Chapter 44 NCLEX Questions Liver Pancreas
1. 1.ID: 809587861
A 54-year-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. To what diagnosis does the nurse attribute these
findings?
A.
Malnutrition
B.
Osteomyelitis
C.
Alcohol abuse Correct
D.
Diabetes mellitus
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.
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2. 2.ID: 809587845
The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for
effectiveness of this medication for this patient by assessing what?
A.
Relief of constipation
B.
Relief of abdominal pain
C.
Decreased liver enzymes
D.
Decreased ammonia levels Correct
Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels.
Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting
in decreased serum ammonia levels and correction of hepatic encephalopathy.
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3. 3.ID: 809587857
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill
themselves. Which response by the nurse is mostappropriate?
A.
"The hepatitis vaccine will provide immunity from this exposure and future exposures."
B.
"I am afraid there is nothing you can do since the patient was infectious before admission."
C.
"You will need to be tested first to make sure you don't have the virus before we can treat you."
D.
"An injection of immunoglobulin will need to be given to prevent or minimize the effects from this
exposure." Correct
Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if
given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness
to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.
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4. 4.ID: 809587847
When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis?
A.
Impaired skin integrity related to edema, ascites, and pruritus
B.
Imbalanced nutrition: less than body requirements related to anorexia
C.
Excess fluid volume related to portal hypertension and hyperaldosteronism
D.
Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume Correct
Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway
and breathing are always the highest priorities.
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5. 5.ID: 809650436
When caring for a patient with liver disease, the nurse recognizes the need to prevent bleeding resulting from
altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this
outcome (select all that apply)?
A.
Use smallest gauge needle possible when giving injections or drawing blood. Correct
B.
Teach patient to avoid straining at stool, vigorous blowing of nose, and coughing. Correct
C.
Advise patient to use soft-bristle toothbrush and avoid ingestion of irritating food. Correct
D.
Apply gentle pressure for the shortest possible time period after performing venipuncture.
E.
Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present. Correct
Using the smallest gauge needle for injections will minimize the risk of bleeding into the tissues. Avoiding straining,
nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The use of a soft-bristle toothbrush
and avoidance of irritating food will reduce injury to highly vascular mucous membranes. The nurse should apply
gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not
be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for
bleeding.
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6. 6.ID: 809587863
A patient with type 2 diabetes and cirrhosis asks the nurse if it would be okay to take silymarin (milk thistle) to help
minimize liver damage. The nurse responds based on what knowledge?
A.
Milk thistle may affect liver enzymes and thus alter drug metabolism. Correct
B.
Milk thistle is generally safe in recommended doses for up to 10 years.
C.
There is unclear scientific evidence for the use of milk thistle in treating cirrhosis.
D.
Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.
There is good scientific evidence that there is no real benefit from using milk thistle to protect the liver cells from
toxic damage in the treatment of cirrhosis. Milk thistle does affect liver enzymes and thus could alter drug
metabolism. Therefore patients will need to be monitored for drug interactions. It is noted to be safe for up to 6
years, not 10 years, and it may lower, not elevate, blood glucose levels.
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7. 7.ID: 809650442
When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin
supplements (select all that apply)?
A.
Vitamin A Correct
B.
Vitamin D Correct
C.
Vitamin E Correct
D.
Vitamin K Correct
E.
Vitamin B
Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble
vitamins. Vitamins A, D, E, and K are all fat-soluble and thus would need to be supplemented in a patient with biliary
obstruction.
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8. 8.ID: 809587865
A patient who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after
knee surgery. Which medication order should the nurse question because it is most likely to cause hepatic
complications?
A.
Tramadol (Ultram)
B.
Hydromorphone (Dilaudid)
C.
Oxycodone with aspirin (Percodan)
D.
Hydrocodone with acetaminophen (Vicodin) Correct
The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and
is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a
toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.
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9. 9.ID: 809587871
The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help
determine if the patient has developed liver cancer?
A.
Serum α-fetoprotein level
B.
Ventilation/perfusion scan
C.
Hepatic structure ultrasound Correct
D.
Abdominal girth measurement
Hepatic structure ultrasound, CT, and MRI are used to screen and diagnose liver cancer. Serum α-fetoprotein level
may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans do not diagnose liver cancer.
Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.
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10. 10.ID: 809587867
The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What
should the nurse expect to do for this patient?
