Term
1. Esophageal varices are the most life-threatening complication in patients with chronic liver disease.
A. True
B. False |
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Definition
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Term
The patient receiving lactulose is monitored closely for the development of constipation, which indicates medication overdose.
A. True
B. False |
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Definition
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Term
Most patients with acute or chronic hepatitis C are symptomatic.
A. True
B. False |
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Definition
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Term
Shock and multiple organ failure may occur with acute pancreatitis.
A. True
B. False |
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Definition
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Term
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Definition
Caused by impairment of the liver’s ability to metabolize and secrete bilirubin
Types include hepatocellular jaundice, obstructive jaundice, and hemolytic jaundice |
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Term
| What is Portal hypertension? |
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Definition
caused by increased resistance to blood flow through the liver and increased blood flow due to vasodilatation
Major complications are ascites and gastroesophageal varices |
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Term
| What vitamin deficiencies are associated with hepatic disfunction? |
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Definition
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Term
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Definition
| Accumulation of fluid in the peritoneal cavity |
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Term
| What are the symptoms of ascities? |
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Definition
| increased abdominal girth, weight gain, and swelling of the lower extremities |
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Term
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Definition
| sodium restriction, diuretics, paracentesis, or transjugular intrahepatic portosystemic shunt (TIPS) |
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Term
Which of the following nursing interventions would be most effective in assessing for hypovolemia after a paracentesis?
Taking vital signs every 4 hours
Measuring intake and output every shift
Performing daily weights
Measuring abdominal girth every shift |
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Definition
| Taking vital signs every 4 hours |
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Term
A client weighing 90.9 kg (200 lb) prior to a paracentesis had 1,000 ml of fluid removed. How much weight should the nurse anticipate the client lost based on this fluid removal?
1 kg (2.2 lb)
3.6 kg (8 lb)
0.91 kg (2 lb)
0.64 kg (1.4 lb) |
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Definition
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Term
A client’s laboratory results are albumin 2.3 g/dL, BUN 36 mg/dL, and creatinine 1.8mg/dL prior to a scheduled paracentesis. The appropriate action for the nurse to take is:
Prepare the client for paracentesis
Document these findings
Notify the provider
Cancel the procedure |
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Definition
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Term
Prior to a client’s discharge from the outpatient diagnostic center, the nurse evaluates the client’s understanding of potential complications and symptoms to report. Which of the following statements best indicates the client understands symptoms of the most common complication from the procedure to report to the provider?
“I will notify the provider if this leakage continues from the needle insertion site.”
“The doctor should be called if I develop fever or have abdominal pain.”
“If my abdomen does not continue to decrease in size, I should call my doctor.”
“I will call the doctor if I notice any weight change over the next several days.” |
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Definition
| “The doctor should be called if I develop fever or have abdominal pain.” |
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Term
| What are esophageal varicose? |
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Definition
Dilated, tortuous veins that are usually found in the submucosa of the lower esophagus
Associated with a high risk of hemorrhage |
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Term
| What are the treatments for esophageal varicose? |
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Definition
| medications, variceal banding, endoscopic injection sclerotherapy (EIS), and balloon tamponade |
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Term
| What are the nursing priorities for esophageal varicose? |
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Definition
| monitoring for bleeding, perforation of the esophagus, aspiration pneumonia, and esophageal stricture |
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Term
| What is used to treat esophageal varicose mechanically? |
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Definition
Blakemore-Sengstaken:
Esophageal Tamponade |
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Term
| What does hepatic encephalopathy result from? |
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Definition
| Results from the accumulation of ammonia and other toxic metabolites in the blood |
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Term
| What are the side effects of hepatic encephalopathy? |
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Definition
| mental changes and motor disturbances (eg, asterixis [flapping tremor of the hands]) |
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Term
| What is used to reduce ammonia levels in the blood? |
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Definition
| Lactulose (Cephulac) is administered to reduce serum ammonia levels |
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Term
| What is the nursing care of hepatic encephalopathy? |
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Definition
| prevent injury, bleeding, and infection |
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Term
A patient with a history of heavy alcohol use is receiving lactulose for the treatment of hepatic encephalopathy. What is a desired outcome of this treatment?
Two to three soft bowel movements daily
Watery diarrhea several times daily
Prevention of constipation
Maintenance of fecal continence |
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Definition
| Two to three soft bowel movements daily |
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Term
Which of the following nursing interventions should be given the highest priority when caring for a client with esophageal varices who is hypotensive and confused as to person, place, and time?
