Chapter 06 Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder

Chapter 06  Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder

MULTIPLE CHOICE

1. Which abnormal lab value would be found in a patient with a pathological condition of the liver?

1. Hemoglobin
2. Alkaline phosphatase
3. pH 5.0
4. Ca– 125

ANS: B
Liver enzyme tests are AST, ALT, LDH, alkaline phosphatase, and gamma GT.

DIF: Cognitive Level: Analysis REF: Pages 232, 244
OBJ: 2 TOP: Diagnostic procedures
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign?
a. Jaundice

b. Edema c. Pruritus d. Pallor

ANS: B
Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema.

DIF: Cognitive Level: Analysis REF: Page 232 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

3. An essential nursing measure to prevent peritonitis after a paracentesis is a. thoroughly cleansing the skin of the abdominal wall.
b. examining ascites for bacteria.
c. providing oral or intravenous fluids.

d. maintaining sterile technique during the procedure. ANS: C

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-2

An incision is made in the skin, and a hollow trocar cannula, or catheter, is passed through the incision and into the cavity. Thoroughly cleansing the skin of the abdominal wall is done prior to the procedure.

DIF: Cognitive Level: Application REF: Page 238 OBJ: 3 TOP: Paracentesis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

4. Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated?

1. Hemoglobin
2. Hematocrit
3. Prothrombin time
4. White blood cell count

ANS: C
The cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII, IX, and X. This causes the patient with cirrhosis to have bleeding tendencies. Prothrombin time measures clotting time.

DIF: Cognitive Level: Analysis REF: Pages 237, 241
OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity

5. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purpose of the T-tube is to

1. decompress the duct and relieve pain caused by stimulation the sphincter of

   Oddi.

2. improve diaphragmatic expansion and prevention of atelectasis.
3. shorten postoperative recovery and hasten the healing process.
4. keep the duct open and allow drainage of the bile until edema resolves.

ANS: D
If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves.

DIF: Cognitive Level: Comprehension REF: Page 250, Figure 6-8 OBJ: 3 TOP: Cholecystectomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity

6. If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to
a. open the T-tube to air so that it will drain freely.

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 6-3

2. position and secure the drainage bag at the abdominal level.
3. make certain that the tube is tightly taped to the patient near the nipple.
4. irrigate the T-tube with normal saline to ensure the free flow of bile.

ANS: B
The nurse will be responsible for the care of the T-tube if one is placed. The drainage bag for the T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated.

DIF: Cognitive Level: Application REF: Pages 250-251, Figure 6-8 OBJ: 3 TOP: Cholecystectomy
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity