Chapter 40 - Liver, Gallbladder, and Pancreatic Disorders

Chapter 40: Liver, Gallbladder, and Pancreatic Disorders
MULTIPLE CHOICE
1. For which complication should a nurse be careful to monitor a patient after a liver biopsy?
a. Headache
b. Muscle cramps
c. Bleeding
d. Respiratory distress
ANS: C
Liver biopsy places the patient at risk for hemorrhage. Liver disorders make patients
especially vulnerable to hemorrhage.
DIF: Cognitive Level: Comprehension REF: p. 772 OBJ: 1

TOP: Liver Biopsy KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
2. What is pruritus related to in the patient diagnosed with hepatitis?

a. Decreased fat intake
b. Poor appetite and therefore poor protein intake
c. Accumulation of bile salts under the skin
d. Altered urinary output of bile
ANS: C
Bile salts accumulate under the skin, causing irritation.

TOP: Hepatitis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
3. A young woman with severe jaundice has an altered body image. The patient says, “Will I
always be this horrible color?” What is the best response by the nurse?
a. “Yes, but your sclera will return to their previous white color.”
b. “No. The color will fade gradually as liver inflammation decreases.”
c. “Yes, but cosmetics can disguise the color.”
d. “No. The color will change to freckles.”
ANS: B
Jaundice causes patients to be self-conscious and reclusive because of the change in physical
appearance. Patients can be reassured that the color improves as liver function improves,
usually in 2 to 4 weeks.

TOP: Hepatitis and Jaundice KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
4. What action should a nurse implement to prevent complications in a patient with hepatitis
who has been prescribed bed rest?
a. Raise the knee gatch to prevent the patient from sliding down in bed.
b. Provide undisturbed periods of 6 hours to encourage rest.
c. Restrict fluids.
d. Encourage turning, coughing, and deep breathing every 2 hours.
ANS: D
The nurse must encourage measures that will prevent pneumonia and improve impaired skin
integrity because of the increased risk factors associated with bed rest.
DIF: Cognitive Level: Application REF: p. 777 OBJ: 2

TOP: Bedrest for Hepatitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease
5. Which sign indicates that the need for increased fluid intake would be contraindicated in a
patient diagnosed with a hepatic disorder?
a. Low blood pressure
b. Increased urinary output
c. Signs of edema
d. Bradycardia
ANS: C
Edema may indicate fluid overload; therefore, question the intake, as well as electrolyte and
cardiac status.

TOP: Fluid Volume and Hepatitis KEY: Nursing Process Step: Planning
6. What intervention should a nurse implement when assessing a patient with jaundice who has
been given the nursing diagnosis of disrupted skin integrity?
a. Sedate the patient.
b. Apply mittens or socks to the hands.
c. Restrain the hands.
d. Distract the patient with conversation.
ANS: B
Jaundice causes itching, which can cause the patient to scratch and create a break in the skin.
Mittens provide some comfort without causing further skin impairment.

TOP: Jaundice KEY: Nursing Process Step: Planning
7. Which vaccination does the Occupational Health and Safety Administration (OSHA) require
all health care providers to receive?
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. All strains of hepatitis
ANS: B
OSHA requires that all health care providers be vaccinated against hepatitis B.
DIF: Cognitive Level: Knowledge REF: p. 765 OBJ: 2

TOP: OSHA Requirements KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
8. What is the meaning of a dropping bilirubin level in a patient diagnosed with hepatitis?
a. Red blood cell destruction is decreasing.
b. Liver function is improving.
c. Kidneys are compensating for liver dysfunction.
d. Kupffer cell damage is continuing.
ANS: B
As liver function improves, the bilirubin level will decrease because of the liver’s ability to
conjugate and excrete the bilirubin. The flow of bile out of the liver increases.

TOP: Liver Disease KEY: Nursing Process Step: Evaluation
9. A goal of medical treatment for patients with cirrhosis is to prevent complications and limit
cell damage. A major approach is to promote rest. What rationale supports this approach?
a. Allows time for a transplant
b. Allows the liver to regenerate
c. Prevents red cell destruction
d. Decreases the risk of trauma
ANS: B
With rest, the liver will regenerate healthy tissue and return to normal functioning. Rest must
include other measures to promote healing, such as dietary measures and no alcohol.

