Chapter 58: Care of Patients with Liver Problems

33. What test result is the tumor marker for cancers of the liver? a. Decreased alkaline phosphatase b. Increased serum ammonia c. Decreased serum total bilirubin d. Increased alpha-fetoprotein (AFP)

d. Increased alpha-fetoprotein (AFP)

20 How is neomycin sulfate (Mycifradin) used to treat patients with cirrhosis? a. It treats the current infection the patient has. b. It prevents future infections of the liver. c. It restores normal function to the liver cells. d. It decreases the rate of ammonia production

d. It decreases the rate of ammonia production

26 How many injections does a healthcare worker usually need to be protected with the hepatitis B vaccine? a. 1 b. 2 c. 3 d. 4

c. 3

43. The nurse is teaching a young woman about cirrhosis prevention by limiting alcohol intake. What is the nurse's best advice? a. "As few as two or three drinks per day over 10 years can lead to cirrhosis" b. "You should be alright as long as you drink less than five drinks per day" c. "Binge drinking, rather than drinking every day, reduces your risk for hepatitis or fatty liver" d. The amount of alcohol that causes cirrhosis does not vary by gender"

a. "As few as two or three drinks per day over 10 years can lead to cirrhosis"

6. Which key points does the nurse include when teaching the patient with cirrhosis and his family about drug therapy before discharge? Select all that apply. a. "Do not take over-the-counter medications unless approved by your healthcare provider." b. "The beta blocker called propranolol (Inderal) will cause your heart rate to increase." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or light- headedness to your health care provider right away." f. Your health care provider may prescribe a potassium supplement to replace losses

a. "Do not take over-the-counter medications unless approved by your health care provider." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or light- headedness to your health care provider right away." f. Your health care provider may prescribe a potassium supplement to replace losses

19. The nurse is teaching a patient with cirrhosis about lactulose therapy. Which statement by the patient indicates the teaching has been effective? a. "This therapy will promote the removal of ammonia in my stool." b. "Constipation is a frequent side effect of this therapy." c. "I will know the therapy is working when I am less itchy." d. "The drug tastes bitter and is watery."

a. "This therapy will promote the removal of ammonia in my stool."

18. Which statements about a patient with cirrhosis and esophageal varices are accurate? Select all that apply a. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. b. Bleeding esophageal varices are a medical emergency. c. Esophageal balloon tamponade is often used to control bleeding esophageal varices. d. A nonselective beta blocker such as propranolol (Inderal) is prescribed to prevent varices from bleeding. e. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation. f. The bleeding appears as dark coffee grounds in emesis or stool

a. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. b. Bleeding esophageal varices are a medical emergency. d. A nonselective beta blocker such as propranolol (Inderal) is prescribed to prevent varices from bleeding. e. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation.

10. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a patient with cirrhosis experiencing pruritus? a. Apply lotion to soothe the patient's skin b. Use lots of soap and hot water to cleanse the skin c. Assess the patient for signs of skin infection d. Encourage the patient to use distraction to avoid scratching

a. Apply lotion to soothe the patient's skin

14. When preparing a patient for paracentesis, what does the nurse do? Select all that apply a. Ask the patient to void before the procedure. b. Place the patient in the supine position. c. Weigh the patient before the procedure. d. Obtain the patient's heart rate. e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

a. Ask the patient to void before the procedure. c. Weigh the patient before the procedure. d. Obtain the patient's heart rate. e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

44. The nurse is providing care for a patient with cirrhosis who has massive ascites and has developed hepatopulmonary syndrome. Which elements of nursing care are appropriate for this patient? Select all that apply. a. Auscultate lungs every 4-8 hours for crackles b. Monitor the patient's oxygen saturation c. Elevate the head of the bead 15 degrees d. Apply oxygen therapy e. Weigh the patient every day f. Lower the patient's leg and feet

a. Auscultate lungs every 4-8 hours for crackles b. Monitor the patient's oxygen saturation d. Apply oxygen therapy e. Weigh the patient every day

40. The nurse is teaching a patient with cirrhosis about nutrition therapy. Which key points must the nurse include? Select all that apply. a. Do not use table salt. b. Adding salt when cooking is acceptable. c. Eat small frequent meals. d. Drink supplemental liquids such as Ensure. e. Be sure to take a multivitamin every day. f. Avoid foods that are high in Vitamin K

a. Do not use table salt. c. Eat small frequent meals. d. Drink supplemental liquids such as Ensure. e. Be sure to take a multivitamin every day.

