Liver Prep U
A client was admitted for critical care due to esophageal varices and precarious physical condition. What could cause the client's varices to hemorrhage? a. All options are correct. b. little protective tissue to protect fragile veins c. rough food d. chemical irritation
a. 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.
Which of the following is the most effective strategy to prevent hepatitis B infection? a. Vaccine b. Barrier protection during intercourse c. Covering open sores d. Avoid sharing toothbrushes
a. 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.
Which of the following diagnostic studies definitely confirms the presence of ascites? a. Ultrasound of liver and abdomen b. Abdominal x-ray c. Colonoscopy d. Computed tomography of abdomen
a. 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.
In what location would the nurse palpate for the liver? a. Left lower quadrant b. Left upper quadrant c. Right lower quadrant d. Right upper quadrant
d.
When assessing a client with obstructive jaundice, which of the following stool characteristics is the client likely to report? a. Yellow-green b. Black and tarry c. Blood tinged d. Clay-colored or whitish
d. 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.
Which position should be used for a client undergoing a paracentesis? a. Upright at the edge of the bed b. Prone c. Trendelenburg d. Supine
d. The client undergoing paracentesis should be placed in a supine or lateral decubitus position per the National Center for Biotechnology Information.
The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? a. Hemolytic b. Hepatocellular c. Obstructive d. Nonobstructive
a. Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? a. Ammonia b. Calcium c. Bicarbonate d. Alcohol
a. Lactulose (Cephulac) is administered to reduce serum ammonia levels. Cephulac does not influence calcium, bicarbonate, or alcohol levels.
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a. Alterations in mood b. Agitation c. Decreased deep tendon reflexes d. Report of headache e. Insomnia
a, b, e The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The client appears confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns.
A client's physician has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply. a. Alanine aminotransferase (ALT) b. C-reactive protein (CRP) c. Gamma-glutamyl transferase (GGT) d. Aspartate aminotransferase (AST) e. B-type natriuretic peptide (BNP)
a, c, d Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.
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. a. Enlarged liver size b. Ascites c. Accelerated behaviors and mental processes d. Hemorrhoids e. Excess storage of vitamin C
a,b,d Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.
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 liver biopsy b. A CT scan c. A prothrombin time d. Platelet count
a. 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.
A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? a. Abstain from drinking alcohol. b. Use aspirin at least once a day. c. Avoid intake of sodium-rich food. d. Increase intake of potassium-rich food.
a. A soft diet and elimination of alcohol, aspirin, and other locally irritating substances minimize the risk for developing esophageal varices. Intake of sodium- or potassium-rich food has no effect on the formation of varices.
An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is: a. Acetaminophen b. Ibuprofen c. Dextromethorphan d. Benadryl
a. Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.
Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction? a. Asterixis b. Paracentesis c. Ascites d. Dialysis
a. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances
During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus? a. Following proper hand-washing techniques b. Avoiding chemicals that are toxic to the liver c. Wearing a condom during sexual contact d. Limiting alcohol intake
a. Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation. Consequently, none of the other listed preventative measures is indicated.
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications? a. metabolism of medications b. need for increased drug dosages c. need for more frequently divided doses d. medications becoming ineffective in clients with liver disease
a. Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.
Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a. Hemolytic b. Hepatocellular c. Obstructive d. Nonobstructive
a. Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive and hepatocellular jaundice are results of liver disease. Nonobstructive jaundice occurs with hepatitis.
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention c. Peripheral vascular assessment related to immobility d. Skin assessment related to increase in bile salts
a. If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.
A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client? a. "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." b. "You would not be scheduled for a transplant if there was a concern about rejection." c. "The problem of rejection is not as common in liver transplants as in other organ transplants." d. "It is easier to get a good tissue match with liver transplants than with other types of transplants."
a. Rejection is a primary concern. A transplanted liver is perceived by the immune system as a foreign antigen. This triggers an immune response, leading to the activation of T lymphocytes that attack and destroy the transplanted liver. Immunosuppressive agents are used as long-term therapy to prevent this response and rejection of the transplanted liver. These agents inhibit the activation of immunocompetent T lymphocytes to prevent the production of effector T cells. Although the 1- and 5-year survival rates have increased dramatically with the use of new immunosuppressive therapies, these advances are not without major side effects. The other statements are inaccurate or will not decrease the client's anxiety.
