Question 1

0.15 out of 0.15 points A 55-year-old male with acute pancreatitis is being admitted. What is the critical care nurse aware of concerning the common description of acute pancreatitis? Selected Answer: Pancreatic enzymes digest the pancreas. Correct Answer: Pancreatic enzymes digest the pancreas. Feedback: Although the mechanisms causing pancreatitis are unknown, pancreatitis is commonly described as the autodigestion of the pancreas. Less commonly, toxic substances, alcohol, and viruses are implicated as the cause of pancreatitis.

Question 2

0 out of 0.15 points The nurse in the walk-in clinic cares for a wide range of individuals. The nurse knows that the patient at increased risk for an acute pancreatitis attack is which of the following? Selected Answer: A 45-year-old woman with a high-fat diet Correct Answer: A 39-year-old man with chronic alcoholism Feedback: The median age of patients diagnosed with chronic pancreatitis is 37 to 40 years. Frequently, at that age, patients already report a long history of alcohol abuse. Excessive and prolonged consumption of alcohol accounts for approximately 70% to 80% of all cases of chronic pancreatitis. Therefore options A, B, and D are incorrect.

Question 3

0.15 out of 0.15 points A nurse is explaining to a patient about an ultrasound of the gallbladder the patient is going to have the following morning. What will the nurse do in preparation for this diagnostic study? Selected Answer: Initiate NPO status after midnight Correct Answer: Initiate NPO status after midnight Feedback: An ultrasound of the gallbladder is most accurate if the patient fasts overnight, so that the gallbladder is distended. Contrast and radioactive agents are not used when performing ultrasonography of the gallbladder, as an ultrasound is based on reflected sound waves.

Question 4

0.15 out of 0.15 points

A patient who had surgery for gallbladder disease has just returned to the unit. The nurse caring for this patient knows to immediately report what assessment finding to the physician? Selected Answer: Rigidity of the abdomen Correct Answer: Rigidity of the abdomen Feedback: The location of the subcostal incision will likely cause the patient to take shallow breaths to prevent pain, and this may result in decreased breath sounds. The nurse should remind patients to take deep breaths and cough to expand the lungs fully and prevent atelectasis. Acute pain is an expected assessment finding following surgery and analgesics should be administered for pain relief. Abdominal splinting or application of an abdominal binder may assist in reducing the pain. Bile may continue to drain from the drainage tract after surgery and this will require frequent changes of the abdominal dressing. Increased abdominal tenderness and rigidity should be reported immediately to the physician, as it may indicate bleeding from an inadvertent puncture or nicking of a major blood vessel during the surgical procedure. Question 5 0.15 out of 0.15 points A student nurse is preparing a plan of care for a patient with chronic pancreatitis. What nursing diagnosis related to the care of a patient with chronic pancreatitis with drainage through the skin and abdominal wall is a priority? Selected Answer: Impaired skin integrity Correct Answer: Impaired skin integrity Feedback: While each of the diagnoses may be applicable to a patient with pancreatitic drainage, the priority nursing diagnosis is: Impaired skin integrity. The drainage is often perfuse and destructive to tissue because of the enzyme contents. Nursing measures must focus on steps to protect the skin near the drainage site from excoriation. The application of ointments or the use of a suction apparatus protect the skin from excoriation. Question 6 0 out of 0.15 points The home health nurse is caring for a patient discharged home after extensive pancreatitic surgery. The nurse documents the nursing diagnosis "Risk for Imbalanced Nutrition: less than body requirements" on the care plan based on the potential complications that may occur after surgery. What are potential

complications for the patient who has had pancreatic surgery? Selected Answer: Weight loss and hypoglycemia Correct Answer: Malabsorption and hyperglycemia Feedback: The nurse arrives at this diagnosis based upon the complications of malabsorption and hyperglycemia. These complications often lead to the need for dietary modifications. Pancreatic enzyme replacement, a low-fat diet, and vitamin supplementation are also often required to meet the patient's nutritional needs and restrictions. Electrolyte imbalances often accompany pancreatic disorders and surgery but the electrolyte levels are more often deficient than excessive. Hemorrhage is a complication related to surgery, but not specific to the nutritionally based nursing diagnosis. Weight loss is a common complication related to pancreatic disorders but is excluded as an answer option due to the second part of the answer, hypoglycemia. Question 7 0 out of 0.15 points A patient returns to the floor after a laparoscopic cholecystectomy. The nurse caring for the patient is aware that the most serious potential complication is what? Selected Answer: Pulmonary atelectasis Correct Answer: Bile duct injury Feedback: Careful screening of patients and identification of those at low risk for problems limits the frequency of conversion to an open abdominal procedure. With wider use of lapraroscopic procedures, however, there may be an increase in the number of such conversions. The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Therefore options A, B, and C are incorrect. Question 8 0 out of 0.15 points A nurse is caring for a patient who has just returned from the ERCP removal of gallstones. What would the nurse know to monitor the patient for? Selected Answer: Development of gangrene of the gallbladder

