Nokea
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.
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A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has?
- A. Hemolytic jaundice
- B. Hepatocellular jaundice
- C. Obstructive jaundice
- D. Cirrhosis of the liver
Correct Answer: C
Rationale: Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice.
A client is about to undergo a liver biopsy. Which should the nurse administer to the client before the procedure?
- A. Potassium
- B. Vitamin K
- C. Vitamin B
- D. Oral bile acids
Correct Answer: B
Rationale: Clients about to undergo a liver biopsy may require vitamin K before the procedure to reduce the risk of bleeding. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client about to undergo a liver biopsy, they are given to dissolve gallstones. Vitamin B has no implications in the procedure.
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor?
- A. Elevated white blood cell count
- B. Elevated alpha-fetoprotein
- C. Decreased AST levels
- D. Decreased alkaline phosphatase levels
Correct Answer: B
Rationale: Alpha-fetoprotein, a serum protein normally produced during fetal development, is a marker that, if elevated, can induce a primary malignant liver tumor. Total bilirubin and serum enzyme levels may be elevated. White blood cell count elevation would indicate an inflammatory response.
The nurse is admitting a client to their room at the hospital and observes that the client's skin and sclera are jaundiced. What does the nurse expect the client's total bilirubin levels to be?
- A. 0.2 mg/dL
- B. 1.0 mg/dL
- C. 2.0 mg/dL
- D. 3.0 mg/dL
Correct Answer: D
Rationale: Normally, total bilirubin concentration ranges from 0.2 to 1.3 mg/dL. If the serum bilirubin level exceeds 2.5 mg/dL, jaundice is visible, notably on the skin, oral mucous membranes, and, especially, sclera.
The nurse is reviewing laboratory work that is consistent with a client being positive for hepatitis and in the incubation phase of the illness. What should the nurse be concerned with at this stage of the illness?
- A. The client is infectious.
- B. The client may have enlargement of the liver and spleen.
- C. The client will have weight loss.
- D. The client has jaundice.
Correct Answer: A
Rationale: In the incubation phase, the virus replicates within the liver, and the client is asymptomatic. Late in this phase, the virus can be found in blood, bile, and stools. At this point, the client is considered infectious.