Chapter 49 PrepU: Hepatic Disorders

When assessing a client with obstructive jaundice, which of the following stool characteristics is the client likely to report? a. Blood tinged b. Black and tarry c. Clay-colored or whitish d. Yellow-green

c. Clay-colored or whitish Rationale: Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be indicators of obstructive jaundice but may indicate other GI tract 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. Excess potassium loss subsequent to prolonged use of diuretics. b. Excessive diuresis and dehydration. c. Severe infections and high fevers. d. The digestion of dietary and blood proteins.

d. The digestion of dietary and blood proteins. Rationale: Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (i.e., bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? a. Angiography b. Electroencephalogram c. Magnetic resonance imaging d. Ultrasonography

d. Ultrasonography Rationale: A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.

In what location would the nurse palpate for the liver? a. Right upper quadrant b. Left lower quadrant c. Right lower quadrant d. Left upper quadrant

a. Right upper quadrant Rationale: The liver may be palpable in the right upper quadrant. A palpable liver presents as a firm, sharp ridge with a smooth surface.

After undergoing a liver biopsy, a client should be placed in which position? a. Supine position b. Semi-Fowler's position c. Right lateral decubitus position d. Prone position

c. Right lateral decubitus position Rationale: After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding. Semi-Fowler's position and the supine and prone positions wouldn't achieve this goal.

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? a. Albumin b. Urobilinogen c. Creatinine e. Chloride

a. Albumin Rationale: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. a. Cyanosis of the lips b. Jaundice c. Aphthous stomatitis d. Ecchymoses e. Petechiae

b. Jaundice d. Ecchymoses e. Petechiae Rationale: The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed? a. Thoracentesis b. Upper endoscopy c. Abdominal paracentesis d. Abdominal CT scan

c. Abdominal paracentesis Rationale: Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain. Fluid is removed from the lung via a thoracentesis. Fluid cannot be removed with an abdominal CT scan, but it can assist with placement of the needle. Fluid cannot be removed via an upper endoscopy.

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. Asterixis b. Fetor hepaticus c. Ataxia d. Constructional apraxia

a. Asterixis Rationale: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy (Fig. 49-13).

Which of the following diagnostic studies definitely confirms the presence of ascites? a. Colonoscopy b. Ultrasound of liver and abdomen c. Computed tomography of abdomen d. Abdominal x-ray

b. Ultrasound of liver and abdomen Rationale: Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites.

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. Potassium d. Oral bile acids

b. Vitamin K Rationale: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a. Vomiting b. Ringing in the ears c. Watery diarrhea d. Asterixis

c. Watery diarrhea Rationale: The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a. Clay-colored stools b. Elevated urobilinogen in the urine c. Straw-colored urine d. Reduced hematocrit

a. Clay-colored stools Rationale: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? a. Hypotension b. Polyuria c. Bradycardia d. Warm moist skin

a. Hypotension Rationale: Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority? a. Ineffective breathing pattern b. Fatigue c. Excess fluid volume d. Imbalanced nutrition: less than body requirements

a. Ineffective breathing pattern Rationale: In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the respiratory rate and low oxygen saturation would indicate the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? a. Obstructive jaundice b. Hepatocellular jaundice c. Hemolytic jaundice d. Cirrhosis of the liver

a. Obstructive jaundice Rationale: Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice.

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? a. Octreotide b. Spironolactone c. Propranolol d. Lactulose

a. Octreotide Rationale: In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

A client has undergone a liver biopsy. Which postprocedure position is appropriate? a. On the right side b. High Fowler c. On the left side d. Trendelenburg

a. On the right side Rationale: In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on his left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? a. Pancakes with butter and honey, and orange juice b. Ham and cheese sandwich, baked beans, potatoes, and coffee c. Omelet with green peppers, onions, mushrooms, and cheese with milk d. Baked chicken with sweet potato french fries, cornbread, and tea

a. Pancakes with butter and honey, and orange juice Rationale: Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client's ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.

