CH 58

Which activity by the nurse will best relieve symptoms associated with ascites? Administering oxygen Elevating the head of the bed Monitoring serum albumin levels Administering intravenous fluids

B

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? Colon cancer with metastasis to the liver Hypertension Hepatic encephalopathy Ascites and shortness of breath

A

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? Kidney failure Refractory ascites Fetor hepaticus Paracentesis scheduled for today

A

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? Vitamin K-containing products Potassium-sparing diuretics Nonabsorbable antibiotics Nonsteroidal anti-inflammatory drugs (NSAIDs)

D

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) Prolonged partial thromboplastin time Icterus of skin Swollen abdomen Elevated magnesium Currant jelly stool Elevated amylase level

ABC

When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) Esophageal varices Hematuria Fever Ascites Hemorrhoids

ADE

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? Preventing hypotension Keeping the T-tube in a dependent position Administering antibiotic vaccinations Administering immune-suppressant drugs

B

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? Obtain the charts from the previous admission. Listen for bowel sounds in all quadrants. Obtain pulse and blood pressure. Ask about abdominal pain.

C

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? Provides enzymes necessary to digest dairy products Reduces portal pressure Promotes gastrointestinal (GI) excretion of ammonia Decreases GI bleeding

C

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? Client who is taking lactulose and has diarrhea Client with hepatitis C who requires a dressing change Client with end-stage cirrhosis who needs teaching about a low-sodium diet Obtunded client with alcoholic encephalopathy who needs a blood draw

C

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? The client must not consume alcohol. Avoid sharing the bathroom with the client. Members of the household must not share toothbrushes. Drink only bottled water and avoid ice.

C

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? Hemoglobin and hematocrit Leukocytes Alpha-fetoprotein Serum albumin

C

Which problem for a client with cirrhosis takes priority? Insufficient knowledge related to the prognosis of the disease process Discomfort related to the progression of the disease process Potential for injury related to hemorrhage Inadequate nutrition related to an inability to tolerate usual dietary intake

C

Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? Measure and record drainage. Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Obtain informed consent for the procedure. Have the client void before the procedure is performed.

D

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) Recent influenza infection Brown stool Tea-colored urine Right upper quadrant tenderness Itching

CDE

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? Requesting vaccination for hepatitis A Using a needleless system in daily work Getting the three-part hepatitis B vaccine Requesting an injection of immunoglobulin

D

Following paracentesis, during which 2500 mL of fluid was removed, which assessment finding is most important to communicate to the heath care provider? The dressing has a 2-cm area of serous drainage. The client's platelet count is 135,000/mm3. The client's albumin level is 2.8 mg/dL. The client's heart rate is 122 beats/min.

D

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? Provides small frequent meals for the client Suggests taking daily potassium supplements Elevates the head of the bed in high-Fowler's position Requests a bedside commode for the client

D

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? Right shoulder pain Polyuria Bone marrow suppression Bleeding

D

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing skin integrity and abdominal distention Drawing blood from a central venous line for electrolyte studies Evaluating laboratory study results for the presence of hypokalemia Placing the client in a semi-Fowler's position

D

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? "Cirrhosis is a chronic disease that has scarred my liver." "The scars on my liver create problems with blood circulation." "Because of the scars on my liver, blood clotting and blood pressure are affected." "My liver is scarred, but the cells can regenerate themselves and repair the damage."

D

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? Increased blood pressure, increased respiratory rate Decreased blood pressure, increased heart rate Increased respiratory rate, increased apical pulse, pallor Tachypnea, diaphoresis, increased blood pressure

B

The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? Client with ascites who had a paracentesis 2 hours ago and is reporting a headache Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

B

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? Client with hepatitis A reporting severe and ongoing itching Client with severe ascites who has a temperature of 101.4° F (38° C) Client with cirrhosis who has had a 3-pound weight gain over 2 days Client with esophageal varices and mild right upper quadrant pain

B

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? Clients who work with shellfish Men who prefer sex with men Clients traveling to a third-world country Clients with elevations of aspartate aminotransferase and alanine aminotransferase

B

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? Having a larger meal early in the morning Consuming increased carbohydrates and moderate protein Restricting fluids to 1500 mL/day Limiting alcoholic beverages to once weekly

B

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? Positive Babinski's sign Hyperreflexia Kehr's sign Asterixis

D