally restricted to 2 g or
less/per day to reduce ascites and generalized edema.
Fluids are generally limited to 1500 mL/day.
Magnesium deficiency often accompanies alcohol-
induced cirrhosis, necessitating magnesium
replacement. When serum ammonia levels are high,
protein is restricted to 75 to 100 g per day. When
serum ammonia levels stabilize, protein intake is
allowed as tolerated.
6- Prior to insertion of the nasogastric tube, the client is
intubated endotracheally to support the airway and
reduce the risk of aspiration. An upper endoscopy,
gastric lavage, or variceal ligation would not be
 performed until the client is hemodynamically stable.
Bleeding esophageal varicies are life-threatening and
restoration of hemodynamic stability is the first priority
7- The preparation of a client for abdominal paracentesis
includes positioning in a sitting position, either in a
chair on the side of the bed. Baseline vital signs are
obtained, and since this is an invasive procedure,
informed consent is also obtained. The client should
void immediately prior to the paracentesis to avoid
bladder puncture.
8- The normal total bilirubin is 0.1 to 1.0 mg/dL, normal
ammonia is 35 to 65 mm/dL, and normal RBC is 4.6 to
5.9 million/mm3. Normal platelet count is
150,000/mm3. The value of 68,000 places the client at
high risk for abnormal bleeding or hemorrhage.
9- Control of pain is a priority for the client with acute
pancreatitis. Analgesics should be administered on a
regular schedule. Management of nutrition, maintaining
fluid volume balance, and promoting self-care are all
appropriate interventions for the client, and can be
better achieved with pain control.
10- Clients with chronic pancreatitis are prescribed

pancreatic enzyme supplements to reduce fatty, frothy,

foul-smelling stools (steatorrhea) which are caused by
a decrease in pancreatic enzyme secretions. The
supplements do not reduce abdominal distention or
pain, nor do they increase appetite