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EDAPT: Altered Hepatobiliary
Function With 63 Test Your
Knowledge questions
The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The client asks, "Will I need to continue a low-fat diet when I get home?" Which is the best response made by the nurse? - "A low-fat diet is recommended for several weeks after the surgery, which allows your body to adjust not having a gallbladder."
The nurse is planning to discharge a client following a laparoscopic cholecystectomy. Which statement made by the client indicates an understanding of the teaching? - "I will report any pus or drainage from my incisions to the provider immediately."
A nurse is caring for a client during a routine, physical examination. Identify which finding, documented in the medical record, would alert the nurse of the client's increased risk for cholecystitis? - Female client taking norgestimate-ethinyl estradiol daily
The nurse is admitting a client with suspected acute cholecystitis. When reviewing the medical record, which clinical manifestations would be expected to be documented to support this diagnosis? Select all that apply. - Pain in the right upper quadrant of the abdomen after eating a fatty meal.
Fever
Feelings of indigestion
A nurse is caring for a client diagnosed with obstructive cholelithiasis. When reviewing the medical record, which laboratory result is expected? - Expected:
Direct bilirubin 2.5 mg/dL
Not Expected:
Serum amylase 75 U/L
White blood cell (WBC) count 9,
Alkaline phosphatase 48 U/L
The nurse is teaching a client with a new prescription for chenodeoxycholic acid to treat cholelithiasis. What information should the nurse include in the teaching? - This medication will dissolve the gallstones gradually over time.
A client diagnosed with cholelithiasis has been prescribed cholestyramine. After teaching, which statement made by the client indicates a need for clarification? - "This medication can only be taken with water."
A nurse is preparing a client for an endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones. After teaching, which statement made by the client indicates a need for further information? - "I'm so glad I don't have to lie supine for very long for this procedure."
nurse (LPN/LVN), or unlicensed assistive personnel (UAP) who is appropriate for the assigned task. - RN:
- Transfuse two units packed red blood cells (PRBCs).
- Evaluate two clients returning to the floor after surgery.
LPN/LVN:
- Administer oral pain medication.
- Reinforce medication teaching prior to discharge.
UAP:
- Ambulate the stable client in the hallway twice.
- Collect intake and output on all clients.
Which client is most at risk for the development of Hepatitis C (HCV)? - John, a 28-year-old male with a history of intravenous drug misuse.
What laboratory value will alert providers to a current, acute hepatitis B viral (HBV) infection? - Hepatitis B surface antigen (HBsAg)
Stan has arrived at the emergency department (ED) with new onset fatigue and clay-colored stools. He also mentions that his skin is starting to turn yellow. The nurse recognizes that Stan may have manifestations of hepatitis. How should the nurse document his integumentary assessment finding? - Jaundice
Which of Stan's orders from the healthcare provider would the nurse question? - Place client on contact precautions.
Select the corresponding hepatitis for each risk factor. Each risk factor may be applied to more than one hepatitis. - Hepatitis A:
- Misuse of intravenous (IV) drugs
- Travel to regions with high hepatitis infection rates, such as • Asia, the Pacific Islands, Africa, and Eastern Europe
- Have high-risk sexual activity
- Work at day care centers
Hepatitis B:
- Misuse of intravenous (IV) drugs
- Travel to regions with high hepatitis infection rates, such as • • • • Asia, the Pacific Islands, Africa, and Eastern Europe
- Have high-risk sexual activity
- Work with blood or needles
- Care for or live with an individual infected with hepatitis
Hepatitis C:
- Misuse of intravenous (IV) drugs
- Have high-risk sexual activity
Not Included:
- Importance of weekly exercise
- Benefits of a vegetarian diet
Stan has been admitted to the medical surgical unit for further observation and evaluation. His blood work has returned, and Stan has a positive anti-HCV result. Which statement made by Stan should the nurse recognize as a risk factor that, if continued, will place Stan at risk for other infections? - "I didn't think about how dangerous sharing needles would be."
