Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas

MULTIPLE CHOICE

1. The complication that the nurse would monitor for after a liver biopsy is:
1. headache.
2. muscle cramps.
3. bleeding.
4. respiratory distress.
ANS: 3 Liver biopsy is a vascular process and, if liver disease is present, there may be an
interference with clotting factors that were not noted on the workup.

2. The nurse explains that pruritus in the patient with hepatitis is related to:
1. decreased fat intake.
2. poor appetite and therefore poor protein intake.
3. accumulation of bile salts under the skin.
4. altered urinary output of bile.
ANS: 3 Bile salts accumulate under the skin, causing irritation.

3. The young woman with severe jaundice has a nursing diagnosis of altered body image related
to jaundice. When the patient says, “Will I always be this horrible color?” the nurse replies:
1. “Yes, but your sclera will return to their previous white color.”
2. “No. The color will fade gradually as liver inflammation decreases.”
3. “Yes, but cosmetics can disguise the color.”
4. “No, the color will change to freckles.”
ANS: 2 Jaundice causes patients to be self-conscious and reclusive because of the change in
physical appearance. Patients can be reassured that the color improves as liver function
improves, usually in 2 to 4 weeks.

4. To prevent complications in a hepatitis patient on bed rest, the nurse would plan to:
1. raise the knee gatch to prevent the patient from sliding down in bed.
2. provide undisturbed periods of 6 hours to encourage rest.
3. restrict fluids.
4. encourage turning, coughing, and deep breathing every 2 hours.
ANS: 4 The nurse must encourage measures that will prevent pneumonia and impaired skin
integrity because of the increased risk factors associated with bed rest.

5. The sign that would be a contraindication for the need of increased fluid intake for the patient
with a hepatic disorder is:
1. low blood pressure.
2. increased urinary output.
3. signs of edema.
4. bradycardia.
ANS: 3 Edema may indicate fluid overload; therefore, question intake as well as electrolyte and
cardiac status.
 Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas

6. The patient with jaundice has a nursing diagnosis for impaired skin integrity to:
1. sedate the patient.
2. apply mittens or socks to hands.
3. restrain hands.
4. distract with conversation.
ANS: 2 Jaundice causes itching, which can result in scratching and create a break in the skin.
Mittens provide some comfort without causing further skin impairment.

7. The nurse assures the patient that the Occupational Health and Safety Administration (OSHA)
has a requirement that all health care providers have the vaccination for:
1. hepatitis A.
2. hepatitis B.
3. hepatitis C.
4. all strains of hepatitis.
ANS: 2 OSHA requires that all health care providers be vaccinated against hepatitis B.

8. The nurse assesses a dropping bilirubin level in a patient with hepatitis to mean that the:
1. red blood cell destruction is decreasing.
2. liver function is improving.
3. kidneys are compensating for liver dysfunction.
4. Kupffer cell damage is continuing.
ANS: 2 As liver function improves, the bilirubin level will decrease because of the liver’s ability to
conjugate and excrete the bilirubin. The flow of bile out of the liver increases.

9. The goal of medical treatment for patients with cirrhosis is to prevent complications and limit
cell damage. A major approach is to promote rest. The reason for this is to:
1. allow time for a transplant.
2. allow the liver to regenerate.
3. prevent red cell destruction.
4. decrease risk of trauma.
ANS: 2 With rest, the liver will regenerate healthy tissue and return to normal functioning. Rest
must include other measures to promote healing, such as dietary measures and no alcohol.

10. The nurse explains that with the continued rise in ammonia levels in the cirrhotic patient, the
diet will be modified to restrict:
1. protein.
2. carbohydrates.
3. fats.
4. water-soluble vitamins.
ANS: 1 Ammonia is the waste product of protein breakdown. Decreasing protein intake will
decrease the end product.
 Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas
11. The nurse would assess the progress of ascites on a daily basis by:
1. daily weights and measuring abdominal girth.
2. intake-output and electrolyte levels.
3. blood pressure and pulse.
4. daily temperatures and oxygen levels.
ANS: 1 Daily weights and abdominal girth measurements will accurately measure the fluid
accumulating in the peritoneal cavity.

12. The patient with ascites is scheduled for a LeVeen peritoneal-venous shunt. The patient asks
why this needs to be done instead of the paracentesis. The nurse replies:
1. “It helps the kidneys to retain needed sodium.”
2. “It will decrease the need for analgesics.”
3. “This procedure will prevent the loss of protein.”
4. “There is less risk of infection with this procedure.”
ANS: 3 Fluids containing protein are returned to the vascular compartment to retain important
elements such as albumin. The retention of albumin reduces fluid accumulation.

13. A high ammonia level contributes to hepatic encephalopathy. As this level increases, the
nursing implementation that needs to be added to the nursing care plan is:
1. mouth care.
2. seizure precautions.
3. oxygen saturation monitoring.
4. intake and output.
ANS: 2 As the ammonia level rises, the patient becomes at greater risk for seizures because of
the encephalopathy.

