Disorders of the Liver

The registered nurse is teaching a group of nursing students about hyperbilirubinemia. Which statements made by a student nurse indicates effective learning? Select all that apply. "Steatosis can cause hyperbilirubinemia." "Excessive RBC hemolysis can cause hyperbilirubinemia." "Hepatocellular injury can cause hyperbilirubinemia." "Hemochromatosis can cause hyperbilirubinemia." "Bile duct obstruction can cause hyperbilirubinemia."

"Bile duct obstruction can cause hyperbilirubinemia." "Hepatocellular injury can cause hyperbilirubinemia." "Excessive RBC hemolysis can cause hyperbilirubinemia."

After explaining about viral hepatitis to a group of nursing students, the registered nurse asks, "What are the common changes observed in this condition?" Which response made by the student nurse indicates effective learning? Select all that apply. "The liver becomes infiltrated with fibrotic tissue." "Serological tests are used to diagnose hepatitis." "Viral hepatitis causes caput medusa." "Acetaminophen use can cause viral hepatitis."

"Serological tests are used to diagnose hepatitis." "Viral hepatitis causes caput medusa."

Which of the following are liver enzymes? Select all that apply. Albumin ALT Lipase AST Bilirubin

ALT AST

Alcoholic Liver Disease AST and ALT 2-7 times higher than normal Hyperpigmentation Elevated triglycerides and cholesterol Steatosis Elevated HBsAg Portal hypertension Hepatic encephalopathy

AST and ALT 2-7 times higher than normal Elevated triglycerides and cholesterol Steatosis Portal hypertension Alcoholic liver disease develops as a result of excessive alcohol consumption. As the liver processes alcohol, excessive consumption may lead to damage to the liver cells. Liver enzymes, such as AST and ALT may elevate in the serum, indicating damage to hepatocytes. Liver processing of lipids may be impaired resulting in elevated triglycerides and cholesterol. Steatosis, the accumulation of fat in liver cells, may also occur. With severe damage, the liver is no longer able to detoxify the blood. For example, ammonia levels may increase to the point that damage to the nervous system, including the brain, results. This is known as hepatic encephalopathy.

Hepatitis A Fecal-oral transmission Anti-HAV antibodies Six different genotypes Hepatomegaly Antimicrobial antibodies (AMAs) RUQ tenderness

Anti-HAV antibodies Hepatomegaly RUQ tenderness Fecal-oral transmission Hepatitis A is a viral form of hepatitis transmitted through the fecal-oral route. It can lead to typical signs of liver problems, including enlargement of the liver and tenderness in the right upper quadrant area. Infection with hepatitis A results in the formation of anti-HAV antibodies, which can be detected with a blood test.

A patient is worried about his risk for hepatitis C and is requesting to receive the vaccine. Which of the following is the correct response by the nurse? At this time, there is no vaccine for hepatitis C. Hepatitis B and C vaccines are normally given together. Do you want both? The hepatitis C vaccine requires three doses. The hepatitis C vaccine is given a single immunization.

At this time, there is no vaccine for hepatitis C.

Which of the following may cause hyperbilirubinemia? Select all that apply. Bile duct obstruction Increased red blood cell breakdown Injury to hepatocytes Lack of albumin synthesis Lack of prothrombin synthesis

Bile duct obstruction Increased red blood cell breakdown Injury to hepatocytes

A nurse is caring for a patient diagnosed with portal hypertension. What development should the nurse be concerned about? Increased risk for esophageal varices Decreased detoxification of the blood Increased blood clotting time Decreased bile production

Increased risk for esophageal varices

A patient has been diagnosed with hepatitis B and wants to understand how he contracted the infection. Which of the following does the nurse share as a means of transmission of hepatitis B? Select all that apply. Blood-borne transmission Skin-to-skin contact Sexual activity Fecal-oral route Needle sharing with infected person

Blood-borne transmission Sexual activity Needle sharing with infected person

The physical examination findings of a patient who has liver disease show dilated veins over the umbilical area of the abdomen. What is this finding called? Caput medusa Jaundice Ascites Icterus

Caput medusa

A patient with liver cirrhosis has severe portal hypertension. Which of the following does the nurse expect to observe? Select all that apply. Grey Turner's sign Caput medusa Retroperitoneal pain Esophageal varices Splenomegaly

