Chapter 43: Liver, Pancreas, and Biliary Tract Problems
1. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG)
injection?
A. A caregiver who lives in the same household with the patient
B. A friend who delivers meals to the patient and family each week
C. A relative with a history of hepatitis A who visits the patient daily
D. A child living in the home who received the hepatitis A vaccine 3 months ago
IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or
foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 mw3onth previously or who have a history of HAV infection do not
require IG.
2. 2.ID: 14478179959
The nurse provides discharge instructions for a 64-yr-old woman with ascites and peripheral edema related to cirrhosis. Which patient statement indicates
teaching was effective?
A. “Lactulose should be taken every day to prevent constipation.”
B. “It is safe to take acetaminophen up to four times a day for pain.”
C. “Herbs and other spices should be used to season my foods instead of salt.”
D. “I will eat foods high in potassium while taking spironolactone (Aldactone).”
A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided.
Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as
acetaminophen, aspirin, and ibuprofen should be avoided because these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic
over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic.
Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.
3. 3.ID: 14478179967
The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect?
A. Hematochezia
B. Left upper abdominal pain
C. Ascites and peripheral edema
D. Temperature over 102o F (38.9o C)
1
, Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include
nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel
sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration
of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner‟s spots or sign, a bluish flank discoloration) and the periumbilical
area (Cullen‟s sign, a bluish periumbilical discoloration).
4. 4.ID: 14478179963
The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer?
2
, A. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia
B. A 72-yr-old African American man who has smoked cigarettes for 50 years
C. A 23-yr-old man who has cystic fibrosis–related pancreatic enzyme insufficiency
D. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus
Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and
exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established
environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer compared with nonsmokers. The risk
is related to duration and number of cigarettes smoked.
5. 5.ID: 14478179961
The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates
understanding of the instructions?
A. “This medication will help me digest fats and fat-soluble vitamins.”
B. “I will apply the medicated lotion sparingly to the areas where I itch.”
C. “The medication is a powder and needs to be mixed with milk or juice.”
D. “I should take this medication on an empty stomach at the same time each day.”
For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces.
Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.
6. 6.ID: 14478179991
A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase
level of 310 U/L. Which diagnosis does the nurse expect?
A. Starvation
B. Pancreatitis
C. Systemic sepsis
D. Diabetic ketoacidosis
The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal, 30-122 U/L) and serum
lipase (normal, 31- 186 U/L) levels as shown.
7. 7.ID: 14478179983
3
, The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective?
A. Relief of constipation
B. Relief of abdominal pain
C. Decreased liver enzymes
D. Decreased ammonia levels
4
1. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG)
injection?
A. A caregiver who lives in the same household with the patient
B. A friend who delivers meals to the patient and family each week
C. A relative with a history of hepatitis A who visits the patient daily
D. A child living in the home who received the hepatitis A vaccine 3 months ago
IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or
foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 mw3onth previously or who have a history of HAV infection do not
require IG.
2. 2.ID: 14478179959
The nurse provides discharge instructions for a 64-yr-old woman with ascites and peripheral edema related to cirrhosis. Which patient statement indicates
teaching was effective?
A. “Lactulose should be taken every day to prevent constipation.”
B. “It is safe to take acetaminophen up to four times a day for pain.”
C. “Herbs and other spices should be used to season my foods instead of salt.”
D. “I will eat foods high in potassium while taking spironolactone (Aldactone).”
A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided.
Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as
acetaminophen, aspirin, and ibuprofen should be avoided because these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic
over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic.
Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.
3. 3.ID: 14478179967
The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect?
A. Hematochezia
B. Left upper abdominal pain
C. Ascites and peripheral edema
D. Temperature over 102o F (38.9o C)
1
, Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include
nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel
sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration
of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner‟s spots or sign, a bluish flank discoloration) and the periumbilical
area (Cullen‟s sign, a bluish periumbilical discoloration).
4. 4.ID: 14478179963
The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer?
2
, A. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia
B. A 72-yr-old African American man who has smoked cigarettes for 50 years
C. A 23-yr-old man who has cystic fibrosis–related pancreatic enzyme insufficiency
D. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus
Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and
exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established
environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer compared with nonsmokers. The risk
is related to duration and number of cigarettes smoked.
5. 5.ID: 14478179961
The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates
understanding of the instructions?
A. “This medication will help me digest fats and fat-soluble vitamins.”
B. “I will apply the medicated lotion sparingly to the areas where I itch.”
C. “The medication is a powder and needs to be mixed with milk or juice.”
D. “I should take this medication on an empty stomach at the same time each day.”
For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces.
Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.
6. 6.ID: 14478179991
A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase
level of 310 U/L. Which diagnosis does the nurse expect?
A. Starvation
B. Pancreatitis
C. Systemic sepsis
D. Diabetic ketoacidosis
The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal, 30-122 U/L) and serum
lipase (normal, 31- 186 U/L) levels as shown.
7. 7.ID: 14478179983
3
, The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective?
A. Relief of constipation
B. Relief of abdominal pain
C. Decreased liver enzymes
D. Decreased ammonia levels
4
