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EDAPT: Altered Hepatobiliary Function
63 Comprehensive Practice Exam
Questions for Final Assessment
A nurse is caring for a client diagnosed with obstructive cholelithiasis. When reviewing the medical record, which laboratory result is expected? - ✔ ✔ Expected:
Direct bilirubin 2.5 mg/dL
Not Expected:
Serum amylase 75 U/L
White blood cell (WBC) count 9,
Alkaline phosphatase 48 U/L
The nurse is teaching a client with a new prescription for chenodeoxycholic acid to treat cholelithiasis. What information should the nurse include in the teaching? - ✔ ✔ This medication will dissolve the gallstones gradually over time.
A client diagnosed with cholelithiasis has been prescribed cholestyramine. After teaching, which statement made by the client indicates a need for clarification? - ✔ ✔ "This medication can only be taken with water."
A nurse is preparing a client for an endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones. After teaching,
which statement made by the client indicates a need for further information? - ✔ ✔ "I'm so glad I don't have to lie supine for very long for this procedure."
The nurse is caring for a client who is to undergo a laparoscopic cholecystectomy. Which statement made by the client indicates a need for further preoperative teaching? - ✔ ✔ "I will have a drain coming out of my abdomen after the procedure, which will need to be emptied daily."
In the medical/surgical unit, a nurse is caring for four clients diagnosed with cholecystitis. Which assessment finding should be immediately reported to the provider? - ✔ ✔ The client's stools are tan colored.
What are the main functions of the liver? Select all that apply. - ✔ ✔ Bilirubin excretion
Drug metabolism
Protein metabolism
Which processes are most closely related to causing hemolytic jaundice? Select all that apply. - ✔ ✔ Blood transfusion reaction
Sickle cell disease
Alterations in which laboratory values would indicate to the nurse that the client is having hepatobiliary dysfunction? Select all that apply. - ✔ ✔ Bilirubin
Alkaline phosphatase (ALP)
Alanine aminotransferase (ALT)
- Travel to regions with high hepatitis infection rates, such as • • • • Asia, the Pacific Islands, Africa, and Eastern Europe
- Have high-risk sexual activity
- Work with blood or needles
- Care for or live with an individual infected with hepatitis
Hepatitis C:
- Misuse of intravenous (IV) drugs
- Have high-risk sexual activity
- Have been in prison
- Work with blood or needles
- Care for or live with an individual infected with hepatitis
The nurse and a nursing student are assessing a client in the emergency department (ED) for potential jaundice. Which areas of the body should the nurse remind the student to assess the presence and degree of jaundice? Select the correct option from the drop-down menu for each item below. - ✔ ✔ 1. Do not assess
- Assess
- Assess
- Do not assess
- Assess
- Assess
The nurse draws Nikki's blood for laboratory testing, and the Hepatitis B surface antibody (HBsAb) result comes back positive. What can the nurse interpret based on the result? - ✔ ✔ Nikki was previously exposed to the virus or properly immunized for Hepatitis B (HBV).
The nurse is preparing to provide education to a group of adults about prevention of hepatitis. Which teaching points should be included in the nurse's presentation? - ✔ ✔ Included:
- Good hand hygiene techniques
- Safe sex practices
- Proper vaccine schedules
Not Included:
- Importance of weekly exercise
- Benefits of a vegetarian diet
Stan has been admitted to the medical surgical unit for further observation and evaluation. His blood work has returned, and Stan has a positive anti-HCV result. Which statement made by Stan should the nurse recognize as a risk factor that, if continued, will place Stan at risk for other infections? - ✔ ✔ "I didn't think about how dangerous sharing needles would be."
Click on the "Nurses' Notes" tab and read the documented assessment findings. Which assessment findings indicated that Stan may have
- Complete admission assessment on newly admit client.
Licensed Practical Nurse (LPN):
- Administer prescribed antiemetic.
- Reinforce previous education about prevention of hepatitis.
Unlicensed Assistive Personnel (UAP):
- Obtain vital signs.
- Assist to the bathroom, as needed.
Stan is preparing to be discharged home. Which of the following actions prioritized by Stan can help the nurse determine Stan does understand the key aspects of self-care when he is at home? Select all that apply. - ✔ ✔ Resting frequently
Eating frequent, small meals
For each nursing action, select the appropriate care focus that will support positive client outcomes. - ✔ ✔ Promote Rest:
- Encourage family to coordinate visits.