11. Which elevated laboratory test results indicate hepatic cell destruction? Select all that apply a. Elevated serum aspartate aminotransferase(AST) b. Elevated serum alanine aminotransferase(ALT) c. Elevated lactate dehydrogenase (LDH) d. Decreased serum total bilirubin e. Increased fecal urobilinogen f. Increased International Normalized Ratio(INR)

a. Elevated serum aspartate aminotransferase(AST) b. Elevated serum alanine aminotransferase(ALT) c. Elevated lactate dehydrogenase (LDH) f. Increased International Normalized Ratio(INR)

8. The nurse is assessing a male patient with cirrhosis. Which male-specific characteristics does the nurse expect to find? Select all that apply. a. Gynecomastia b. Testicular atrophy c. Ascites d. Impotence e. Spider angiomas f. Petechiae

a. Gynecomastia b. Testicular atrophy d. Impotence

42. Which factors may lead to hepatic encephalopathy in patients with cirrhosis? Select all that apply a. High-protein diet b. Hypervolemia c. Infection d. Constipation e. Hyperkalemia f. Use of illicit drugs

a. High-protein diet c. Infection d. Constipation f. Use of illicit drugs

35. What is the priority focus in caring for a patient with advanced liver cancer? a. Hospice and end-of life care b. Getting placed on the liver transplant list c. Hepatic arterial infusion of chemotherapy d. Cryotherapy to freeze and destroy liver tumors

a. Hospice and end-of life care

28 Which laboratory test result indicates permanent immunity to hepatitis A? a. Immunoglobulin G (IgG) antibodies b. Immunoglobulin M (IgM) antibodies c. A positive enzyme-linked immunosorbent assay (ELISA) d. The presence of anti-HAV antibodies

a. Immunoglobulin G (IgG) antibodies

1. A patient with decompensated cirrhosis is at risk for which complications? Select all that apply a. Jaundice b. Esophageal varices c. Coagulation defects d. Hepatitis A virus (HAV) e. Spontaneous bacterial peritonitis f. Ascites

a. Jaundice b. Esophageal varices c. Coagulation defects e. Spontaneous bacterial peritonitis f. Ascites

29 Which antiviral drugs are given to patients with chronic hepatitis B virus? Select all that apply. a. Lamivudine b. Entecavir c. Tenofovir d. Oral ribavirin e. Adefovir f. Telaprevir

a. Lamivudine b. Entecavir c. Tenofovir e. Adefovir

39 Which patients would not be considered candidates for a liver transplant? Select all that apply. a. Patient with metastatic tumors b. Patient with type 2 diabetes c. Patient with severe respiratory disease d. Patient with chronic liver disease e. Patient with advanced cardiac disease f. Patient who is unable to follow instructions

a. Patient with metastatic tumors c. Patient with severe respiratory disease e. Patient with advanced cardiac disease f. Patient who is unable to follow instructions

24. Which people are in need of immunization against hepatitis B (HBV)? Select all that apply. a. People who have unprotected sex with more than one partner b. Men who have sex with men c. Any patient scheduled for a surgical procedure d. Firefighters e. Health care providers f. Patients prescribed immunosuppressant drugs

a. People who have unprotected sex with more than one partner b. Men who have sex with men d. Firefighters e. Health care providers f. Patients prescribed immunosuppressant drugs

23 When teaching a group of adult patients measures for preventing hepatitis A (HAV), which information does the nurse include? Select all that apply. a. Perform proper hand washing, especially after handling shellfish. b. Receive immune globulin within 14 days if exposed to the virus. c. Receive the HAV vaccine before traveling to Mexico or the Caribbean. d. After exposure, HAV symptoms always let the patient know something is wrong. e. Receive the vaccine if working in a longterm care facility f. Avoid unprotected sex with a person who has HAV.

