Comprehensive Nursing Assessment, Care Planning, Patient Education, Medication Management, Monitoring, and Evidence-Based Interventions for Cirrhosis, Hepatic Encephalopathy, Ascites, Esophageal Varices, Pancreatitis, Hepatitis, Cholecystitis, Gallbladder

Comprehensive Nursing Assessment, Care Planning, Patient Education, Medication Management, Monitoring, and Evidence-Based Interventions for Cirrhosis, Hepatic Encephalopathy, Ascites, Esophageal Varices, Pancreatitis, Hepatitis, Cholecystitis, Gallbladder Disorders, Liver Transplantation, and Postoperative Gastrointestinal Complications Exam Questions Verified and Provided with A+ Graded Rationales Latest Updated 2026 A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: a. Initiate oxygen therapy at 2 L/min to increase gas exchange. b. Notify the health care provider so that a paracentesis can be performed. c. Ask the patient to cough and breathe deeply to clear respiratory secretions. d. Place the patient in Fowler's position to relieve pressure on the diaphragm. Place the patient in Fowler's position to relieve pressure on the diaphragm. Rationale: Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler's or Fowler's position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not by respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure is only a temporary measure and is reserved for severe respiratory distress or abdominal pain. Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis? a. Maintaining good nutrition b. Avoiding alcohol ingestion c. Taking lactulose (Cephulac) d. Using Vitamin B Supplements Avoiding Alcohol Ingestion Rationale: The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease. Which data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis? a. Hemoglobin b. Temperature c. Activity level d. Albumin level Albumin Level Rationale: The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the patient's current symptoms. Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy? a. Request that the patient stand on one foot. b. Ask the patient to extend both arms forward. c. Request that the patient walk with eyes closed. d. Ask the patient to perform the Valsalva maneuver. Ask the patient to extend both arms forward. Rationale: Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests also might be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy. A 53-year-old patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care? a. Instruct the patient to cough every hour. b. Monitor the patient for shortness of breath. c. Verify the position of the balloon every 4 hours. d. Deflate the gastric balloon if the patient reports nausea. Monitor the patient for shortness of breath. Rationale: The most common complication of balloon tamponade is aspiration pneumonia. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway. Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago? a. Dry palpebral and oral mucosa b. Crackles at bilateral lung bases c. Temperature 100.8° F (38.2° C) d. No bowel movement for 4 days Temperature 100.8° F (38.2° C) Rationale: Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action. The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase) a. at bedtime. b. in the morning. c. with each meal. d. for abdominal pain. With each Meal Rationale: Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal. Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)? a. Teach symptoms of variceal bleeding. b. Draw blood for hepatitis serology testing. c. Discuss the need to increase caloric intake.