chapt 39
An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage?
Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation.
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral
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?
Hepatic encephalopathy The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.
A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?
Vasopressin (Pitressin)
Which of the following medications are used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin (Pitressin)
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?
Vitamin A
Which of the following indicates an overdose of lactulose?
Watery diarrhea
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.
• Glucose metabolism • Ammonia conversion • Protein metabolism
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 and the physician instituted interventions to begin treatment of this condition. What is the primary aim of portal hypertension treatment? Choose all correct options.
• Reduce venous pressure • Reduce fluid accumulation
When caring for a client with cirrhosis, which of the following should a nurse notify immediately? Choose all correct options
• Signs of GI bleeding • Change in mental status
A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?
Excrete bile Explanation: The liver forms and excretes bile, synthesizes amino acids from the breakdown of proteins, converts ammonia into urea, and synthesizes the factors needed for blood coagulation.
A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?
Excrete bile
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?
Loss of 2.2 lb (1 kg) in 24 hours
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention?
Discuss meals that include low-fat high-carbohydrate content.
client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention?
Discuss meals that include low-fat high-carbohydrate content. Explanation: In cirrhosis, the liver's metabolic function is compromised, increasing the client's need for carbohydrates and other energy sources for cellular metabolism. The nurse should limit the client's fat intake to prevent satiation and should restrict protein intake because a cirrhotic liver can't metabolize protein effectively.
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.
Enlarged liver size Ascites Hemorrhoids
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
"How did this happen? I've been faithful my entire marriage."
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?
Liver biopsy
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:
cirrhosis.
The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?
"How often do you drink alcohol?"
A nurse is reviewing laboratory test results from a client. The report indicates that the client has jaundice. What serum bilirubin level must the client's finding exceed? Enter the correct number only.
2.2.
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
Albumin
Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?
Alcoholic cirrhosis
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?
Ammonia
Which of the following is an age-related change of the hepatobiliary system?
Decreased blood flow
Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction?
Asterixis
Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?
Asterixis Explanation: Hepatic encephalopathy is manifested by numerous central nervous system effects including: disorientation, confusion, personality changes, memory loss, a flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (referred to as fetor hepaticus), and lethargy to deep coma.
When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately?
Change in mental status
nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?
Clay-colored stools
Which type of deficiency results in macrocytic anemia?
Folic acid
Which of the following would be the least important assessment in a patient diagnosed with ascites
Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.
Which type of jaundice is the result of increased destruction of red blood cells?
Hemolytic
A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions?
Hepatic encephalopathy
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
Hepatitis C increases a person's risk for liver cancer.
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?
Hypotension
Which of the following laboratory test results would the nurse associate with obstructive jaundice?
Increased direct bilirubin
A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply
Infection at school • Suboptimal sanitary habits • Consumption of sewage-contaminated water or shellfish • Sexual activity
A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply.
Instructing the client to remove salty and salted foods from the diet • Administering prescribed spironolactone (Aldactone) • Assisting with placement of a transjugular intrahepatic portosystemic shunt
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
Irritability and drowsiness
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
Irritability and drowsiness Explanation: Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.
A physician has ordered a liver biopsy for a client whose condition is deteriorating. Which of the following places the client at high risk due to her altered liver function during the biopsy?
Low platelet count Certain blood tests provide information about liver function. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.
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?
Measure abdominal girth according to a set routine.
patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate?
On the right side
Which of the following the are early manifestations of liver cancer? Select all that apply.
Pain Continuous aching in the back
Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid?
Paracentesis
The most common cause of esophageal varices includes which of the following?
Portal hypertension
A client has worked for a company that produces paint and varnishing compounds for 24 years. She is visiting the clinic for chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of her skin and sclera. She reports clay-colored stools and frequent nosebleeds. What would the nurse suspect is the cause of the client's symptoms?
Postnecrotic cirrhosis Explanation: Postnecrotic cirrhosis results from destruction of liver cells secondary to infection (e.g., hepatitis), metabolic liver disease, or exposure to hepatotoxins or industrial chemicals
An elderly homeless client with a lengthy history of alcohol addiction is visiting the clinic. He has worsening jaundice. 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?
Preserving liver function
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction
Radioisotope liver scan
The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase
Rash Explanation: During the prodromal or preicteric phase, the following signs and symptoms would be noted: urticaria; nausea; vomiting; anorexia; fever; malaise; arthralgia; headache; right upper quadrant (RUQ) discomfort; enlargement of the spleen, liver, and lymph nodes; weight loss; and rash. Jaundice and clay-colored stools would be characteristic of the icteric phase. Liver function tests returning to normal would be noted in the posticteric phase.
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position
In what location would the nurse palpate for the liver?
Right upper quadrant
The nurse is caring for a patient who has undergone surgery for a liver disorder. The client experiences a risk of fluid loss from drainage. The nurse should monitor which of the following to determine the presence of decreased intravascular volume in the patient?
Serum sodium levels
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
Signs of GI bleeding • Change in mental status
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone (Aldactone)
Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?
Spironolactone (Aldactone)
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?
Tacrolimus
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?
The client's hepatic function is decreasing.
A nurse educator is teaching a group that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?
The effect of liver problems on medication metabolism
nurse educator is teaching a group that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?
The effect of liver problems on medication metabolism
Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses
Ultrasonography
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
Which of the following is a contraindication for a liver transplant? Select all that apply.
Uncontrolled hypertension • Extrahepatic malignancy • Irreversible brain damage • Anatomic difficulties • Multiorgan failure
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply
Valproic acid Acetaminophen Ketoconazole
client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
You may have eaten contaminated restaurant food.
client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
anorexia, nausea, and vomiting
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:
cryoprecipitate and fresh frozen plasma.
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:
level of consciousness (LOC).
A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful?
might need to have this procedure done again." Explanation: Persistent portal hypertension allows varices to form again, making it necessary to repeat injection sclerotherapy or variceal banding regularly. Injection sclerotherapy involves passing an endoscope orally to locate the varix.
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. The nurse suspects that these findings result from:
perforation of the colon caused by the liver biopsy. Explanation: After any invasive procedure, the nurse must stay alert for complications in the affected region — in this case, the abdomen. This client exhibits classic signs and symptoms of a perforated colon — severe abdominal pain, fever, and a decreasing level of consciousness
A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:
phytonadione (Mephyton). Explanation: Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis.
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
subnormal serum glucose and elevated serum ammonia levels.
A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
wash her hands after touching the client. Explanation: To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.
• Enlarged liver size • Ascites • Hemorrhoids
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply
• Glucose metabolism • Ammonia conversion • Protein metabolism
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply
• Jaundice • Ecchymoses • Petechiae