a. Perform proper hand washing, especially after handling shellfish. b. Receive immune globulin within 14 days if exposed to the virus. c. Receive the HAV vaccine before traveling to Mexico or the Caribbean. e. Receive the vaccine if working in a longterm care facility

31. In performing an assessment on a patient with liver trauma, what does the nurse expect to find? Select all that apply. a. Right upper quadrant pain b. Increased blood pressure c. Guarding of the abdomen d. Bradypnea e. Kehr's sign f. Abdominal rigidity

a. Right upper quadrant pain c. Guarding of the abdomen e. Kehr's sign f. Abdominal rigidity

15. A patient will undergo an abdominal paracentesis. Which factor provides an additional safety measure? a. The procedure is performed using ultrasound. b. The procedure is performed at the bedside. c. A trocar is inserted into the peritoneal cavity. d. General anesthesia is administered

a. The procedure is performed using ultrasound.

4. When admitting the patient with cirrhosis, the nurse assesses for which conditions related to splenomegaly as possible complications of the disease? a. Thrombocytopenia b. Bleeding esophageal varices c. Hepatorenal syndrome d. Portal hypertensive gastropathy

a. Thrombocytopenia

16. The student nurse is caring for a patient with cirrhosis. Which action by the student nurse causes the supervising nurse to intervene? a. Uses a straight-edge razor to shave the patient b. Monitors for orthostatic changes of blood pressure c. Avoids intramuscular injections d. Uses a toothette for oral care

a. Uses a straight-edge razor to shave the patient

27. Which actions will help prevent viral hepatitis in health care workers? Select all that apply. a. Wash hands before and after each patient b. Needleless systems c. Use contact and respiratory precautions d. After exposure to hepatitis A, get immunoglobulin (Ig) e. Report all cases of hepatitis to the health department f. Wear gloves during all patient contact

a. Wash hands before and after each patient b. Needleless systems d. After exposure to hepatitis A, get immunoglobulin (Ig) e. Report all cases of hepatitis to the health department

21. The patient with liver cancer will be discharged with a tunneled ascites drain. What statements by the patient indicate an understanding of the purpose of this device? Select all that apply. a. "I will have this drain until I am able to get the tumor removed." b. "I will not remove more than 2000 mL of fluid at a time." c. "The drain will make breathing more comfortable for me after some fluid is removed." d. "After I drain off the extra fluid, I can remove the drain." e. "This drain will be useful to remove fluid from my belly when there is too much." f. "I will flush the tunneled ascites drain twice a day with normal saline."

b. "I will not remove more than 2000 mL of fluid at a time." c. "The drain will make breathing more comfortable for me after some fluid is removed." e. "This drain will be useful to remove fluid from my belly when there is too much."

13. The nurse is teaching a patient with cirrhosis about nutrition therapy. Which statement by the patient indicates teaching has been effective? a. "I will only use table salt with my dinner meal." b. "I will read the sodium content labels on all food and beverages." c. "I will avoid the use of vinegar." d. "I will not take vitamin supplements."

b. "I will read the sodium content labels on all food and beverages."

47. The nurse is caring for a patient with acute viral hepatitis. What is the major care concern at this time? a. Providing three small meals a day b. Alternating periods of activity with periods of rest c. Monitoring for the development of jaundiced skin d. Teaching the patient the importance of avoiding alcohol intake

b. Alternating periods of activity with periods of rest

45. The patient who needs a liver transplant asks the nurse where the livers come from. What is the nurse's best response? a. "Most commonly they come from family members" b. "Often they are harvested from cadavers" c. "Trauma victims are where most donor livers come from" d. "It is best if the liver comes from a blood relative"

c. "Trauma victims are where most donor livers come from"

