CA 2 Billi

1.
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
D. Diabetes mellitus
Answer: C
Rationale: 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.
Core Competency: Patient Care Competency
Key Areas: Safe and Quality Nursing Care
References: https://quizlet.com/59417530/medsurg-ch-44-liver-pancreasand-biliary-problems_evolve-nclex-questions-flash-cards/
2. 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
Answer: D
Rationale: 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

3. 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 most appropriate?
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."
Answer: D
Rationale: "An injection of immunoglobulin will need to be given to

prevent or minimize the effects from this exposure." 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.

Key Areas: Communication
4. 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
Answer: D
Rationale: Ineffective breathing pattern related to pressure on diaphragm

and reduced lung volume. 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.

5. 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.
B. Teach patient to avoid straining at stool, vigorous blowing of
nose, and coughing.
C. Advise patient to use soft-bristle toothbrush and avoid ingestion
of irritating food.
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.
Answer: A, B,C and E

Rationale: Use smallest gauge needle possible when giving injections or
drawing blood.
B. Teach patient to avoid straining at stool, vigorous blowing of nose, and
coughing.
C. Advise patient to use soft-bristle toothbrush and avoid ingestion of
irritating food.
E. Instruct patient to avoid aspirin and NSAIDs to prevent hemorrhage when
varices are present.
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
6. 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.
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.
Answer: A
Rationale: 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.

7. When caring for a patient with a biliary obstruction, the nurse will
anticipate administering which vitamin supplements (select all that
apply)?
A. Vitamin A
B. Vitamin D
C. Vitamin E
D. Vitamin K
E. Vitamin B
Answer: A,B,C,D
Rationale: 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.
8. 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)
Answer: D
Rationale: 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.

9. 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 -fetoprotein level

B. Ventilation/perfusion scan
C. Hepatic structure ultrasound
D. Abdominal girth measurement
Answer: C
Rationale: Hepatic structure ultrasound, CT, and MRI are used to screen
and diagnose liver cancer. Serum -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.

10. 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.
C. Provide enteral feedings.
D. Avoid dietary cholesterol.
Answer: B
Rationale: 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

11. 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
D. Multiple obstructions in the cystic and common bile duct
Answer: C
Rationale: 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.

12. 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."
Answer: D
Rationale: 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.

13. 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.
B. Hyperaldosteronism related to damaged hepatocytes increases
sodium and fluid retention.
C. Portal hypertension pushes proteins from the blood vessels,
causing leaking into the peritoneal cavity.
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.
Answer: A,B,C
Rationale: 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

14. 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."
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."
Answer: A
Rationale: 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.

15. 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.
Answer: D
Rationale: 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 post-transplant course.

16. 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.
Answer: D
Rationale: 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 post-transplant course.
17. 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.
C. Initiate early prophylactic antibiotic therapy to prevent infection.
D. Administer acetaminophen (Tylenol) every 4 hours for pain relief.
Answer: B
Rationale: 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.


CA 2 Billi

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1.

A 54-year-old patient admitted with diabetes mellitus, malnutrition,

Rationale: Hepatic encephalopathy is a complication of liver disease and

ammonia from the colon, resulting in decreased serum ammonia levels

Core Competency: Patient Care Competency

A. "The hepatitis vaccine will provide immunity from this exposure

Rationale: "An injection of immunoglobulin will need to be given to

Core Competency: Patient Care Competency

A.Impaired skin integrity related to edema, ascites, and pruritus

Rationale: Ineffective breathing pattern related to pressure on diaphragm

Core Competency: Patient Care Competency

appropriate to achieve this outcome (select all that apply)?

A. Use smallest gauge needle possible when giving injections or

Answer: A, B,C and E

6. A patient with type 2 diabetes and cirrhosis asks the nurse if it

Core Competency: Patient Care Competency

8. A patient who has hepatitis B surface antigen (HBsAg) in the serum

Key Areas: Safe and Quality Nursing Care

9. The condition of a patient who has cirrhosis of the liver has

A. Serum -fetoprotein level

Core Competency: Patient Care Competency

nurse expect to do for this patient?

A. Prevent all oral intake.

Rationale: Patients with cholelithiasis can have severe pain, so controlling

Core Competency: Patient Care Competency

A. Low-grade fever of 100 F and dehydration

Rationale: An aPTT of 54 seconds is above normal and indicates

Core Competency: Patient Care Competency

Key Areas: Communication

A. There is decreased colloid oncotic pressure from the liver's

Rationale: The ascites related to cirrhosis are caused by decreased colloid

Core Competency: Patient Care Competency

14. The patient with cirrhosis is being taught self-care. Which

Rationale: If the patient with cirrhosis experiences a fast or irregular heart

Core Competency: Patient Care Competency

the comprehensive evaluation, the nurse knows that which factor

A. Has completed a college education

Rationale: Contraindications for liver transplant include severe

Core Competency: Patient Care Competency

A. Has completed a college education

Rationale: Contraindications for liver transplant include severe

A. Immediately start enteral feeding to prevent malnutrition.

Rationale: Initial treatment with acute pancreatitis will include an NG tube

Core Competency: Patient Care Competency

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