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. Reduce fluid accumulation and venous pressure. b. Promote optimal neurologic function. c. Cure the cirrhosis. d. Treat the esophageal varices.

a. Reduce fluid accumulation and venous pressure. Rationale: Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern? a. The client's hands flap back and forth when the arms are extended. b. The skin on the client's abdomen has multiple spider-shaped blood vessels. c. The client has gained 2 kg from the previous day. d. The client reports nausea and anorexia.

a. The client's hands flap back and forth when the arms are extended. Rationale: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and, if untreated, a hepatic coma may occur.

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. Folic acid deficiency d. Vitamin A deficiency

a. Vitamin K deficiency Rationale: Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? a. "You must have the second one in 2 weeks and the third in 1 month." b. "You must have the second one in 1 month and the third in 6 months." c. "You must have the second one in 6 months and the third in 1 year." d. "You must have the second one in 1 year and the third the following year."

b. "You must have the second one in 1 month and the third in 6 months." Rationale: Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? a. Weight loss of 2 pounds in 3 days b. Change in the client's handwriting and/or cognitive performance c. Constipation for more than 2 days d. Anorexia for more than 3 days

b. Change in the client's handwriting and/or cognitive performance Rationale: The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? a. Biliary colic b. Cholelithiasis c. Cholecystitis d. Hepatitis

b. Cholelithiasis Rationale: Initially, with cholelithiasis clients experience belching, nausea, and right upper quadrant discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic. The symptoms do not correlate with hepatitis.

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration? a. Liver enzyme changes b. Electrocardiogram changes c. Urinary output changes d. Electrolytes level changes

b. Electrocardiogram changes Rationale: Vasopressin (Pitressin) is administered during the management of an urgent situation with an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose clients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the client for evidence of chest pain, ECG changes, and vital sign changes. Vasopressin will does not infer with urinary output, electrolytes, or liver enzymes.

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. a. Taking the client's weight every 3 to 4 days b. Instructing the client to remove salty and salted foods from the diet c. Administering prescribed spironolactone (Aldactone) d. Mobilizing the client every 2 hours e. Assisting with placement of a transjugular intrahepatic portosystemic shunt

b. Instructing the client to remove salty and salted foods from the diet c. Administering prescribed spironolactone (Aldactone) e. Assisting with placement of a transjugular intrahepatic portosystemic shunt Rationale: The goal of treatment for the client with ascites is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all ordinary canned and frozen foods that are not specifically prepared for low-sodium diets should be avoided. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is a method of treating ascites in which a cannula is threaded into the portal vein by the transjugular route. In clients with ascites, an upright posture is associated with activation of the renin-angiotensin-aldosterone system and sympathetic nervous system. This causes reduced renal glomerular filtration and sodium excretion and a decreased response to loop diuretics. Therefore, bed rest may be a useful therapy, especially for clients whose condition is refractory to diuretics. Other measures include assessment and documentation of intake and output, abdominal girth, and daily weight to assess fluid status.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? a. Magnetic resonance imaging (MRI) b. Radioisotope liver scan c. Angiography d. Electroencephalography (EEG)

b. Radioisotope liver scan Rationale: A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction. MRI is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. EEG is used to detect abnormalities that occur with hepatic coma.

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 is relaxed and not in pain. b. The client's hepatic function is decreasing. c. The client didn't take his morning dose of lactulose (Cephulac). d. The client is avoiding the nurse.

b. The client's hepatic function is decreasing. Rationale: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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: a. elevated blood urea nitrogen and creatinine levels and hyperglycemia. b. subnormal serum glucose and elevated serum ammonia levels. c. elevated liver enzymes and low serum protein level. d. subnormal clotting factors and platelet count.

b. subnormal serum glucose and elevated serum ammonia levels. Rationale: In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. a. fluid output b. venous pressure c. blood coagulation d. fluid accumulation

b. venous pressure d. fluid accumulation Rationale: Methods of treating portal hypertension aim to reduce venous pressure and fluid accumulation.