9. Which assessment finding indicates neurologic function deterioration in a patient with stage II cirrhosis? a. Fetor hepaticus b. Asterixis c. Palmar erythema d. Icterus

b. Asterixis

30 Which conditions place a patient at high risk for the development of fatty liver (steatosis)? Select all that apply. a. Hypertension b. Diabetes mellitus c. Obesity d. Elevated lipid profile e. Alcohol abuse f. Hepatitis A

b. Diabetes mellitus c. Obesity d. Elevated lipid profile e. Alcohol abuse

7. The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? a. Elevated sodium level b. Elevated ammonia level c. Increased blood urea nitrogen (BUN) d. Increased clotting time

b. Elevated ammonia level

22. Which statements about hepatitis are accurate?Select all that apply. a. Hepatitis D is the leading cause of cirrhosis and liver failure in the U.S. b. Hepatitis A is spread through the fecal- oral route. c. Hepatitis B can be transmitted through unprotected sexual intercourse. d. Hepatitis carriers have chronic obvious signs of hepatitis B. e. Hepatitis C is transmitted by casual contact or intimate household contact. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

b. Hepatitis A is spread through the fecal- oral route. c. Hepatitis B can be transmitted through unprotected sexual intercourse. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

32. The nurse is assessing a patient with liver trauma and finds that the patient is confused with a blood pressure of 86/50 mm Hg; heart rate of 128/minute; and cool, clammy skin. What does the nurse suspect? a. Septic shock b. Liver hemorrhage c. Liver cancer d. GI bleeding

b. Liver hemorrhage

25 What is the major source of hepatitis B transmission to health care workers? a. Improper handwashing b. Needle sticks c. Touching contaminated surfaces d. Contact with infected stool

b. Needle sticks

12. A patient is scheduled for a procedure to place a stent in the biliary tract. For which procedure does the nurse provide patient teaching?a.Esophagogastroduodenoscopy (EGD) b.Endoscopic retrograde cholangiopancreatography (ERCP) c.Upper gastrointestinal (GI) series d.Cholangiogram

b.Endoscopic retrograde cholangiopancreatography (ERCP)

3. The nurse is assessing a patient with massive ascites. What related complication must the nurse monitor for with this patient? a. Bleeding due to fragile, thin-walled veins b. Hematemesis due to absence of clotting factors c. Increased ascites due to sodium and water retention d. Bruising due to low platelet count

c. Increased ascites due to sodium and water retention

37. The patient who had a liver transplant develops a heart rate of 134/minute, temperature of 102° F (38.8°C), jaundiced skin, and right upper quadrant pain. What does the nurse suspect? a. Liver infection b. Hypovolemic shock c. Liver transplant rejection d. Liver trauma from the transplant surgery

c. Liver transplant rejection

34. Which treatment offers the patient with liver cancer the possibility of long-term survival? a. Chemotherapy b. Selective internal radiation therapy c. Liver transplantation d. Hepatic arterial embolization

c. Liver transplantation

2. What is the most common cause for Laennec's cirrhosis? a. Hepatitis C virus (HPC) b. Chronic biliary obstruction c. Autoimmune disorders d. Chronic alcoholism

d. Chronic alcoholism

36. Administration of which drug has greatly improved the success of organ transplants? a. Telaprevir b. Entecavir c. Tenofovir d. Cyclosporine

d. Cyclosporine

41. The patient with cirrhosis is prescribed furosemide 60 mg orally each morning. Which patient care concept is at risk for this patient? a. Comfort b. Cellular regulation c. Immunity d. Fluid and electrolyte balance

d. Fluid and electrolyte balance

46. The patient who just had a liver transplant develops oozing around two IV sites as well as some new bruising. What is the nurse's best action? a. Apply pressure to the IV sites b. Measure the size of the bruises c. Document these findings as the only action d. Notify the surgeon immediately

d. Notify the surgeon immediately

38. Which procedure uses energy waves to heat cancer cells and kill them? a. Cryotherapy b. Selective internal radiation therapy (SIRT) c. Hepatic artery embolization d. Radiofrequency ablation (RFA)

d. Radiofrequency ablation (RFA)

17. The nurse who is assessing a patient with portal-systemic encephalopathy finds that the patient has fetor hepaticus, a positive Babinski's sign, and seizures, but no asterixis. The nurse identifies the patient as being in which stage of portal-systemic encephalopathy? a. Stage I prodromal b. Stage II impending c. Stage III stuporous d. Stage IV comatose

d. Stage IV comatose

5. Patients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver preventing the absorption of which vitamin? a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K

d. Vitamin K