14. The nurse includes in the teaching plan for a patient with hepatitis A to avoid sharing:
1. food.
2. bodies.
3. needles.
4. housing.
ANS: 1 Hepatitis A is spread from contact with saliva, which can be transmitted by shared food or
drinks.

15. The nurse will evaluate that dietary teaching is successful when the patient on a low-sodium
diet selects:
1. bologna sandwich with tomato juice.
2. hot dog on a bun with pickle relish and skim milk.
3. baked chicken, white rice, and apple juice.
4. peanut butter and jelly sandwich with tomato soup.
ANS: 3 This meal has the lowest sodium levels.
 Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas
16. The nursing measure that takes priority in relation to the care of a patient with an
gastroesophageal balloon tube is to:
1. deflate the balloon periodically.
2. advance the tube as instructed.
3. monitor respirator status.
4. withhold medications that could decrease restlessness.
ANS: 3 Because of close proximity of the esophagus and trachea, any upward movement of the
tube could cause airway obstruction.

17. The instruction that should be given to the patient with portal hypertension to reduce the
threat of hemorrhage is to:
1. eat bland foods.
2. avoid straining to have a bowel movement.
3. increase fluid intake.
4. use an electric razor to shave.
ANS: 2 Straining can increase pressure and may cause the dilated vessels in the GI tract to
bleed. Shaving with an electric razor does not prevent serious bleeding.

18. The nurse caring for a patient with hepatitis B should initiate the precaution of:
1. reverse isolation.
2. standard precautions.
3. respiratory precautions.
4. enteric precautions.
ANS: 2 Standard precautions protect the nurse from organisms that may be in all body fluids.

19. The patient was positive for hepatitis B virus although she had the disease 4 years ago and
now is symptom-free. The nurse explains that the patient:
1. is likely to have hepatitis B again.
2. now has noninfectious hepatitis.
3. is an infectious carrier and always will be.
4. is at risk for hepatitis E.
ANS: 3 A certain percentage of persons who have had hepatitis B convert to carriers. They have
the live virus, which causes no symptoms in them, but they are able to transmit the disease and
always will be infectious.

20. The nurse explains to a patient with pancreatitis that the drug Pancrease (lipase, protease,
amylase), a pancreatic enzyme, should be:
1. taken before meals.
2. sprinkled on warm food.
3. mixed with juice.
4. taken 1 hour after eating.
ANS: 3 Pancreatic enzyme medication takes the place of enzymes missing from the damaged
pancreas. The drug should be mixed with juice or applesauce or sprinkled on cold food, but
should not be chewed, because it will irritate the mouth and lips.
 Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas
21. A patient in acute pain is admitted with pancreatitis. The nurse sees a laboratory report
showing an elevation that is diagnostic for acute pancreatitis, which is:
1. serum bilirubin.
2. serum calcium.
3. serum lipids.
4. serum amylase.
ANS: 4 Serum amylase is the most significant of the diagnostic findings.

22. In planning care for the patient with pancreatitis, the nurse assigns the highest priority to:
1. patient claims satisfaction with pain control.
2. patient states understanding of medications needed on discharge.
3. patient’s activity level tolerance shows an increase.
4. patient can maintain a normal bowel pattern.
ANS: 1 Pain control is the most important priority.

23. Patients with pancreatic disease often have a history of:

1. rigorous diets.
2. low-fat diets.
3. alcohol abuse.
4. excessive sugar intake.
ANS: 3 Pancreatic disease is often related to alcohol abuse.

24. The nurse reports the observation that would indicate blocked flow of bile from the liver to
the intestine, which is:
1. clay-colored stools.
2. jaundice.
3. high blood pressure.
4. tachycardia.
ANS: 1 Bile is unable to get to feces to give it the normal brown color.

25. The nurse is alert to another chronic condition related to the presence of chronic pancreatitis,
which is:
1. chronic obstructive pulmonary disease (COPD).
2. urinary tract infection (UTI).
3. diabetes mellitus.
4. arteriosclerotic heart disease.
ANS: 3 Chronic pancreatitis patients are at risk for developing diabetes mellitus because of the
destruction of the insulin-secreting cells in the pancreas.

COMPLETION
 Chapter 39: Disorders of the Liver, Gallbladder, and Pancreas

1. The nurse reminds the patient with liver disease that the level of ____________________ in the
blood is an indicator of the how well the liver is functioning.
ANS: Bilirubin

2. The nurse explains to the patient that when the blood sugar level drops, the liver is capable of
converting the stored glycogen to glucose by the process of ____________________.
ANS: Glycogenesis

3. The nurse is alert for bleeding in a patient with hepatic disorders because the inflamed liver
may not be able to synthesize two clotting factors, which are ____________________ and
____________________.
ANS: Prothrombin, fibrinogen

4. In assessing a dark-skinned patient for jaundice, the nurse would assess the
____________________ for yellow color.
ANS: Sclera