C H A P T E R
Nursing Management: Liver, Pancreas,
Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems 193
10. During the incubation period of viral hepatitis, what should the nurse expect the patient to report?
a. Pruritus and malaise
b. Dark urine and easy fatigability
c. Anorexia and right upper quadrant discomfort d. Constipation or diarrhea with light-colored stools
11. The occurrence of acute liver failure is most common in which situation?
a. An individual with hepatitis A c. Antihypertensive medication use
b. An individual with hepatitis C d. Use of acetaminophen with alcohol abuse 12. Following a needle stick, what is used as prophylaxis against HBV?
a. Interferon c. Hepatitis B immune globulin (HBIG)
b. HBV vaccine d. HBV vaccine and HBIG
13. The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?
a. “No immunization is available for hepatitis A, nor are you likely to get the disease.”
b. “All family members should receive the hepatitis A vaccine to prevent or modify the infection.”
c. “Those who have had household or close contact with the patient should receive immune globulin.”
d. “Only those individuals who have had sexual contact with the patient should receive immunization.”
14. A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse?
a. “Only chronic hepatitis C is treatable and primarily with antiviral agents and interferon.”
b. “There are no specific drug therapies that are effective for treating acute viral hepatitis.”
c. “Interferon combined with lamivudine (Epivir) will decrease viral load and prevent complications.”
d. “There are no drugs used for the treatment of viral hepatitis because of the risk of additional liver damage.”
15. The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement?
a. “I should avoid alcohol completely for as long as a year.”
b. “I must avoid all physical contact with my family until the jaundice is gone.”
c. “I should use a condom to prevent spread of the disease to my sexual partner.”
d. “I will need to rest several times a day, gradually increasing my activity as I tolerate it.”
16. What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis?
a. Providing adequate nutritional intake
b. Promoting strict bed rest during the icteric phase
c. Providing pain relief without using liver-metabolized drugs d. Providing quiet diversional activities during periods of fatigue
17. When caring for a patient with autoimmune hepatitis, the nurse understands that what in this patient is different from the patient who has viral hepatitis?
a. Does not manifest hepatomegaly or jaundice b. Experiences less liver inflammation and damage
c. Is treated with corticosteroids or other immunosuppressive agents
d. Is usually an older adult who has used a wide variety of prescription and over-the-counter drugs
18. The patient has been newly diagnosed with Wilson’s disease and D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect?
a. Pruritus c. Corneal Fleischer rings
b. Acute kidney injury d. Elevated serum iron levels
19. The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What diagnosis should the nurse expect for this patient?
a. Cirrhosis c. Hepatorenal syndrome
b. Acute liver failure d. Primary sclerosing cholangitis
194 Chapter 44 Nursing Management: Liver, Pancreas, and Biliary Tract Problems
20. The patient is an older woman with cirrhosis who also has anemia. What pathophysiologic changes may contribute to this patient’s anemia (select all that apply)?
a. Vitamin B deficiencies d. Decreased prothrombin production
b. Stretching of liver capsule e. Decreased bilirubin conjugation and excretion c. Vascular congestion of spleen
21. A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?
a. Weight loss
b. Diabetes management
c. Ulcerative colitis dietary changes d. Dietary management of hyperlipidemia
e. Maintaining blood pressure with increased sodium and fluid intake
22. Which manifestations may be seen in the patient with cirrhosis related to esophageal varices?
a. Jaundice, peripheral edema, and ascites from increased intrahepatic pressure and dysfunction b. Loss of the small bile ducts and cholestasis and cirrhosis in patients with other autoimmune disorders c. Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal
hypertension
d. Scarring and nodular changes in the liver lead to compression of the veins and sinusoids, causing resistance of blood flow through the liver from the portal vein
23. Which conditions contribute to the formation of abdominal ascites?
a. Esophageal varices contribute to 80% of variceal hemorrhages
b. Increased colloidal oncotic pressure caused by decreased albumin production c. Hypoaldosteronism causes increased sodium reabsorption by the renal tubules d. Blood flow through the portal system is obstructed, which causes portal hypertension 24. What laboratory test results should the nurse expect to find in a patient with cirrhosis?
a. Serum albumin: 7.0 g/dL (70 g/L) b. Total bilirubin: 3.2 mg/dL (54.7 mmol/L) c. Serum cholesterol: 260 mg/dL (6.7 mmol/L)
d. Aspartate aminotransferase (AST): 6.0 U/L (0.1 mkat/L)
25. Malnutrition can be a big problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?
a. Oral hygiene before meals and snacks c. Improve oral intake by feeding the patient b. Provide all foods the patient likes to eat d. Limit snack offers to when the patient is hungry 26. The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)?
a. GI bleeding d. Body image disturbances
b. Hypokalemia e. Increased clotting tendencies
c. Renal function
27. What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy?
a. Manifests asterixis c. Has increasing oliguria
b. Becomes unconscious d. Is irritable and lethargic
28. To treat a cirrhotic patient with hepatic encephalopathy, lactulose (Cephulac), rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient’s family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient’s family?
a. It reduces portal venous pressure. c. It traps ammonia and eliminates it in the feces.
b. It eliminates blood from the GI tract. d. It decreases bacteria to decrease ammonia formation.