- Schedule activities through the day.
Prevent Transmission:
- Discourage share of personal care items.
- Incorporate standard precautions.
- Implement safe handling of needles.
Monitor for Complications:
- Check weight daily.
- Observe for bruising.
Provide Adequate Nutrition:
- Encourage fluid intake of 2.5 L per day.
- Administer prescribed antiemetic medication.
Select the correct hepatitis to match each of the following characteristics. Each characteristic is associated with one type of hepatitis. - ✔ ✔ Hepatitis A:
- Fecal-oral route is the primary way of transmission.
- Administer immunoglobulin (most effective if given within 1-2 weeks of exposure) for post exposure prophylaxis.
Hepatitis B:
- Administer immunoglobulin (most effective if given within 24 hours of exposure) for post exposure prophylaxis.
- Vaccine is a three-shot series.
A nurse is caring for a client recently admitted with acute pancreatitis. When reviewing the medical record, which laboratory finding would the nurse expect? - ✔ ✔ Increased blood glucose level
A nurse is providing care to a client with a pancreatic abscess that was recently drained. A Jackson-Pratt drain was left in place for continuous drainage. Which action took by the nurse will ensure proper function of the drain? - ✔ ✔ Keep the bulb compressed.
A nurse is caring for a client with acute pancreatitis. Which actions should be included in the plan of care? - ✔ ✔ Included:
- Administering intravenous (IV) morphine
- Monitoring Chvostek's sign
- Monitoring blood glucose for hyperglycemia
- Auscultating lung fields for crackles
Not Included:
- Providing a diet low in carbohydrates and high in fat
A nurse is teaching a client about taking pancrelipase to manage chronic pancreatitis. Which statement by the client indicates an understanding of the medication? - ✔ ✔ "I will drink a full glass of water after taking this medication."
Based on Patrick's history, what is the likely cause of this medical condition? - ✔ ✔ Chronic alcohol consumption
The nurse is provided numerous prescriptions to care for Patrick. Select the three priority nursing actions that need immediate nurse intervention. - ✔ ✔ Start oxygen via nasal cannula at 4 L/min.
Establish intravenous (IV) access and administer morphine.
Position the client side-lying with the head of the bed elevated.
Within a few hours, Patrick is admitted to an inpatient hospital bed on the medical/surgical unit. After receiving report from the emergency department and performing an assessment, what should the nurse include in the plan of care as priority outcomes for Patrick? Select all that apply. - ✔ ✔ Reducing pancreatic secretions
Preventing complications, such as hypovolemic shock
Restoring fluid and electrolyte balance
Ongoing pain management
The nurse caring for Patrick notes that his serum calcium level is low. Which statement made by the nurse indicates their understanding of the reason for hypocalcemia in acute pancreatitis? - ✔ ✔ "Calcium combines with fatty acids during fat necrosis."
the nurse take to minimize the risks? Select all that apply. - ✔ ✔ Encourage the client to turn, cough, and deep breath hourly.
Keep the head of the bed elevated at least 45 degrees.
Instruct the client on using an incentive spirometer.
Patrick's condition is not improving with routine medical management. A pancreatic pseudocyst is suspected. Which procedure does the nurse anticipate to prepare the client to undergo? - ✔ ✔ Computed tomography (CT)-guided percutaneous drainage
A nurse caring for clients with acute cholecystitis understands that reducing gallbladder stimulation is necessary to recovery. Which action will prevent stimulation of the gallbladder? - ✔ ✔ Keeping the client nothing by mouth (NPO) and using nasogastric (NG) suctioning.
The nurse is caring for a client who will undergo a laparoscopic removal of the gallbladder. Which information should be included in the preoperative teaching? - ✔ ✔ "You will have four small abdominal incisions that will need to be monitored for signs of infection."
- A 44-year-old admitted to the medical surgical unit after blood transfusion reaction in the emergency department
- A 28-year-old with sickle cell disease
Obstructive Jaundice:
- A 78-year-old with cancerous liver tumor blocking the bile ducts
- A 60-year-old with acute pancreatitis
Hepatocellular Jaundice:
- A 56-year-old with chronic hepatitis C (HCV)
During the assessment of a client with right upper quadrant (RUQ) abdominal pain, which assessment findings should cause the nurse to complete a focused assessment of the gallbladder? Select all that apply.
