Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The mode of transmission of hepatitis A virus (HAV) includes which of the following? a) Semen b) Fecal-oral c) Saliva d) Blood
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a) Gynecomastia and testicular atrophy b) Ascites and orthopnea c) Purpura and petechiae d) Dyspnea and fatigue
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Foul-smelling breath b) Palpation of abdomen for a fluid shift c) Measurement of abdominal girth d) Weight
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? a) Vasopressin (Pitressin) b) Vitamin K c) Epinephrine d) Octreotide (Sandostatin)
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a) Infection with hepatitis G is similar to hepatitis A. b) Hepatitis B is transmitted primarily by the oral-fecal route. c) Hepatitis C increases a person's risk for liver cancer. d) Hepatitis A is frequently spread by sexual contact.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a patient's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The patient is placed in a high Fowler's position and a BP cuff is secured around the arm in preparation for which of the following procedures? a) Liver biopsy b) Dialysis c) Paracentesis d) Abdominal ultrasound
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? a) Vitamin K deficiency b) Riboflavin deficiency c) Vitamin A deficiency d) Folic acid deficiency
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient with end-stage liver disease who is scheduled to undergo a liver transplant tells the nurse, "I am worried that my body will reject the liver." Which of the following statements is the nurse's best response to the patient? a) "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." b) "It is easier to get a good tissue match with liver transplants than with other types of transplants." c) "The problem of rejection is not as common in liver transplants as in other organ transplants." d) "You would not be scheduled for a transplant if there was a concern about rejection.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which type of jaundice is the result of increased destruction of red blood cells? a) Nonobstructive b) Hepatocellular c) Obstructive d) Hemolytic
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? a) Postnecrotic cirrhosis b) Compensated cirrhosis c) Alcoholic cirrhosis d) Biliary cirrhosis
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following indicates an overdose of lactulose? a) Hypoactive bowel sounds b) Constipation c) Fecal impaction d) Watery diarrhea
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? a) Raise all four side rails on the bed b) Prevent visitors, so as not to agitate the patient c) Pad the side rails on the bed d) Apply soft wrist restraints
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a) The digestion of dietary and blood proteins. b) Excess potassium loss subsequent to prolonged use of diuretics. c) Excessive diuresis and dehydration. d) Severe infections and high fevers.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications? a) The need for more frequently divided doses b) The need for increased drug dosages c) Medications will no longer be effective in clients with liver disease. d) Metabolism of medications
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
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) Platelet count b) A liver biopsy c) A CT scan d) A prothrombin time
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? a) Yellow-green b) Clay-colored or whitish c) Blood tinged d) Black and tarry
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? a) Fetor hepaticus b) Constructional apraxia c) Ataxia d) Asterixis
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Patients with chronic liver dysfunction have problems with insufficient vitamin intake. Which of the following may occur as a result of vitamin C deficiency? a) Hypoprothrombinemia b) Scurvy c) Night blindness d) Beriberi
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a) Cholecystectomy b) Endoscopic retrograde cholangiopancreatography (ERCP) c) Colonoscopy d) Abdominal x-ray
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy? a) Prone b) Left-lateral Sims' c) Upright d) Supine
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following is the most effective strategy to prevent hepatitis B infection? a) Vaccine b) Barrier protection during intercourse c) Covering open sores d) Avoid sharing toothbrushes
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? a) Magnetic resonance imaging b) Liver biopsy c) Coagulation studies d) Radioisotope liver scan
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? a) Asterixis b) Cirrhosis c) Hepatic encephalopathy d) Portal hypertension
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following would be the most important nursing assessment in a patient diagnosed with ascites? a) Assessment of oral cavity for foul-smelling breath b) Daily weight and measurement of abdominal girth c) Palpation of abdomen for a fluid shift d) Auscultation of abdomen
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
After undergoing a liver biopsy, a client should be placed in which position? a) Right lateral decubitus position b) Semi-Fowler's position c) Supine position d) Prone position
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is administering medications to a patient that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? a) Spironolactone (Aldactone) b) Cholestyramine (Questran) c) Kanamycin (Kantrex) d) Lactulose (Cephulac)
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: a) peptic ulcer disease. b) appendicitis. c) cholelithiasis. d) cirrhosis.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse identifies which of the following types of jaundice in an adult experiencing a transfusion reaction? a) Hepatocellular b) Nonobstructive c) Obstructive d) Hemolytic
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? a) Measure abdominal girth according to a set routine. b) Report the condition to the physician immediately. c) Provide the client with nonprescription laxatives. d) Ask the client about food intake.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals? a) Maintaining the airway b) Relieving the patient's anxiety c) Controlling bleeding d) Maintaining fluid volume
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Connie, a 60-year-old retired financial planner, is recently diagnosed with carcinoma of the pancreas. She has just met with her surgeon and feels overwhelmed by all the information she was given. She tells you that she is having the head of the pancreas removed; additionally, the surgeon is also removing the duodenum and stomach and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is Connie having performed? a) Distal pancreatectomy b) Total pancreatectomy c) Cholecystojejunostomy d) Radical pancreatoduodenectomy
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices? a) Vasopressin (Pitressin) b) Spironolactone (Aldactone) c) Cimetidine (Tagamet) d) Nitroglycerin
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a) Vitamin B b) Vitamin K c) Oral bile acids d) Potassium
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? a) Blood pH of 7.25 b) Loss of 2.2 lb (1 kg) in 24 hours c) Serum sodium level of 135 mEq/L d) Serum potassium level of 3.5 mEq/L
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which type of deficiency results in macrocytic anemia? a) Vitamin K b) Vitamin C c) Vitamin A d) Folic acid
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? a) Such clients can digest high-fat foods. b) Such clients are at risk for gallbladder contraction. c) Such clients cannot tolerate high-glucose concentration. d) Such clients are at risk for hepatic encephalopathy.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? a) Urinary output related to increased sodium retention b) Peripheral vascular assessment related to immobility c) Skin assessment related to increase in bile salts d) Respiratory assessment related to increased thoracic pressure
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? a) Bumetanide (Bumex) b) Furosemide (Lasix) c) Acetazolamide (Diamox) d) Spironolactone (Aldactone)
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a) Thiamine b) Riboflavin c) Vitamin K d) Vitamin A
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse? a) Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated. b) You can use milk thistle instead of the medications you have been prescribed. c) Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider. d) You should not use herbal supplements in conjunction with medical treatment.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? a) Calcium b) Alcohol c) Bicarbonate d) Ammonia
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
An elderly homeless client with a lengthy history of alcohol addiction is visiting the health clinic where you work. He has worsening jaundice. After diagnostic testing is complete, the physician returns a diagnosis of cirrhosis. The nurse begins client education about this condition. What would the nurse emphasize as the principal goal of cirrhosis therapy? a) Restoring fat-soluble vitamin absorption b) Curing the illness c) Preserving liver function d) Increasing alcohol toleration
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? a) Esophageal varices b) Hepatic encephalopathy c) Portal hypertension d) Hepatitis C
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Louisa Collins, a 52-year-old high school science teacher, is your client on the medical-surgical floor at the hospital where you practice nursing. She is undergoing diagnostics to determine what is causing her liver disorder. As you discuss her condition, Louisa asks questions pertaining to liver physiology and cellular function. Which liver cells perform most of the liver's metabolic functions? a) Parenchymal cells b) Canaliculi cells c) Kupffer cells d) Islets of Langerhans
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
In what location would the nurse palpate for the liver? a) Right upper quadrant b) Left upper quadrant c) Left lower quadrant d) Right lower quadrant
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Bradycardia b) Hypotension c) Polyuria d) Warm moist skin
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A 67-year-old client is returning for a follow-up appointment to the primary care group where you practice nursing. At his last appointment, he received the diagnosis of portal hypertension. What is the primary aim of portal hypertension treatment? Select all that apply. a) Reduce fluid output. b) Reduce fluid accumulation. c) Reduce venous pressure. d) Reduce blood coagulation.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
The most common cause of esophageal varices includes which of the following? a) Portal hypertension b) Jaundice c) Ascites d) Asterixis
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client? a) Spironolactone (Aldactone) b) Propranolol (Inderal) c) Lactulose (Cephulac) d) Vasopressin (Pitressin)
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? a) Lavage b) Gavage c) Instillation d) Decompression
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? a) Cure the cirrhosis. b) Reduce fluid accumulation and venous pressure. c) Treat the esophageal varices. d) Promote optimal neurologic function.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? a) Vasopressin (Pitressin) b) Transjugular intrahepatic portosystemic shunting (TIPS) c) Balloon tamponade d) Sclerotherapy
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction? a) Radioisotope liver scan b) Magnetic resonance imaging (MRI) c) Electroencephalogram (EEG) d) Angiography
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? a) The client didn't take his morning dose of lactulose (Cephulac). b) The client's hepatic function is decreasing. c) The client is avoiding the nurse. d) The client is relaxed and not in pain.
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Reduced hematocrit b) Elevated urobilinogen in the urine c) Straw-colored urine d) Clay-colored stools
Chapter 49: Assessment and Management of Patients With Hepatic Disorders
Louisa Collins, a 52-year-old high school science teacher, is your client on the medical-surgical floor at the hospital where you practice nursing. She is undergoing diagnostics to determine what is causing her liver disorder. As you discuss her condition, Louisa asks questions pertaining to liver physiology and cellular function. Which liver cells perform most of the liver's metabolic functions? a) Parenchymal cells b) Canaliculi cells c) Kupffer cells d) Islets of Langerhans