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? a. Bilirubin b. Temperature c. Albumin d. Hemoglobin

c. Albumin Rationale: With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? a. Elevated white blood cell count b. Decreased AST levels c. Elevated alpha-fetoprotein d. Decreased alkaline phosphatase levels

c. Elevated alpha-fetoprotein Rationale: Alpha-fetoprotein, a serum protein normally produced during fetal development, is a marker that, if elevated, can induce a primary malignant liver tumor. Total bilirubin and serum enzyme levels may be elevated. White blood cell count elevation would indicate an inflammatory response.

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. Hepatitis C b. Esophageal varices c. Hepatic encephalopathy d. Portal hypertension

c. Hepatic encephalopathy Rationale: 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 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. Serum sodium level of 135 mEq/L b. Serum potassium level of 3.5 mEq/L c. Loss of 2.2 lb (1 kg) in 24 hours d. Blood pH of 7.25

c. Loss of 2.2 lb (1 kg) in 24 hours Rationale: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

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. Ask the client about food intake. b. Provide the client with nonprescription laxatives. c. Measure abdominal girth according to a set routine. d. Report the condition to the physician immediately.

c. Measure abdominal girth according to a set routine. Rationale: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? a. Beriberi b. Night blindness c. Scurvy d. Hypoprothrombinemia

c. Scurvy Rationale: Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Nitroglycerin b. Cimetidine c. Vasopressin d. Spironolactone

c. Vasopressin Rationale: Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

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. Riboflavin b. Thiamine c. Vitamin A d. Vitamin K

c. Vitamin A Rationale: Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

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. cholelithiasis. b. peptic ulcer disease. c. cirrhosis. d. appendicitis.

c. cirrhosis. Rationale: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

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. A prothrombin time b. Platelet count c. A CT scan d. A liver biopsy

d. A liver biopsy Rationale: A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? a. Diuretic therapy b. Platelet infusions c. Therapeutic paracentesis d. Albumin infusion

d. Albumin infusion Rationale: Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of postparacentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

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? a. Break down coagulation factors b. Breakdown amino acids c. Convert urea into ammonia d. Excrete bile

d. Excrete bile Rationale: 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.

Which type of jaundice is the result of increased destruction of red blood cells? a. Hepatocellular b. Nonobstructive c. Obstructive d. Hemolytic

d. Hemolytic Rationale: Hemolytic jaundice is the result of an increased destruction of red blood cells. Hepatocellular jaundice is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood. Obstructive jaundice resulting from extrahepatic obstruction may be caused by occlusion of the bile duct from a gall stone, inflammatory process, tumor, or pressure from an enlarged organ. Nonobstructive jaundice occurs with hepatitis.

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? a. Liver transplantation b. Paracentesis c. Azathioprine d. High-dose corticosteroids

d. High-dose corticosteroids Rationale: Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdrawal fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis.

Gynecomastia is a common side effect of which of the following diuretics? a. Vasopressin b. Furosemide c. Nitroglycerin (IV) d. Spironolactone

d. Spironolactone Rationale: Gynecomastia is a common side effect caused by spironolactone. Vasopressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

Which of the following is the most effective strategy to prevent hepatitis B infection? a. Avoid sharing toothbrushes b. Barrier protection during intercourse c. Covering open sores d. Vaccine

d. Vaccine Rationale: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: a. abdominal ascites. b. severe abdominal pain radiating to the shoulder. c. eructation and constipation. d. anorexia, nausea, and vomiting.

d. anorexia, nausea, and vomiting. Rationale: Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

What is the recommended dietary treatment for a client with chronic cholecystitis? a. low-residue diet b. low-protein diet c. high-fiber diet d. low-fat diet

d. low-fat diet Rationale: The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? a. bradycardia and bradypnea b. bradycardia and tachypnea c. tachycardia and bradypnea d. tachycardia and tachypnea

d. tachycardia and tachypnea Rationale: The compensatory stage is the first stage of shock. During this stage, the sympathetic nervous system (SNS) is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia, and the respiratory system, causing tachypnea. Thus, tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.