Click on the "Nurses' Notes" tab and read the documented assessment findings. Which assessment findings indicated that Stan may have overexerted himself during physical therapy? Select all that apply. - Respirations rapid and shallow
Pale
Diaphoretic
Reports feeling "shaky and like I want to vomit"
Which nursing diagnoses would be important for the nurse to include in Stan's plan of care? Select all that apply. - Imbalanced nutrition, less than body requirements
Risk for ineffective coping
Activity intolerance
What is the correct order of the following steps that the nurse should take to provide care for Stan after physical therapy? Drag and drop the steps in the correct order. - 1. Raise the head of bed (HOB) to 90 degrees.
- Initiate prescribed supplemental oxygen.
- Obtain vital signs.
- Administer prescribed antiemetic.
Which colleague (licensed practical nurse [LPN], registered nurse [RN], or unlicensed assistive personnel [UAP]) is most appropriate to complete each aspect of Stan's ongoing care? Select one of the colleagues for each task. - Registered Nurse (RN):
- Create an education plan for Stan's discharge home.
- Complete admission assessment on newly admit client.
Licensed Practical Nurse (LPN):
- Administer prescribed antiemetic.
- Reinforce previous education about prevention of hepatitis.
Unlicensed Assistive Personnel (UAP):
- Obtain vital signs.
- Assist to the bathroom, as needed.
- Administer prescribed antiemetic medication.
Select the correct hepatitis to match each of the following characteristics. Each characteristic is associated with one type of hepatitis. - Hepatitis A:
- Fecal-oral route is the primary way of transmission.
- Administer immunoglobulin (most effective if given within 1-2 weeks of exposure) for post exposure prophylaxis.
Hepatitis B:
- Administer immunoglobulin (most effective if given within 24 hours of exposure) for post exposure prophylaxis.
- Vaccine is a three-shot series.
Hepatitis C:
- Currently no vaccine is available.
- More likely to become a chronic infection.
A nurse is caring for a newly admitted client diagnosed with acute pancreatitis. In addition to providing analgesics for pain control, what action should be included in the plan of care to relieve pain? - Position the client on the side with the head of bed elevated 45 degrees.
A nurse is teaching about ways of preventing an acute attack to a client with chronic pancreatitis. Which of the following statements made by
the client indicates an understanding of the teaching? Select all that apply. - "I will use skim milk when cooking."
"I will eat easy-to-digest foods with limited spice."
"I will plan to eat small, frequent meals."
A nurse is performing an assessment on a client diagnosed with acute pancreatitis. Which of the following clinical manifestations would the nurse anticipate as a sign of pancreatitis? - Gray-blue discoloration of the skin around the umbilicus.
A nurse is admitting a client with acute pancreatitis. When completing the assessment, which finding should the nurse expect? - Epigastric pain radiating to the back.
A nurse is caring for a client recently admitted with acute pancreatitis. When reviewing the medical record, which laboratory finding would the nurse expect? - Increased blood glucose level
A nurse is providing care to a client with a pancreatic abscess that was recently drained. A Jackson-Pratt drain was left in place for continuous drainage. Which action took by the nurse will ensure proper function of the drain? - Keep the bulb compressed.