Correct Answer: Development of pancreatitis Feedback: After an ERCP endoscope is inserted, a cutting instrument is passed through the endoscope into the ampulla of Vater of the common bile duct. It may be used to cut the submucosal fibers, or papilla, of the sphincter of Oddi, enlarging the opening, which may allow the lodged stones to pass spontaneously into the duodenum. Another instrument with a small basket or balloon at its tip may be inserted through the endoscope to retrieve the stones. The patient is observed closely for bleeding, perforation, and the development of pancreatitis or sepsis. Question 9 0.15 out of 0.15 points A patient with acute pancreatitis asks her nurse why they have to remain in bed. What is the nurse's best answer? Selected Answer: Correct Answer:

Staying in bed decreases the metabolic rate of your body and reduces the secretion of pancreatic and gastric enzymes. Staying in bed decreases the metabolic rate of your body and reduces the secretion of pancreatic and gastric enzymes.

Feedback: The acutely ill patient is maintained on bed rest to decrease the metabolic rate and reduce the secretion of pancreatic and gastric enzymes. Staying in bed does not release energy from the body to fight the disease. Option B is incomplete. Option D would be giving the patient an incorrect answer. Question 10 0.15 out of 0.15 points Why does acute pancreatitis change the metabolic needs of the body? Selected Answer: needs. Correct Answer: Acute illness, infection, and fever increase metabolic needs. Feedback: Alteration in pancreatic secretions interferes with normal digestive processes. Acute illness, infection, and fever increase metabolic needs. Question 11 0.15 out of 0.15 points A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain. The physician's notes indicate that over 80% of

Acute illness, infection, and fever increase metabolic

the patient's pancreas has been destroyed. The patient asks you why the diagnosis wasn't made earlier in the disease process. What would be the nurse's best response? Selected Answer: Correct Answer:

Chronic pancreatitis often goes undetected until more than 80% of the pancreatic tissue is destroyed. Chronic pancreatitis often goes undetected until more than 80% of the pancreatic tissue is destroyed.

Feedback: Chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrine tissue is destroyed. Options A, B, and D are inappropriate to tell the patient at this time. Question 12 What are the major causes of chronic pancreatitis? Selected Answer: Alcohol consumption and obesity Correct Answer: Malnutrition and alcohol consumption Feedback: Alcohol consumption in Western societies and malnutrition worldwide are the major causes of chronic pancreatitis. Obesity is a form of malnutrition. Acute pancreatitis does not usually lead to chronic pancreatitis unless complications develop. Question 13 0.15 out of 0.15 points Why is laparoscopic cholecystectomy preferred by surgeons over an open procedure? Selected Answer: Surgical risks are fewer. Correct Answer: Surgical risks are fewer. Feedback: Open surgery has largely been replaced by laparoscopic cholecystectomy (removal of the gallbladder through a small incision through the umbilicus). As a result, surgical risks have decreased, along with the length of hospital stay and the long recovery period required after standard surgical cholecystectomy. Question 14 0.15 out of 0.15 points A patient presents to the emergency department complaining of right upper quadrant pain that is severe in nature. The patient states that his doctor told him 0 out of 0.15 points

he had gallstones. What is a possible complication of gallstones? Selected Answer: Gangrene of the gallbladder Correct Answer: Gangrene of the gallbladder Feedback: In calculous cholecystitis, a gallbladder stone obstructs bile outflow. Bile remaining in the gallbladder initiates a chemical reaction; autolysis and edema occur; and the blood vessels in the gallbladder are compressed, compromising its vascular supply. Gangrene of the gallbladder with perforation may result. Question 15 0.15 out of 0.15 points A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension? Selected Answer: Ascites Correct Answer: Ascites Feedback: Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Portal hypertension does not generally cause bowel obstruction. Vitamin A deficiency is not something the nurse assesses for. Hepatic encephalopathy is a complication of cirrohsis. Question 16 0.15 out of 0.15 points A patient who has undergone liver transplantation is ready to be discharged home. The nurse is providing discharge teaching. Which topic will the nurse emphasize the most related to discharge teaching? Selected Answer: Correct Answer:

The patient will take immunosuppressive agents as required. The patient will take immunosuppressive agents as required.