TOP: Cirrhosis KEY: Nursing Process Step: Planning
10. What is necessary to restrict when the ammonia level of a patient diagnosed with cirrhosis
continues to rise?
a. Protein
b. Carbohydrates
c. Fats
d. Water-soluble vitamins
ANS: A
Ammonia is the waste product of protein breakdown. Decreasing protein intake will decrease
the end product.

TOP: Cirrhosis KEY: Nursing Process Step: Planning
11. What actions should a nurse implement to correctly assess the progress of ascites on a daily
basis?
a. Daily weights and abdominal girth measurements
b. Intake-output and electrolyte levels
c. Blood pressure and pulse
d. Daily temperatures and oxygen levels
ANS: A
Daily weights and abdominal girth measurements will accurately measure the fluid
accumulating in the peritoneal cavity.

TOP: Ascites KEY: Nursing Process Step: Assessment
12. A patient with ascites is scheduled for a LeVeen peritoneal-venous shunt. The patient asks
why this needs to be done instead of a paracentesis. What is the best response by the nurse?
a. “It helps the kidneys retain needed sodium.”
b. “It will decrease the need for analgesics.”
c. “This procedure will prevent the loss of protein.”
d. “The risk of infection is lessened with this procedure.”
ANS: C
Fluids containing protein are returned to the vascular compartment to retain important
elements such as albumin. The retention of albumin reduces fluid accumulation.

TOP: Ascites KEY: Nursing Process Step: Implementation
13. A high ammonia level contributes to hepatic encephalopathy. Which nursing implementation
needs to be added to the nursing care plan as this level continues to increase?
a. Mouth care
b. Increased frequency of neurologic checks
c. Oxygen saturation monitoring
d. Intake and output
ANS: B
As the ammonia level rises, the patient becomes at greater risk for confusion and hepatic coma
related to encephalopathy.

TOP: Seizure Precautions KEY: Nursing Process Step: Planning
14. A nurse is educating a patient diagnosed with hepatitis A. What should the nurse instruct this
patient to avoid sharing?
a. Food
b. Bodies
c. Needles
d. Housing
ANS: A
Hepatitis A is spread from contact with saliva, which can be transmitted by shared food or
drinks.

TOP: Hepatitis A KEY: Nursing Process Step: Planning
15. Which dietary selection should lead the nurse to conclude that the dietary teaching is
successful for a patient on a low-sodium diet?
a. Bologna sandwich with tomato juice
b. Hotdog on a bun with pickle relish and skim milk
c. Baked chicken, white rice, and apple juice
d. Peanut butter and jelly sandwich with tomato soup
ANS: C
A meal of baked chicken, white rice, and apple juice has the lowest sodium levels.

TOP: Nutrition: Low-Sodium Diet KEY: Nursing Process Step: Evaluation
16. Which nursing measure takes priority in relation to the care of a patient with a
gastroesophageal balloon tube?
a. Deflate the balloon periodically.
b. Advance the tube as instructed.
c. Monitor respiratory status.
d. Withhold medications that could decrease restlessness.
ANS: C
Because of the close proximity of the esophagus and trachea, any upward movement of the
tube could cause airway obstruction.

TOP: Esophageal Balloon KEY: Nursing Process Step: Implementation
17. Which instruction should be given to a patient with portal hypertension to reduce the threat of
hemorrhage?
a. Eat bland foods.
b. Avoid straining to have a bowel movement.
c. Increase fluid intake.
d. Use an electric razor to shave.
ANS: B
Straining can increase pressure and may cause the dilated vessels in the gastrointestinal tract
to bleed. Shaving with an electric razor does not prevent serious bleeding.
TOP: Portal Hypertension KEY: Nursing Process Step: Implementation
18. What precaution should a nurse initiate when caring for a patient with hepatitis B?
a. Reverse isolation
b. Standard Precautions
c. Respiratory precautions
d. Enteric precautions
ANS: B
Standard Precautions protect the nurse from organisms that may be in all body fluids.

TOP: Hepatitis B KEY: Nursing Process Step: Implementation
19. A patient was positive for hepatitis B virus, although she had the disease 4 years ago and now
is symptom free. What is the nurse aware is true regarding this patient?
a. Is likely to have hepatitis B again
b. Now has noninfectious hepatitis
c. Is an infectious carrier and always will be
d. Is at risk for hepatitis E
ANS: C
A certain percentage of persons who have had hepatitis B convert to carriers. They have the
live virus, which causes no symptoms in them, but they are able to transmit the disease and
always will be infectious.