A nurse is caring for a client with acute pancreatitis. Which actions should be included in the plan of care? - Included:
- Administering intravenous (IV) morphine
- Monitoring Chvostek's sign
- Monitoring blood glucose for hyperglycemia
- Auscultating lung fields for crackles
Preventing complications, such as hypovolemic shock
Restoring fluid and electrolyte balance
Ongoing pain management
What are the main functions of the liver? Select all that apply. - Bilirubin excretion
Drug metabolism
Protein metabolism
Which processes are most closely related to causing hemolytic jaundice? Select all that apply. - Blood transfusion reaction
Sickle cell disease
Alterations in which laboratory values would indicate to the nurse that the client is having hepatobiliary dysfunction? Select all that apply. - Bilirubin
Alkaline phosphatase (ALP)
Alanine aminotransferase (ALT)
For each client in the left column, indicate if they have hemolytic Jaundice, obstructive Jaundice, or hepatocellular Jaundice. - Hemolytic Jaundice:
- A 44-year-old admitted to the medical surgical unit after blood transfusion reaction in the emergency department
- A 28-year-old with sickle cell disease
Obstructive Jaundice:
- A 78-year-old with cancerous liver tumor blocking the bile ducts
- A 60-year-old with acute pancreatitis
Hepatocellular Jaundice:
- A 56-year-old with chronic hepatitis C (HCV)
During the assessment of a client with right upper quadrant (RUQ) abdominal pain, which assessment findings should cause the nurse to complete a focused assessment of the gallbladder? Select all that apply.
Recent tendency to bruise easily
History of loose, fatty stools
While palpating the costal margin in the client's upper right abdominal quadrant, the nurse asks the client to take a deep breath in. The client stops inspiration abruptly and exhibits signs of intense pain. What does the assessment finding indicate to the nurse? - Murphy's sign
The nurse is caring for a client with cholecystitis who is refusing their breakfast tray. Which statement made by the nurse is most appropriate
Kim has a poor appetite, and she is refusing to eat. For each nursing action listed, indicate if the action is appropriate or inappropriate for the nurse to complete. - Appropriate:
- Evaluate the client's ability to chew and swallow.
- Clean the client's dentures daily and after every meal.
- Provide a clean environment where the client eats.
- Ask the client for their input on meal selection.
Inappropriate:
- Administer intravenous (IV) pain medication prior to mealtimes.
- Only provide items the client wants to eat.
The healthcare provider ordered an infusion of packed red blood cells (PRBC) to be administered STAT in preparation for a liver biopsy the following day. The nurse enters Kim's room to check on her 45 minutes after the infusion started and finds that Kim is having difficulty breathing and has developed a yellow discoloration on her skin. Arrange the actions the nurse should take in order from first to last. - 1. Stop the blood transfusion.
- Call for assistance.
- Apply oxygen via a simple face mask.
- Asses vital signs.
- Assess lung sounds.
- Insert a new peripheral venous access.
- Infuse 0.9% normal saline at a slow rate.
- Notify the healthcare provider.
The nurse caring for Patrick notes that his serum calcium level is low. Which statement made by the nurse indicates their understanding of the reason for hypocalcemia in acute pancreatitis? - "Calcium combines with fatty acids during fat necrosis."
Hypocalcemia can cause tetany as well as numbness and tingling around the lips and in the fingers. The nurse prepares to assess Trousseau's sign. Which nursing action is correct? - Place a blood pressure cuff on the client's arm and inflate 20 mm Hg above systolic blood pressure for 3-5 minutes.
The nurse caring for Patrick begins to implement prescriptions for care. Which prescription should be matched to the associated rationale? Each option can only be used once. - Nothing by mouth (NPO) - Minimizes pancreas stimulation and enzyme secretion.
Lactated Ringer's 150 mL/hour - Restores fluid and electrolyte balance.
Ondansetron intravenous (IV) as needed - Reduces nausea and vomiting.
preoperative teaching? - "You will have four small abdominal incisions that will need to be monitored for signs of infection."
A nurse is caring for a client following a laparoscopic cholecystectomy. What should the nurse include in the discharge teaching? - Report any purulent drainage from the incisions.
The nurse recognizes which characteristics are most associated with the development of gallstones? Select all that apply. - Age over 40 years
Multiparous female
Family history of gallbladder disease
Use of estrogen replacement therapy
Obesity
A client is admitted into the hospital with suspected acute cholecystitis. Which prescriptions should the nurse anticipate being prescribed for the client? Select all that apply. - Lactated Ringer's intravenous (IV)
Antiemetics as needed for nausea and vomiting
Blood draw for liver function tests