Feedback: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to assure that an adequate

supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as they wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress them like they would stress the immunosuppressive drug regimen. Question 17 0.15 out of 0.15 points A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals who ate at this restaurant and have never received the hepatitis A vaccine? Selected Answer: An immune globulin injection Correct Answer: An immune globulin injection Feedback: For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Question 18 0 out of 0.15 points A patient with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the patient. What position should they position the patient in? Selected Answer: Correct Answer: On the right side with a pillow under the costal margin Feedback: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Instruct the patient to remain in this position, recumbent and immobile, for several hours. The patient will not be placed in the supine or the Trendelenberg position. Option C is incorrect. Question 19 0.15 out of 0.15 points

On the left side with a pillow under the knees

A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? Selected Answer: Bleeding esophageal varices Correct Answer: Bleeding esophageal varices Feedback: The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension. Question 20 0 out of 0.15 points A patient with bleeding esophageal varices is brought to the emergency department by the paramedics. An immediate endoscopy is performed. What nursing intervention is appropriate? Selected Answer: Keep patient NPO until results of test are known. Correct Answer: Keep patient NPO until gag reflex returns. Feedback: After the examination, fluids are not given until the patient's gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient's physical condition and mental status permit. Appropriate nursing interventions do not include option A, as the result of the test is known immediately; anesthetic gargles and lozenges are contraindicated until the gag reflex returns. Question 21 How is hepatitis C transmitted? Selected Answer: Unintentional needlesticks Correct Answer: Unintentional needlesticks Feedback: Whereas blood transfusions and sexual contact once accounted for most cases of hepatitis C in the United States, other parenteral means, such as sharing contaminated needles by IV/injection drug 0.15 out of 0.15 points

users and unintentional needlesticks and other injuries in health care workers, now account for a significant number of cases. Hepatitis C is not spread by the fecaloral or airborne route, and it is not spread by contaminated food. Question 22 0.15 out of 0.15 points A critical care nurse is caring for a patient post liver transplantation. The patient has a fall in blood glucose level. What would the nurse do in this instance? Selected Answer: hours Correct Answer: Monitor an infusion of 10% glucose for the first 48 hours Feedback: Metabolic abnormalities require careful attention. A constant infusion of 10% glucose may be required in the first 48 hours to prevent a precipitous fall in the blood glucose level that results from decreased gluconeogenesis. Options A, B, and D are incorrect. Question 23 0 out of 0.15 points A patient is being discharged home after liver transplantation. The patient still has a hepatic artery catheter in place. What is this hepatic artery catheter for? Selected Answer: Correct Answer:

Monitor an infusion of 10% glucose for the first 48

To monitor vascular changes in the hepatic system To deliver a continuous chemotherapeutic dose until completed

Feedback: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system. Question 24 0.15 out of 0.15 points A 55-year-old female patient is undergoing radiofrequency thermal ablation of her primary liver tumor. What does this treatment entail? Selected Answer:

A needle electrode is inserted into the tumor and

heated by radiofrequency. Correct Answer: A needle electrode is inserted into the tumor and heated by radiofrequency.

Feedback: In radiofrequency thermal ablation, a needle electrode is inserted into the liver tumor under imaging guidance. Radiofrequency energy passes through to the noninsulated needle tip, causing heat and tumor cell death from coagulation necrosis. No tube is inserted into the tumor. Question 25 0 out of 0.15 points A health care provider who has never been immunized for hepatitis B is exposed to the hepatitis B virus through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include Selected Answer: Correct Answer: Question 26

hepatitis B immune globulin (HBIG) injection. both the hepatitis B vaccine and hepatitis B immune globulin.

0.15 out of 0.15 points While the nurse is obtaining a nursing history from a patient diagnosed with hepatitis C, information reported by the patient that indicates the highest risk factor for hepatitis C includes Selected Answer: intravenous drug abuse. Correct Answer: intravenous drug abuse.