Caput medusa Splenomegaly Esophageal varices

A patient is suffering from liver failure. Which of the following does the nurse expect to see elevated? Select all that apply. Clotting times Plasma albumin Aspartate aminotransferase (AST) levels Risk for jaundice Total plasma bilirubin

Clotting times Aspartate aminotransferase (AST) levels Risk for jaundice

Hepatic encephalopathy may begin to develop in a patient with which of the following? Hypernatremia Elevated serum ammonia levels Hypokalemia Deficient fat-soluble vitamins

Elevated serum ammonia levels

Hemochromatosis Hereditary forms Low ceruloplasmin Elevated serum iron Increased IgM Elevated serum ferritin Primary and secondary forms Silent, gradual disease

Elevated serum iron Elevated serum ferritin High serum transferrin Hereditary forms Primary and secondary forms Hemochromatosis develops when too much iron is present in the blood. Most frequently, this is due to an inheritable genetic defect. The elevation in iron causes higher than normal ferritin and transferrin levels. Ceruloplasmin levels are related to copper levels, thus are not affected by hemochromatosis.

Crigler-Najjar Syndrome Genetic defect affecting bilirubin processing Liver scarring Steatosis RUQ tenderness Elevated unconjugated bilirubin Elevated total bilirubin Positive HCV RNA assay

Elevated unconjugated bilirubin Elevated total bilirubin Genetic defect affecting bilirubin processing Crigler-Najjar syndrome is a rare genetic disorder in which the breakdown of bilirubin is compromised. Bilirubin builds up in the body leading to elevated levels of unconjugated bilirubin. Nonhemolytic jaundice develops.

A patient has been diagnosed with hepatitis A and wants to know how he may have contracted this disease. What is the primary route of hepatitis A transmission? Blood transfusion Needle stick Sexual activity Fecal-oral

Fecal-oral

An infection of hepatitis D virus requires which of the following for replication and expression? Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis E virus

Hepatitis B virus

Which form of hepatitis is primarily transmitted through the blood, often through IV drug use? Hepatitis C Hepatitis A Hepatitis D Hepatitis B

Hepatitis C

A nurse is reviewing cases of liver cirrhosis. Which of the following risk factors concern her the most, as it is the leading cause of liver cirrhosis in the United States? Alcohol abuse Illegal drug use Hepatitis B infection Hepatitis C infection

Hepatitis C infection

Which of the following are common signs of liver disorders? Select all that apply. Hepatomegaly Jaundice Increased liver enzyme levels in blood Skin rash Fever

Hepatomegaly Jaundice Increased liver enzyme levels in blood

A patient with advanced liver failure has presented with edema. Which of the following likely played a role in this development? Excess clotting factors Decreased capillary permeability Hypoalbuminemia Hypovolemic hypernatremia

Hypoalbuminemia

Biliary Cirrhosis Elevated serum ferritin Medical emergency Increased IgM Increased ESR Xanthelasma Hepatic encephalopath Antimicrobial antibodies (AMAs)

Increased IgM Increased ESR Xanthelasma Antimicrobial antibodies (AMAs) Destruction of the bile ducts occurs in biliary cirrhosis. The primary form of biliary cirrhosis is considered an autoimmune disease. Thus, inflammatory mediators, such as ESR, and antibodies, such as IgM and AMAs, are elevated. Xanthelasma, which are yellow patches of cholesterol that develop near the eyes, may be present.

A nurse educator is outlining the progression of a hepatitis B infection. Please place the following steps in the correct order. No signs or symptoms, although virus can be passed to others Reduction in hepatitis B virus (HBV) viral load to immune response No viral levels detected, high level of HBV antibodies Inflammatory reaction of the hepatocytes Inoculation with HBV

Inoculation with HBV No signs or symptoms, although virus can be passed to others Inflammatory reaction of the hepatocytes Reduction in hepatitis B virus (HBV) viral load to immune response No viral levels detected, high level of HBV antibodies

A patient has elevated aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin levels. Which of the following does the nurse expect to observe? Red discoloration of the skin Elevated heart rate and blood pressure Jaundice Decreased urine output

Jaundice

Cirrhosis and Liver Failure Elevated triglycerides and cholesterol Liver scarring Develops from hepatitis A infection Silent, gradual disease Portal hypertension Kayser-Fleischer rings of the cornea Widespread decrease in liver function parameters

Liver scarring Silent, gradual disease Portal hypertension Widespread decrease in liver function parameters Cirrhosis is late stage fibrotic scarring of the liver. The scarring manifests as a result of damage to the liver. Liver function becomes impaired, as indicated by laboratory results. The disease is not rapid in onset and does not present with acute symptoms in the early stages. Portal hypertension often develops in response to cirrhosis, as the veins become blocked by the damaged liver. Hepatitis C, not hepatitis A, is more likely to cause cirrhosis.

