Nokea
The nurse caring for a patient who has had an open cholecystectomy with a T Tube will take which action?
- A. open the T tube to the air so that it will drain freely.
- B. position and secure the drainage bag at mid-chest level.
- C. place the collection bag so the tube is not kinked.
- D. irrigate the T tube with normal saline to ensure the free flow of bile.
Correct Answer: C
Rationale: 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.
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A patient returning from a 2-week camping trip a few days ago, reports having nausea, anorexia, and dark urine. Which additional information would assist in diagnosing hepatitis A?
- A. Exposure to blood
- B. Recent ingestion of raw fish
- C. History of intravenous drug use
- D. Multiple sex partners
Correct Answer: B
Rationale: Hepatitis A spreads by direct contact through the oral-fecal route, usually by food and water contaminated with feces.
How does the administration of neomycin reduce the production of ammonia?
- A. By assisting the hepatic cells to regenerate.
- B. By reducing ascites
- C. By decreasing the bacteria in the gut
- D. By helping to digest fats and proteins
Correct Answer: C
Rationale: The buildup of ammonia can be prevented with the use of lactulose and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced.
A patient with cirrhosis of the liver will have which blood test results monitored?
- A. Blood urea nitrogen (BUN)
- B. Platelet counts
- C. Aspartate aminotransferase (AST)
- D. Hemoglobin and Hematocrit (HGB and HCT)
Correct Answer: C
Rationale: The nurse will monitor the patient with cirrhosis for an elevated AST level which would indicate worsening liver function. The BUN monitors kidney function. The platelet count is part of the complete blood count which is not necessary to monitor with cirrhosis. The HGB and HCT monitor for anemia.
Which action will the nurse take to prepare a patient for an endoscopic retrograde cholangiopancreatography (ERCP)?
- A. Confirm that a recent chest x-ray is on file.
- B. Confirm the presence of a consent form.
- C. Warn patient that the procedure will take about 3 hours.
- D. Confirm the presence of a prothrombin time/INR.
- E. Withhold food and drink for 4 hours.
Correct Answer: B,D
Rationale: Before the ERCP, the patient will be held NPO for 8 hours. It is necessary that a consent form be signed as well as evidence of a prothrombin time INR.
The nurse is aware that an elevated serum amylase is diagnostic of pancreatitis at an early stage as an elevation can be assessed as early as how many hours after the onset of pancreatic disease?
- A. 2 hours
- B. 8 hours
- C. 24 hours
- D. 36 hours
Correct Answer: A
Rationale: An increase in the serum amylase can be detected as early as 2 hours after the onset of pancreatic disease. In simple acute pancreatitis, the level returns to normal in about 36 hours. In chronic disease, it remains elevated.