A.
Prevent all oral intake.
B.
Control abdominal pain. Correct
C.
Provide enteral feedings.
D.
Avoid dietary cholesterol.
Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated.
NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis.
Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis.
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11. 11.ID: 809587843
A patient with cholelithiasis needs to have the gallbladder removed. Which patient assessment is a contraindication
for a cholecystectomy?
A.
Low-grade fever of 100° F and dehydration
B.
Abscess in the right upper quadrant of the abdomen
C.
Activated partial thromboplastin time (aPTT) of 54 seconds Correct
D.
Multiple obstructions in the cystic and common bile duct
An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery,
significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration;
the abscess can be assessed, and the obstructions in the cystic and common bile duct would be relieved with the
cholecystectomy.
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12. 12.ID: 809587824
When teaching the patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient
makes which statement?
A.
"I will use care when kissing my wife to prevent giving it to her."
B.
"I will need to take adofevir (Hepsera) to prevent chronic HCV."
C.
"Now that I have had HCV, I will have immunity and not get it again."
D.
"I will need to be checked for chronic HCV and other liver problems." Correct
The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver
cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The
treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir
(Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon
with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected
with another type of HCV.
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13. 13.ID: 809650456
The patient with cirrhosis has an increased abdominal girth from ascites. The nurse should know that this fluid
gathers in the abdomen for which reasons (select all that apply)?
A.
There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Correct
B.
Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Correct
C.
Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal
cavity. Correct
D.
Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluids
orally.
E.
Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation,
which decreases the vascular pressure.
The ascites related to cirrhosis are caused by decreased colloid oncotic pressure from the lack of albumin from liver
inability to synthesize it and the portal hypertension that shifts the protein from the blood vessels to the peritoneal
cavity, and hyperaldosteronism which increases sodium and fluid retention. The intake of fluids orally and the
removal of blood cells by the spleen do not directly contribute to ascites.
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14. 14.ID: 809587837
The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?
A.
"If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." Correct
B.
"I need to take good care of my belly and ankle skin where it is swollen."
C.
"A scrotal support may be more comfortable when I have scrotal edema."
D.
"I can use pillows to support my head to help me breathe when I am in bed."
If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should
be reported to the health care provider, as this is not normal for cirrhosis. Edematous tissue is subject to breakdown
and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency.
A scrotal support may improve comfort if there is scrotal edema.
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15. 15.ID: 809587841
The patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver
transplantation. After the comprehensive evaluation, the nurse knows that which factor discovered may be a
contraindication for liver transplantation?
A.
Has completed a college education
B.
Has been able to stop smoking cigarettes
C.
Has well-controlled type 1 diabetes mellitus
D.
The chest x-ray showed another lung cancer lesion. Correct
Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or
other cancer, ongoing drug and/or alcohol abuse, and the inability to comprehend or comply with the rigorous posttransplant course.
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16. 16.ID: 809587853
The patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute
pancreatitis. What intervention(s) should the nurse expect to include in the patient's plan of care?
A.
Immediately start enteral feeding to prevent malnutrition.
B.
Insert an NG and maintain NPO status to allow pancreas to rest. Correct
C.
Initiate early prophylactic antibiotic therapy to prevent infection.
D.
Administer acetaminophen (Tylenol) every 4 hours for pain relief.
Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease
pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent
shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for
the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with
acute necrotizing pancreatitis and signs of infection.
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17. 17.ID: 809587859
The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to
establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment?
A.
Spiral CT scan
B.
A PET/CT scan
C.
Abdominal ultrasound
D.
Cancer-associated antigen 19-9 Correct
The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic
adenocarcinoma and for monitoring the response to treatment. Although a spiral CT scan may be the initial study
done and provides information on metastasis and vascular involvement, this test and the PET/CT scan or abdominal
ultrasound do not provide additional information.
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18. 18.ID: 809587851
When providing discharge teaching for the patient after a laparoscopic cholecystectomy, what information should
the nurse include?
A.
A lower-fat diet may be better tolerated for several weeks. Correct
B.
Do not return to work or normal activities for 3 weeks.
C.
Bile-colored drainage will probably drain from the incision.
D.
Keep the bandages on and the puncture site dry until it heals.
Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks following surgery.
Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage or pus, redness, swelling,
severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the
patient can shower.
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