Recent tendency to bruise easily
History of loose, fatty stools
While palpating the costal margin in the client's upper right abdominal quadrant, the nurse asks the client to take a deep breath in. The client stops inspiration abruptly and exhibits signs of intense pain. What does the assessment finding indicate to the nurse? - ✔ ✔ Murphy's sign
The nurse is caring for a client with cholecystitis who is refusing their breakfast tray. Which statement made by the nurse is most appropriate when assessing the client's lack of appetite? - ✔ ✔ "Do you have any religious or cultural requirements for your meals?"
The nurse should immediately notify the healthcare provider about which abnormal laboratory value for a client having a liver biopsy in 4 hours? - ✔ ✔ Serum prothrombin time (PT) of 18 seconds
- Provide a clean environment where the client eats.
- Ask the client for their input on meal selection.
Inappropriate:
- Administer intravenous (IV) pain medication prior to mealtimes.
- Only provide items the client wants to eat.
The healthcare provider ordered an infusion of packed red blood cells (PRBC) to be administered STAT in preparation for a liver biopsy the following day. The nurse enters Kim's room to check on her 45 minutes after the infusion started and finds that Kim is having difficulty breathing and has developed a yellow discoloration on her skin. Arrange the actions the nurse should take in order from first to last. - ✔ ✔ 1. Stop the blood transfusion.
- Call for assistance.
- Apply oxygen via a simple face mask.
- Asses vital signs.
- Assess lung sounds.
- Insert a new peripheral venous access.
- Infuse 0.9% normal saline at a slow rate.
- Notify the healthcare provider.
Kim has returned to her room after an uncomplicated liver biopsy. She is lying on her back and is drowsy, but arousable; her vital signs are
stable; she rates her pain as 2/10 and says she just wants to sleep. Into which position should the nurse position Kim? - ✔ ✔ Right lateral position
A nurse is caring for a client (pronouns: he/him/his) with hepatic encephalopathy who is aggressive and agitated. A coworker says to the nurse, "You should just restrain that client. He's going to hurt himself". The nurse recognizes which situation is appropriate for restraining clients? Select all that apply. - ✔ ✔ A client who is physically assaulting staff.
An elderly dementia client who is confused and trying to remove intravenous (IV) lines and their indwelling urinary catheter.
A client who is attempting to dislodge their endotracheal tube (ETT).
The charge nurse is making assignments for the next shift on a busy surgical care unit. For each client need below, indicate if it should be assigned to the registered nurse (RN), licensed practical/vocational nurse (LPN/LVN), or unlicensed assistive personnel (UAP) who is appropriate for the assigned task. - ✔ ✔ RN:
- Transfuse two units packed red blood cells (PRBCs).
- Evaluate two clients returning to the floor after surgery.
LPN/LVN:
the client? Select all that apply. - ✔ ✔ Lactated Ringer's intravenous (IV)
Antiemetics as needed for nausea and vomiting
Blood draw for liver function tests
The nurse is preparing to discharge a client following a laparoscopic cholecystectomy. The client asks, "Will I need to continue a low-fat diet when I get home?" Which is the best response made by the nurse? - ✔ ✔ "A low-fat diet is recommended for several weeks after the surgery, which allows your body to adjust not having a gallbladder."
The nurse is planning to discharge a client following a laparoscopic cholecystectomy. Which statement made by the client indicates an understanding of the teaching? - ✔ ✔ "I will report any pus or drainage from my incisions to the provider immediately."
A nurse is caring for a client during a routine, physical examination. Identify which finding, documented in the medical record, would alert the nurse of the client's increased risk for cholecystitis? - ✔ ✔ Female client taking norgestimate-ethinyl estradiol daily
The nurse is admitting a client with suspected acute cholecystitis. When reviewing the medical record, which clinical manifestations would be expected to be documented to support this diagnosis? Select all that apply. - ✔ ✔ Pain in the right upper quadrant of the abdomen after eating a fatty meal.
Fever
Feelings of indigestion