TOP: Carrier State for Hepatitis B KEY: Nursing Process Step: Implementation
20. A patient in acute pain is admitted with pancreatitis. A nurse reviews a laboratory report
showing an elevation that is diagnostic for acute pancreatitis. Which laboratory report did the
nurse most likely review?
a. Serum bilirubin
b. Serum calcium
c. Serum lipids
d. Serum amylase
ANS: D
Serum amylase is the most significant of the diagnostic findings.

TOP: Pancreatitis KEY: Nursing Process Step: Assessment
21. What is the highest nursing priority outcome when planning the care for the patient with
pancreatitis?
a. Patient claims satisfaction with pain control.
b. Patient states an understanding of medications needed on discharge.
c. Patient’s activity level tolerance shows an increase.
d. Patient can maintain a normal bowel pattern.
ANS: A
Pain control is the most important priority.
DIF: Cognitive Level: Analysis REF: p. 783 OBJ: 1

TOP: Pancreatitis KEY: Nursing Process Step: Evaluation
22. What should a nurse often find in the medical history of a patient diagnosed with pancreatic
disease?
a. Liver disorders
b. Drug abuse
c. Alcohol abuse
d. Excessive sugar intake
ANS: C
Pancreatic disease is often related to alcohol abuse.

TOP: Pancreatic Disease KEY: Nursing Process Step: Assessment
23. Which observation by a nurse would indicate blocked flow of bile from the liver to the
intestine?
a. Clay-colored stools
b. Jaundice
c. High blood pressure
d. Tachycardia
ANS: A
Bile is unable to get to feces to give it the normal brown color.

TOP: Biliary Disease KEY: Nursing Process Step: Planning
24. Which chronic condition is related to the presence of chronic pancreatitis?

a. Chronic obstructive pulmonary disease (COPD)
b. Urinary tract infection (UTI)
c. Diabetes mellitus (DM)
d. Arteriosclerotic heart disease (ASD)
ANS: C
Patients with chronic pancreatitis are at risk for developing DM because of the destruction of
the insulin-secreting cells in the pancreas.

TOP: Chronic Pancreatitis KEY: Nursing Process Step: Assessment
25. Which risk is significantly increased in patients diagnosed with liver disease?
a. Urinary infections
b. Systemic infection
c. Drug toxicity
d. Drug allergy
ANS: C
Because many drugs are metabolized in the liver and a diseased liver does not adequately
clear the system of drugs, drug toxicity is an ongoing problem.

TOP: Risk for Drug Toxicity KEY: Nursing Process Step: Planning
26. What should a nurse include in the discharge teaching for a patient after a laparoscopic
procedure for cholelithiasis?
a. Take water-soluble vitamins.
b. Follow a low-fat diet.
c. Expect light-colored stools for several days.
d. Keep dressing over the T-tube dry.
ANS: B
After the laparoscopic procedure, the patient is to follow a low-fat diet and take fat-soluble
vitamins. Placement of the T-tube is not done with the laparoscopic procedure.

TOP: Laparoscopic Procedure for Cholelithiasis
KEY: Nursing Process Step: Implementation
COMPLETION
1. A nurse reminds a patient with liver disease that the level of ______ in the blood is an
indicator of the how well the liver is functioning.
ANS:
bilirubin
The level of indirect bilirubin indicates the effectiveness of the metabolism of proteins by the
liver.

TOP: Bilirubin as an Indicator of Liver Function
KEY: Nursing Process Step: Implementation
2. In assessing a dark-skinned patient for jaundice, the nurse would assess the ______ for a
yellow color.
ANS:
sclera
Jaundice can be assessed by the yellow pigment on the sclera of a dark-skinned person.

TOP: Assessing Jaundice in Dark-Skinned Persons
KEY: Nursing Process Step: Assessment

Chapter 40 - Liver, Gallbladder, and Pancreatic Disorders

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Chapter 40: Liver, Gallbladder, and Pancreatic Disorders

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2. What is pruritus related to in the patient diagnosed with hepatitis?

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