Wilson's disease Masklike facies Kayser-Fleischer rings of the cornea Positive HCV RNA assay Low ceruloplasmin levels Elevated unconjugated bilirubin High urinary copper Copper accumulation

Masklike facies Kayser-Fleischer rings of the cornea Low ceruloplasmin levels High urinary copper Copper accumulation Wilson's disease is a rare genetic disorder that causes copper to accumulate in some tissues. Copper may begin to be excreted in the urine at a high level. Golden, brown discoloring of the eyes (Kayser-Fleischer rings) may be apparent and result from copper deposition. Ceruloplasmin levels are low, as copper incorporation onto this transport protein is abnormal. Neurological manifestations may develop in Wilson's disease. One such example is masklike facies, in which the facial expression is flat, almost masklike.

Which of the following statements are true? Select all that apply. Portal hypertension may lead to esophageal varices. Decreased bile production by the liver may lead to reduce absorption of water-soluble vitamins. Some forms of hepatitis may be transmitted by fecal-oral route. Decreased albumin synthesis by the liver may lead to jaundice. If the liver is unable to detoxify the blood, ammonia levels may increase.

Portal hypertension may lead to esophageal varices. Some forms of hepatitis may be transmitted by fecal-oral route. If the liver is unable to detoxify the blood, ammonia levels may increase.

Hepatitis B Positive HBcAg Positive HBc Ig High urinary copper Transmitted by fecal-oral route Range of symptoms Vaccine available Dormant subclinical infection

Positive HBcAg Positive HBc Ig Range of symptoms Vaccine available Diagnosis of hepatitis B results from positive serology results for the antigen, including HBcAg, as well hepatitis B antibodies, HBc Ig. Hepatitis B presents with a range of symptoms. It is transmitted by blood and body fluids, not the fecal-oral route. A vaccine against hepatitis B is available.

A clinician needs to determine whether a patient has hepatitis C. Which result would confirm this diagnosis? Positive HBeAg Positive HBV RNA assay Positive HAV RNA assay Positive HCV RNA assay

Positive HCV RNA assay

Hepatitis C Positive HCV RNA assay Positive HBsAg Anti-HCV antibody Genotyping should be completed Fecal-oral transmission Vaccine is available Low ceruloplasmin Dormant infection; asymptomatic initially

Positive HCV RNA assay Anti-HCV antibody Genotyping should be completed Dormant infection; asymptomatic initially Hepatitis C is sometimes referred to as a "silent infection," as few signs and symptoms may be present initially. Diagnosis is based on positive RNA assay results for the virus, as well as positive antibody results. Several genotypes exist for hepatitis C, and there is no vaccine currently available.

A patient is suspected to have a hepatitis infection. Which of the following will be most helpful for the clinician's diagnosis? Presence of jaundice Presence of hepatomegaly Serology results Elevated aspartate aminotransferase (AST) and alanine transaminase (ALT)

Serology results

A patient is suffering from severe hepatitis B infection. Which of the following are dietary recommendations the nurse will make? Select all that apply. Small, frequent meals High-fat meals Liquid-only diet High-calorie meals High-protein meals

Small, frequent meals High-calorie meals High-protein meals

A clinician is asking a patient with severe liver diseases about bruising and other signs of bleeding. Which of the following explains why the clinician is concerned? All medications for liver failure work on thinning the blood to reduce clotting. The liver synthesizes clotting factors, which may be affected by the patient's liver disease. The patient has likely developed an autoimmune response to clotting factors. Liver diseases disrupt portal circulation that may appear as bruising on the extremities.

The liver synthesizes clotting factors, which may be affected by the patient's liver disease.

Which substance is responsible for the yellow color of urine? Biliverdin Bilirubin Stercobilinogen Urobilinogen

Urobilinogen