Observe the client for signs of hemetemsis and melena
Monitor vital signs and hematocrit levels
Administer IV fluids and vasoconstrictors as ordered
Provide a high calorie, protein restricted diet |
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Definition
| Administer IV fluids and vasoconstrictors as ordered |
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Term
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Definition
| A systemic, viral infection involving necrosis and inflammation of liver cells |
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Term
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Definition
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Term
| How is Hep A transmitted? |
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Definition
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Term
| What are the symptoms of Hep A? |
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Definition
| asymptomatically or with acute symptoms such as fever, malaise, anorexia, nausea, diarrhea, vomiting, abdominal pain, and jaundice |
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Term
| Is there a Hep A vaccine? |
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Definition
| Yes Vaccination is encouraged |
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Term
| How is Hep B transmitted? |
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Definition
| by perinatal, percutaneous, sexual exposure, and close person-to-person contact |
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Term
| What is the incubation period of HBV? |
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Definition
| HBV has a long incubation period |
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Term
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Definition
| Signs and symptoms may be insidious and variable |
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Term
| Is there a vaccine for HBV? |
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Definition
| The most effective strategy to prevent infection is through vaccination |
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Term
| What are the goals of HBV treatment? |
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Definition
| to prevent replication of active hepatitis B virus (viral suppression) and reduce the effects of chronic liver inflammation |
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Term
| What is Hep C considered? |
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Definition
| The leading cause of liver disease and is the primary indication for liver transplantation |
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Term
| How is Hep C transmitted? |
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Definition
| Occurs primarily through injection of drugs and through transfusion of blood products prior to 1992 |
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Term
| Are there symptoms with Hep C? |
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Definition
| Most patients with acute or chronic hepatitis C are asymptomatic |
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Term
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Definition
| Antiviral therapy is available |
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Term
| What does ASCITIES stand for? |
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Definition
A - airway
S - swelling
C - variCies
I - inspect labs
T - to prevent bleeding
E - encephalopathy
S - skin |
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Term
Which of the following laboratory findings is supportive of a diagnosis of hepatitis?
ALT 45units/L
WBC 7,800 /mm3
Total bilirubin 1 mg/dL
Albumin 4.9 g/dL |
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Definition
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Term
What client findings would suggest the development of hepatic encephalopathy? (Select all that apply)
Delirium
Serum ammonia 220 mg/dL
Asterixis
Serum sodium of 138 mEq/L
Fruity breath odor |
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Definition
Delirium
Serum ammonia 220 mg/dL
Asterixis
Fruity breath odor |
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Term
A nurse is conducting a health promotion class. What would the nurse describe as the best method to prevent the transmission of the hepatitis A virus?
Following proper hand washing techniques
Avoiding chemicals that are toxic to the liver
Using a condom during sexual contact
Wearing a mask when in large crowds |
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Definition
| Following proper hand washing techniques |
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Term
Diet intervention for the client with hepatitis should include which of the following? (Select all that apply)
Foods high in protein
Foods high in carbohydrates
Alcohol
Whole grain foods
Foods low in fat |
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Definition
Foods high in carbohydrates
Foods low in fat |
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Term
Which of the following interventions are appropriate for clients with hepatitis? (Select all that apply)
Bed rest with limited physical activity
Avoid alcohol
Administer acetaminophen every 3-4 hours around the clock
Implement isolation precautions
Administer supplemental vitamins |
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Definition
Bed rest with limited physical activity
Avoid alcohol
Implement isolation precautions
Administer supplemental vitamins |
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Term
Which of the following precautions are appropriate to prevent the transmission of viral hepatitis? (Select all that apply)
Wear gloves when emptying a bedpan containing feces
Administer immunoglobin
Discourage tattoos and body piercings
Instruct food handlers to carefully wash hands prior to food preparation
Use universal precautions with all clients |
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Definition
Wear gloves when emptying a bedpan containing feces
Administer immunoglobin
Discourage tattoos and body piercings
Instruct food handlers to carefully wash hands prior to food preparation
Use universal precautions with all clients |
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Term
A client has elevated temperature, is very anxious, and reports diarrhea for the past 2 weeks, unrelieved by antidiarrheal medication. She works with children at a daycare center. Which of the following types of hepatitis would most likely be the cause of these symptoms?
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis E |
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Definition
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Term
Assessing which of the following is an observational method to determine the initial level of involvement of hepatitis?
