Med Surg Final Exam

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Med Surg Final Exam
2012-04-22 16:35:51

Gallbladder and Liver
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  1. AST, ALT, LDH, alkaline phosphatase and gamma GT are what kind of tests?
    liver enzyme tests
  2. Low serum albumin levels result also from excessive loss of albumin into the urine or into third space volumes, causing what?
    ascites or edema
  3. An incisionis 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.....also considered to be a __________ ______________
    sterile procedure
  4. The cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII. IX, and X. This causes the pt with cirrhosis to have bleeding tendencies. _________ ______ measures the clotting time.
    prothrombin time
  5. If gallstones are in the common bile duct and edema is present, a biliary drainage tube, or T tube will be inserted for what reason?
    to keep the duct open and allow drainage of the bile until the edema resolves
  6. The nurse will be responsible for thecare 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 the bile. The bag must be positioned _______________________________ or bile cannot drain from the liver. Normal T tubes are not irrigated.
    so the tube is not kinked
  7. Keep the pt lying on their _______ _______ (in _______ ____________ position ) for a minimum of __________ to splint puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrahage or bile leak.
    right side; high Fowlers; 2 hrs
  8. ____________ is a temporary method of removing fluid by withdrawing fluid from the abdominal cavity by either gravity or vacuum.
  9. After procedure (paracentesis ?) keept the pt NPO until when?
    until gag reflex returns
  10. If pt with hepatitis is dehydrated, IV fluids will be given with supplements of :

    1) Vit C to aid in ________
    2) Vit B complex to assist with the damaged liver's ability to _______________
    3) Vit K to combat ____________
    • 1) healing
    • 2) absorb fat soluble vitamins
    • 3) prolonged coagulation time
  11. What does pt have if:

    This pain is usually decreased by flexing the trunk, by leaning forward from a sitting position, or by assuming the fetal position. It is increased by eating or lying down. Low-grade fever may be present.
  12. __________ is a hand flapping tremor in which the pt stretches out an arm and hyperextends the wrist with the fingers separated, relaxed, and extended. This occurs in the pt with ________ ___________.
    asterixis; hepatic encephalopathy
  13. ________ ________ (a complex of longitutinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of ________ ___________.
    esophageal varices; portal hypertension
  14. ________ ________ is a type of brain damage caused by liver disease and consequent ammonia intoxication. ________ is the breakdown product of protein.
    hepatic encephalopathy; ammonia
  15. The buildup of ammonia can be prevented with the use of _________ and _________. Preventing the buildup of ammonia will prevent hepatic encephalopathy from breakdown of blood and the release of ammonia into the intestine.
    lactulose and neomycin
  16. The most recently developed operative procedure, which is now the most common tx for cholecystitis and cholelithiasis, is done by way of _________. It is called ___________ __________ and uses lasser cautery to remove the gallbladder.
    endoscopy; laparoscopic cholecystectomy
  17. The following factors are necessary for adequate dye concentration; ingestion of the correct number of dye tablets, adequate absorption of the dye, abstinence from food the morning of the exam, uptake for the portal system and excretion of the dye by the liver, patency of the cystic duct, and concentration of the dye within the bladder. What is the most important thing to remember when doing tests?
    accuracy of test depends on all of the above
  18. In cholicistitis (gallstones), the pain localizes in the RUQ epigastric region. The pain is where?
    it radiates around the mid torso to the right scapular area
  19. Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material. Teach pts the importance of ________________ after going to the bathroom or changing a diaper, as well as proper food preparations, to prevent the spread of the Hepatitis A virus. What else would you ask the pt?
    good hand washing; ask if they have eaten raw fish
  20. People identified as being high risk for developing Hepatitis B should be ___________ if they are not already immune. These people include who?
    vaccinated; health care workers
  21. The _______ and ________ of pain are important to determine, as well as what aggravates of relieves the pain. Nursing interventions: ________ ________ as prescribed and monitor relief.
    presence and location; admin meds
  22. Hepatitis A spreads by direct contact through the ______ ____ route, usually by ______________ contaminated with feces.
    oral-fecal; food and water
  23. When paracentesis is done, the nurse must have the pt _____________ immediately before the procedure to prevent puncture of the bladder.
  24. Assess for s/s of pancreatitis. These include: increasingly intense abdominal pain, NV and diminished or absent bowel sounds. What nursing intervention is involved?
    control pain
  25. The pain of acute cholecystitis is abrupt and localizes where?
    in the RUQ epigastric region
  26. The pt with hepatic encephalopathy is on a very low protein to no protein diet. The goal of mgmt of this condition is the reduction of ammonia formation in the intestines. What is important to remember for this pts diet?
    do not overload on protein b/c their body cannot absorb it
  27. A critical aspect of nursing care following a liver transplantation is what?
    monitoring for infection
  28. _____________ is an effective immunosuppressant drug. The use of this drug has been a major factor in the success rate of liver transplantion. It does not cause bone marrow suppression and does not impede wound healing. It is also helpful for preventing __________.
    cyclosporine; infection
  29. In addition to the relationship of the infection and nutrition, the nurse may need to teach preop and postop procedures it the pt requires percutaneous of the surgical drainage. What does the pt need to know they need to promote healing?
    their body requires more protein to fight infection
  30. __________ is the discoloration of body tissues caused by abnormally high blood levels of bilirubin. This yellow discoloration is recognized when the total serum bilirubin exceeds __________.
    jaundice; 2.5 mg/dl
  31. __________ and __________disease are the two factors most commonly assoc with pancreatitis.
    alcoholism and biliary tract disease
  32. Food and fluids are withheld to avoid what and why? IV fluids will be admin.
    stimulating pancreatic activity; will aggravate condition
  33. A common compaint is constant, severe pain: in such cases, meperidine PCA is often admin. _____________ may cause spasms of the sphincter of Oddi.
  34. The cause of cancer of the pancreas is unknown, but it is diagnosed more often in ________ _________, people exposed to chemical carcinogens, and people with ___________ _________ and _______________.
    cigarette smokers; diabetes mellitus and pancreatitis
  35. The incidence of cholelithiasis ___________ with aging. Assess older adults for hx of changes in the stool or urine color. ____________ of the liver may cause distention in veins in the upper part of the body.
    increases; cirrhosis
  36. The fluid removed during a paracentesis is removed over a period of ________ to _______ minutes to prevent sudden changes in BP leading to syncope. The bed should be in _______ __________ position. Food and fluid restriction is usually not necessary.
    30 to 90; high Fowlers
  37. While the tube is clamped, the pt may show signs of what? The nurse will unclamp the tube immediately allowing for drainage and relief of both _______ and ________.
    abdominal pain and NV; nausea and pain
  38. Indications for __________ ___________ include congenital biliary abnormalities, inborn error of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end stage liver disease.
    liver transplantation
  39. Coughing, vomiting and performing the ___________ maneuver will increase abdominal venous pressure.
  40. For the pt with viral hepatitis being cared for in the home what precautions should the family be taught to do?
    • 1) clothes should be laundered separately with hot water
    • 2) personal items of the pt should not be shared
    • 3) articles soiled with feces must be disinfected
    • 4) any contaminated items should be disposed of properly