Download NURS 221 Final Exam (New Material) - Liver Disease and Pancreatitis and more Exams Nursing in PDF only on Docsity!
NURS 221 Final Exam (New Material)
With Certified Solutions
NB: Answers appear at the top of the questions
cirrhosis
Typically a person with ____ shows no signs or symptoms initially until the disease is advanced.
When symptoms present, they include: hepatomegaly, splenomegaly (associated anemia and leukopenia), bleeding, weight loss, weakness, anorexia.
pruritis
In a patient with cirrhosis (end-stage liver disease), bile salts in the blood are excreted onto the skin resulting in ____. Treat with Cholestyramine (Questran).
gynecomastia
Male patients with cirrhosis of the liver may present with enlarged breasts due to hormone imbalance known as ____.
spider angiomas
The scientific name for "drinker's nose" referring to a symptom of liver disease is ____ (two words).
bilirubin (conjugated)
The nurse knows that patients with liver disease who have jaundice have an abnormally high level of ____ in their blood.
thrombocytopenia
Low production of clotting factors in a damaged or diseased liver results in ____, which places patients at risk of VTE/DVT.
portal hypertension
Enlarged vessels, ascites (d/t drop in albumin level), collateral shunting like caput medusi (enlarged umbilical veins), esophageal varices (enlarged esophageal vessels) and hemorrhoids are all signs of ____ (two words).
ammonia
Lactulose (Cephulac) PO, binds with ____ in the colon for excretion in the stools. S/E is increased number of stools (3-5/day). This med may be prescribed for patients with liver cirrhosis/hepatic encephalopathy.
bacteria
Neomycin Sulfate (Mycifrudin), PO, kills ammonia producing ____ in the stomach. This med may be prescribed for patients with liver cirrhosis.
hepatic encephalopathy
With liver cirrhosis AMMONIA which is a byproduct of protein and bacterial breakdown does not get metabolized into UREA. Ammonia builds up in the blood resulting in cognitive (confusion) and motor changes known as ____ (two words).
FLU-LIKE SYMPTOMS such as malaise, GI complaints (N/V/D), headache, fatigue, myalgias (sore, achy muscles). In addition may have RUQ pain. These are signs and symptoms of a patient in the ____ stage of hepatitis.
icteric
Occurs 5-10 days post onset of symptoms. JAUNDICE is evident in the sclera of the eyes, the skin and mucous membranes; inflammation of the bile ducts which prevent bilirubin from being excreted into the small intestine. PRURITUS, CLAY-COLORED STOOL, and BROWN URINE. These are signs and symptoms of a patient in the ____ stage of hepatitis.
posticteric
RECOVERY or convalescence can last several weeks to months. The enzymes start to drop in serum. Liver pain decreases and energy gradually returns. These are signs and symptoms of a patient in the ____ stage of hepatitis.
carbohydrate
Patients with liver disease (e.g. cirrhosis and hepatitis) are placed on a high ____ diet with moderated fat and protein intake (1.5g/kg/day) and NO ALCOHOL. The nurse should encourage smaller, more frequent meals.
Hepatitis
The ____ virus replicates in the liver and damages liver cells causing inflammation which can further result in destruction of hepatocytes. Various types A, B, C, D, E.
Tylenol (acetaminophen)
Non-viral, drug-induced types of hepatitis may include alcohol and ___ (trade name) abuse.
albumin
Liver functions include:
- Fatty acids are converted to ketones
- Ammonia is converted to urea
- Blood glucose regulation and blood filtration
- Bile production and drainage
- Synthesis and storage of amino acids, proteins such as ____ and clotting factors, vitamins A, D, E, K and fats
- Metabolism of hormones and drugs
bile
Liver functions include:
- Fatty acids are converted to ketones
- Ammonia is converted to urea
- Blood glucose regulation and blood filtration
- _____ production and drainage into duodenum
- Synthesis and storage of amino acids, proteins such as albumin and clotting factors, vitamins A, D, E, K and fats
- Metabolism of hormones and drugs
steatorrhea
When stool lacks bile it turns clay-colored or gray and is known as ____.
high (greater than 2.0)
bleeding
After a liver transplant the more common complications the nurse should monitor for are infection and ____.
biliary atresia
Congenital absence of the opening from the common bile duct into small intestine (duodenum) in children is known as ____ (two words).
alcohol
Cirrhosis of the liver is also known as ____ liver disease.
cholesterol
The vast majority (75%) of gall stones are made from ____.
elevated
Lab work-up for a patient with obstruction of the pancreatic/bile ducts might show [ elevated / lowered ] levels of bilirubin and the pancreatic enzymes, serum amylase (WNL 0-13 units/L) and lipase (0-160 units/L).
low-fat
The nurse recommends that patients with pancreatitis, gall stones or post cholecystectomy maintain a ____ (two-words) , high-carb diet.
T-tube
The nurse knows that a patient who has undergone an open cholecystectomy for obstruction of the common bile duct may have a ____ (two-words) post-surgery to collect bile and possible stones.
right
After a laparoscopic cholecystectomy, the pain is referred to the [ left / right ] shoulder. Hot packs help to relieve the pain.
pancreatitis
Maintaining a quiet environment, side-lying with knees flexed or HOB 45 degrees (to reduce pain caused by peritoneal stretching d/t edema and inflammation), and having absolutely no food in room are nursing interventions recommended for patients with ____.
fluid replacement
The nurse knows that patients who are experiencing DKA and HHS will require ____ (two words) to maintain tissue perfusion and enhance excess excretion of glucose by the kidneys.
300
For patients being rehydrated from DKA/HHS, when the BG reaches _____ (#) mg/dL or less, change the IV solution to dextrose 5% in water (D5W) to prevent a precipitous decline in blood glucose. Monitor for fluid volume status, especially for older patients who may have heart conditions.
Potassium
