Nokea
A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?
- A. Hepatitis
- B. Biliary colic
- C. Cholelithiasis
- D. Cholecystitis
Correct Answer: C
Rationale: With cholelithiasis, initially, clients experience belching, nausea, and right upper quadrant discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic. The symptoms do not correlate with hepatitis.
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A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis?
- A. A liver biopsy
- B. A CT scan
- C. A prothrombin time
- D. Platelet count
Correct Answer: A
Rationale: A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.
The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones?
- A. Colonoscopy
- B. Abdominal x-ray
- C. Cholecystectomy
- D. Endoscopic retrograde cholangiopancreatography (ERCP)
Correct Answer: D
Rationale: ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.
A client with gallstones tells the nurse, 'The doctor has to do something. Isn't there something he can give me to dissolve them?' What medication does the nurse know may help dissolve the gallstones?
- A. Pancreatin
- B. Chenodiol
- C. Tacrolimus
- D. Cyclosporine
Correct Answer: B
Rationale: Chenodiol suppresses hepatic synthesis of cholesterol and cholic acid to dissolve gallstones. It is administered orally to dissolve gallstones and may require long term therapy for effectiveness. Pancreatin is a pancreatic enzyme and does not have the properties to dissolve gallstones. Tacrolimus is used to prevent transplant rejection as is cyclosporine.
A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which client statement indicates that the nurse's teaching was successful?
- A. The physician will use a balloon to compress the vessels.
- B. I might need to have this procedure done again.
- C. I seems odd that a rubber band can block off the vessels.
- D. A catheter will be inserted through my belly to fix the vessels.
Correct Answer: B
Rationale: Persistent portal hypertension allows varices to form again, making it necessary to repeat injection sclerotherapy or variceal banding regularly. Injection sclerotherapy involves passing an endoscope orally to locate the varix. Balloon tamponade is used to compress actively bleeding esophageal varices as a temporary measure. Variceal banding involves using a rubber band over the varix to restrict blood flow that eventually leads to sloughing.
The nurse is administering furosemide to promote urinary excretion of excess fluids for a client with cirrhosis. When administering furosemide to this client, what should the nurse closely monitor?
- A. Sodium level
- B. Calcium level
- C. Magnesium level
- D. AST levels
Correct Answer: A
Rationale: Diuretics such as furosemide must be administered with caution because long-term use can cause sodium depletion. The other levels do not relate to the administration of furosemide.