Weight
Vital signs
Skin color
Temperature |
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Definition
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Term
| What are other hepatic disorders? |
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Definition
Hepatitis D, E, and G
Alcoholic liver disease (alcoholic hepatitis)
Drug-induced liver disease (drug-related hepatitis)
Fulminant hepatic failure: |
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Term
| What s Fulminant hepatic failure? |
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Definition
The clinical syndrome of sudden and severely impaired liver function in a previously healthy person
Often caused by hepatitis A, B, and E, or acetaminophen |
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Term
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Definition
| Occurs when the normal liver tissue is replaced by fibrotic tissue in response to damage to liver cells |
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Term
| What does a nursing assessment of cirrhosis focus on? |
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Definition
| precipitating factors, particularly long-term alcohol abuse, as well as dietary intake and changes in mental status |
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Term
| What are the symptoms of cirrhosis? |
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Definition
| abdominal distention and bloating, GI bleeding, bruising, and weight changes |
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Term
| What are the nursing interventions of cirrhosis? |
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Definition
| promoting rest and nutrition, skin care, and reducing risk of hemorrhage, fluid excess, and hepatic encephalopathy |
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Term
Is the following statement true or false?
A patient with uncompensated cirrhosis is likely to exhibit increased abdominal girth and pedal edema. |
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Definition
True
Rationale: Fluid volume excess and ascites are characteristic symptoms of cirrhosis and result in increased abdominal girth and peripheral edema |
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Term
Which of the following client findings may indicate biliary obstruction? (Select all that apply)
Conjugated (direct) serum bilirubin 0.6 mg/dL
Serum cholesterol 278 mg/dL
Unconjugated (indirect) serum bilirubin 0.4 mg/dL
Total serum bilirubin 1 mg/dL
Yellow sclera
Light colored bowel movements
Steatorrhea
Dilute yellow urine
Calcifications noted on abdominal x-ray |
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Definition
Conjugated (direct) serum bilirubin 0.6 mg/dL
Serum cholesterol 278 mg/dL
Yellow sclera
Light colored bowel movements
Steatorrhea
Calcifications noted on abdominal x-ray |
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Term
Which of the following instructions is/are appropriate for a client going home with a T-tube drain? (Select all that apply)
Take baths rather than showers
Clamp the T-tube for 1-2 hours before and after meals
Keep the drainage system above the level of the gall bladder.
Avoid heavy lifting and strenuous activity
Empty drainage bag at the same time each day.se sauce
Biscuits and gravy
Sweetened strawberries
Fried eggs and bacon |
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Definition
Clamp the T-tube for 1-2 hours before and after meals
Avoid heavy lifting and strenuous activity
Empty drainage bag at the same time each day.se sauce |
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Term
| What is hepatocellular carcinoma> |
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Definition
Manifestations are typically similar to cirrhosis
Treatment options include surgery and liver transplantation |
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Term
| Who gets a liver transplant? |
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Definition
| ESLD and acute liver failure |
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Term
| What are the complications of liver transplants? |
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Definition
| bleeding, infection, rejection, and delayed graft function, biliary leaks and obstruction, hepatic artery thrombosis, and portal vein thrombosis |
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Term
| What is the Nursing Care: The Patient Undergoing Liver Transplantation? |
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Definition
Infection control
Bleeding prevention
Monitoring of protein levels and clotting factors
Monitoring for signs and symptoms of liver dysfunction
Monitoring for signs and symptoms of rejection |
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Term
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Definition
(gallstones):
May be made up of pigment or cholesterol
Symptoms result from the disease of the gallbladder itself and obstruction of the bile passages by a gallstone |
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Term
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Definition
(acute inflammation of the gallbladder):
Symptoms include upper right abdominal pain, nausea, and vomiting
Treatments include medication, cholecystectomy, and laparoscopic cholecystectomy |
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Term
Which of the following food choices might trigger a cholecystitis attack? (Select all that apply)
Ice cream
Brownie with nuts
Pasta with marinara sauce
Turkey sandwich
Broccoli with cheese sauce
Biscuits and gravy
Sweetened strawberries
Fried eggs and bacon |
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Definition
Ice cream
Brownie with nuts
Broccoli with cheese sauce
Biscuits and gravy
Fried eggs and bacon |
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Term
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Definition
| as autodigestion of the pancreas from temporary pancreatic duct obstruction, accompanied by hypersecretion of the exocrine enzymes |
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Term
| What are common causes of pancreattis? |
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Definition
Drugs, trauma, infection, autoimmune disease, or infection may also result in pancreatitis
alcohol abuse or gallstones: |
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Term
| What is acute pancreatitis? |
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Definition
| Activation of enzymes (especially trypsin) lead to vasodilation, inflammation, increased vascular permeability, necrosis, erosion, hemorrhage, and severe abdominal pain |
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Term
| What is the management of acute pancreatitis? |
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Definition
| prioritizes pain, IV fluids to maintain intravascular volume, and elimination of oral intake |
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Term
| What does nursing care emphasize? |
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Definition
| pain management, respiratory status, nutritional promotion, maintaining skin integrity, and preventing complications |
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Term
| What is chronic pancreatitis? |
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Definition
| An inflammatory disorder that is characterized by progressive anatomic and functional destruction of the pancreas (cells are replaced by fibrous tissue) |
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Term
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Definition
| Characterized by recurring attacks of severe upper abdominal and back pain, accompanied by vomiting |
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Term
| What labs are high with pancreatitis? |
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Definition
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Term
| What does PANCREAS stand for? |
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Definition
P - Pain management/Pancreatic Enzyme
A - Abdominal Pain
N - NPO
C - Calcium is low
R - Risk factors
E
A - Analgesics/Anticholinergics
S - Stiumlants Avoided |
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Term
A patient has presented to the emergency department with signs and symptoms that are characteristic of acute pancreatitis. What assessment question is most likely to relate to the etiology of the problem?
Do you have type 1 diabetes or type 2 diabetes?
Are you a smoker?
Have you ever been diagnosed with hepatitis?
How much alcohol do you typically drink? |
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Definition
| How much alcohol do you typically drink? |
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Term
A client is admitted to the hospital with acute pancreatitis. Which of the following client assessments is most important for the nurse to follow up on first?
History of cholelithiasis
Serum amylase levels are three times normal value
Reports severe pain radiating to the back, rates 8/10
Hand spasm present when the nurse is taking the b/p |
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Definition
| Hand spasm present when the nurse is taking the b/p |
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Term
The client has arrives from the ED with a diagnosis of acute pancreatitis. Which of the following client assessments is most important for the nurse to follow up on first?
Client has bluish discoloration around the periumbilical area
lying b/p 120/80 mm Hg, pulse 80 bpm, standing b/p 94/70 mm Hg, pulse 110 bpm
Serum amylase and lipase levels levels are five times normal value
Client reports vomiting 2 times in the last hour |
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Definition
| lying b/p 120/80 mm Hg, pulse 80 bpm, standing b/p 94/70 mm Hg, pulse 110 bpm |
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Term
Which of the following is most important for a nurse to teach a client who is hospitalized with acute pancreatitis?
Techniques on how to administer insulin at home
Importance of monitoring amylase and lipase levels at home
Avoiding alcohol use for one year
Use of aspirin instead of acetaminophen (Tylenol) as an OTC medication |
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Definition
| Avoiding alcohol use for one year |
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Term
Which of the following nursing interventions are appropriate for a client diagnosed with acute pancreatitis? (Select all that apply)
Drink plenty of fluid
Avoid alcohol
Avoid smoking
Encourage relaxation
Place the client in a rescue position for maximum comfort
Practice pursed lip breathing |
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Definition
Avoid alcohol
Avoid smoking
Encourage relaxation |
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Term
| What are the risk factors for pancreatic cancer? |
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Definition
| Use of tobacco, obesity, and nonhereditary chronic pancreatitis are risk factors |
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Term
| What are the nursing priorities associated with pancreatic cancer? |
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Definition
| pain management, nutrition, and psychosocial needs |
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Term
A client had a Whipple procedure 3 days ago for pancreatic cancer. Which of the following assessments is most important for the nurse to follow up?
Bowel sounds are auscultated 10/min
Wound edges are slightly edematous, reddish, and soft
Client reports abdominal pain radiating to the shoulder and has a fever
WBC 9,000/mm3 |
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Definition
| Client reports abdominal pain radiating to the shoulder and has a fever |
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Term
A client is to undergo emergency liver surgery. Which assessment would be a priority before the anesthesia is administered?
Abdominal girth measurement.
Last time client ate solid food.
History of previous surgeries.
Liver enzyme studies. |
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Definition
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Term
On the 4th postop day after GI surgery, the nurse finds the client shaking and diaphoretic with a temp of 103.6F. The provider orders antibiotics. The most important assessment the nurse would want now is?
Client’s weight.
Vital signs.
Blood and urine cultures.
Neurological evaluation. |
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Definition
| Blood and urine cultures. |
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Term
At the time that the Dx is made of perforated bowel secondary to bowel obstruction, which nursing priority would be most important?
Maintain client in supine position.
Notify client’s next of kin.
Prepare for emergency surgery.
Remove the NG tube. |
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Definition
| Prepare for emergency surgery. |
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Term
| What is important to note for a lapriscopic cholisistectomy? |
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Definition
| assessment of surgical site, air bubble pain in shoulder is NORMAL, if stomach is rigid there is a problem |
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