Recognize Cues
A patient reports right upper quadrant pain that occurs 30 minutes after eating fried foods. The pain radiates to the right shoulder and resolves after several hours.
Answer: Cholelithiasis
A patient reports biliary colic after meals. Which test would the nurse anticipate first?
Answer: Abdominal ultrasound
A patient with acute pancreatitis reports pain rated 9/10 and appears restless.
Answer: Assess and manage pain while monitoring vital signs
A patient with gallstones develops fever, leukocytosis, and persistent RUQ pain.
Answer: Acute cholecystitis
A patient recovering from gallstone disease asks what foods should be limited.
Answer: High-fat and fried foods
A patient has scleral icterus, dark urine, clay-colored stools, and generalized pruritus.
Answer: Posthepatic (obstructive) jaundice
A patient with new ascites requires evaluation. Which procedure helps identify infection and determine the nature of the fluid?
Answer: Diagnostic paracentesis
A patient with cirrhosis develops confusion and asterixis.
Answer: Assess for hepatic encephalopathy and administer prescribed therapy such as lactulose
A cirrhotic patient becomes increasingly confused and difficult to arouse.
Answer: Hepatic encephalopathy
A patient with cirrhosis asks why sodium restriction is recommended.
Answer: To reduce fluid retention and ascites
Most commonly due to increased hemolysis, i.e., increased breakdown of RBCs, which produces an increased amount of unconjugated bilirubin in blood
Pre-hepatic jaundice
A patient with cirrhosis develops increasing confusion and asterixis. Which laboratory value best supports the nurse's concern?
Answer: Elevated ammonia level
A patient with acute pancreatitis develops BP 88/50 mmHg, HR 126 bpm, and urine output of 15 mL/hr.
Answer: Address possible hypovolemic shock and notify the provider immediately
A patient with portal hypertension reports black tarry stools and dizziness.
Answer: GI bleeding from esophageal or gastric varices
The goal of management of hepatic encephalopathy is the reduction of
high in calories (3000 kcal/day, target protein intake 1.2 g to 1.5 g/kg/day) with high carbohydrate content
A patient presents with hematemesis, ascites, splenomegaly, and caput medusae.
Answer: Portal hypertension
A patient presents with severe abdominal pain and suspected acute pancreatitis. Which laboratory test is most diagnostic?
Answer: Serum lipase
A patient begins vomiting bright red blood and has a history of cirrhosis.
Answer: Stabilize ABCs and prepare for emergency management of variceal bleeding
This is a common manifestation of decompensated cirrhosis
What is ascites
A patient taking lactulose asks how the medication helps.
Answer: It lowers ammonia levels and helps prevent hepatic encephalopathy
A patient has Jaundice, dark urine, pale stools, hepatomegaly, elevated AST, ALT, conjugated and unconjugated bilirubin levels.
Answer: Hepatic jaundice caused by liver injury
A patient presents with jaundice and suspected bile duct obstruction. Which diagnostic test would best evaluate the biliary tree?
Answer: endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP)
A 68-year-old patient suddenly vomits 700 mL of bright red blood. Assessment findings include HR 132 bpm, BP 84/48 mmHg, RR 30/min, SpO₂ 92%, cool clammy skin, and increasing restlessness. Orders include IV pantoprazole, NG tube insertion, transfusion of uncrossmatched O-negative blood, urgent endoscopy, and oxygen via non-rebreather mask.
Using clinical judgment, identify the THREE priority nursing actions and explain the order in which they should occur.
Two significant local complications of acute pancreatitis are _____________
What is pseudocyst and abscess
A patient with acute pancreatitis asks why they are kept on NPO status
Answer: to reduce pancreatic secretion