Question 27

0.15 out of 0.15 points A homeless person is hospitalized with severe anorexia and fatigue. She has mild jaundice and hepatomegaly, and her liver function tests are abnormal. The physician suspects viral hepatitis. In planning care for the patient, the nurse assigns the highest priority to the patient outcome of Selected Answer: maintains adequate nutrition. Correct Answer: maintains adequate nutrition.

Question 28

0 out of 0.15 points

A patient with acute hepatitis B asks the nurse if treatment is available for the condition. The nurse explains to the patient that Selected Answer:

lamivudine (Epivir) can decrease viral load and liver damage in those with acute hepatitis B but it must be taken for at least 1 year. because no medication is available for treatment of acute viral hepatitis, adequate nutrition and rest are the most important treatments.

Correct Answer:

Question 29

0.15 out of 0.15 points Combination therapy of -interferon and ribavirin (Rebetol) is being used to treat hepatitis C in a patient with human immunodeficiency virus (HIV). One effect of this drug regimen that the nurse must monitor in the patient is Selected Answer: decreased CD4 cell counts. Correct Answer: decreased CD4 cell counts.

Question 30

0 out of 0.15 points A 68-year-old patient has an abrupt onset of anorexia, nausea and vomiting, hepatomegaly, and abnormal liver function studies. Serologic testing is negative for viral causes of hepatitis. During assessment of the patient, it is most important for the nurse to question the patient regarding Selected Answer: Correct Answer: the use of all prescription and OTC medications.

exposure to children recently immunized for hepatitis B.

Question 31

0.15 out of 0.15 points A 32-year-old patient has early alcoholic cirrhosis diagnosed by a liver biopsy. In teaching the patient about the disease, it is important for the nurse to inform her that the disease may be reversed at this point with Selected Answer: abstinence from alcohol. Correct Answer: abstinence from alcohol.

Question 32

0 out of 0.15 points When assessing a patient for signs of impending coma resulting from hepatic encephalopathy, the nurse asks the patient to Selected Answer: stand on one foot. Correct Answer: extend the arm and hand.

Question 33

0 out of 0.15 points When lactulose (Cephulac) 30 ml qid is ordered for a patient with advanced cirrhosis, he complains that it causes diarrhea. The nurse explains to the patient that it is still important for him to take the drug because the drug will Selected Answer: prevent gastrointestinal bleeding. Correct Answer: improve nervous system function.

Question 34

0.15 out of 0.15 points A patient with cirrhosis has a massive hemorrhage from esophageal varices. In planning care for the patient, the nurse gives the highest priority to the goal of Selected Answer: maintenance of the airway. Correct Answer: maintenance of the airway.

Question 35

0 out of 0.15 points A patient with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor Selected Answer: the prothrombin time. Correct Answer: serum ammonia levels.

Question 36

0 out of 0.15 points The nurse identifies a nursing diagnosis of risk for impaired skin integrity for a patient with cirrhosis who has ascites and 4+ pitting edema of the feet and legs. An appropriate nursing intervention for this problem is to

Selected Answer: turn the patient every 4 hours. Correct Answer: arrange for a special pressure-relieving mattress. Question 37 0.15 out of 0.15 points A patient with cancer of the liver has severe ascites that is causing shortness of breath and difficulty breathing. The physician plans a paracentesis to relieve the fluid pressure on the diaphragm. To prepare the patient for the procedure, the nurse Selected Answer: asks the patient to empty the bladder. Correct Answer: asks the patient to empty the bladder. Question 38 0.15 out of 0.15 points A patient with end-stage liver disease is to undergo a liver transplant. She tells the nurse that she has a friend who had to have two kidney transplants because of rejection and that she hopes she does not have problems with rejection. The nurses best response to the patient is Selected Answer: Correct Answer: Question 39

The problem of rejection is not as common in liver transplants as in kidney transplants. The problem of rejection is not as common in liver transplants as in kidney transplants.

0.15 out of 0.15 points A patient hospitalized with possible acute pancreatitis has severe abdominal pain and nausea and vomiting. The nurse would expect the diagnosis to be confirmed with laboratory testing that reveals elevated serum Selected Answer: amylase and lipase. Correct Answer: amylase and lipase.

Question 40

0.15 out of 0.15 points In planning care for a patient with acute pancreatitis, the nurse assigns the highest priority to the patient outcome of

Selected Answer: maintains adequate fluid and electrolyte balance. Correct Answer: maintains adequate fluid and electrolyte balance.