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's hepatic function is decreasing. b. The client didn't take his morning dose of lactulose (Cephulac). c. The client is relaxed and not in pain. d. The client is avoiding the nurse.
a. 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.
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. a. Altered nutrition, more than body requirements, related to decreased activity and bed rest b. Risk for injury related to altered clotting mechanisms c. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort d. Urinary incontinence related to general debility and muscle wasting e. Disturbed body image related to changes in appearance, sexual dysfunction, and role function
b,c,e Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased gastrointestinal motility, and anorexia. Urinary incontinence is not generally a concern with hepatic cirrhosis.
A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids? a. For 2 hours after the last dose of medication is given b. Until the gag reflex returns c. Until the patient expresses thirst d. For 6 hours after the procedure
b. After the endoscopic examination, fluids are not given until the patient's gag reflex returns.
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 potassium level of 3.5 mEq/L b. Loss of 2.2 lb (1 kg) in 24 hours c. Serum sodium level of 135 mEq/L d. Blood pH of 7.25
b. 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.
Which is the most common cause of esophageal varices? a. Jaundice b. Portal hypertension c. Ascites d. Asterixis
b. Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.
A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? a. Controlling bleeding b. Maintaining the airway c. Maintaining fluid volume d. Relieving the client's anxiety
b. Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.
Which nursing assessment is most important in a client diagnosed with ascites? a. Assessment of the oral cavity for foul-smelling breath b. Daily measurement of weight and abdominal girth c. Auscultation of abdomen d. Palpation of abdomen for a fluid shift
b. Measuring and recording of abdominal girth and body weight daily are essential to assess the progression of ascites and its response to treatment.
A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response? a. Ensure that the client's sodium intake does not exceed recommended levels. b. Report this finding to the primary provider due to the possibility of hepatic encephalopathy. c. Inform the primary provider that the client should be assessed for alcoholic hepatitis. d. Implement interventions aimed at ensuring a calm and therapeutic care environment.
b. Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the client's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the client's physiologic deterioration.
Which term describes the passage of a hollow instrument into a cavity to withdraw fluid? a. Asterixis b. Paracentesis c. Ascites d. Dialysis
b. Paracentesis may be used to withdraw fluid (ascites) if the accumulated fluid is causing cardiorespiratory compromise. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances.
The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? a. Furosemide (Lasix) b. Spironolactone (Aldactone) c. Acetazolamide (Diamox) d. Bumetanide (Bumex)
b. Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents.
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: a. spironolactone (Aldactone). b. phytonadione (Mephyton). c. furosemide (Lasix). d. warfarin (Coumadin).
b. 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. Spironolactone and furosemide are diuretics and have no effect on bleeding or clotting time. Warfarin is an anticoagulant that prolongs PT.
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. Anorexia for more than 3 days d. Constipation for more than 2 days
b. 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.
The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet? a. Peanut butter b. A pear c. Hot dog d. Sliced ham
b. The goal of treatment for the patient with ascites, a complication of cirrhosis, is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for low-sodium (2-g sodium) diets should be avoided (Dudek, 2010). Peanut butter, a hot dog, and ham are all high in sodium. A pear is not.
A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's treatment, the nurse should anticipate what intervention? a. Administration of immune globulins b. A regimen of antiviral medications c. Rest and watchful waiting d. Administration of fresh-frozen plasma (FFP)
b. There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that antiviral agents are most effective. Immune globulins and FFP are not indicated.
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Spironolactone b. Vasopressin c. Nitroglycerin d. Cimetidine
b. Vasopressin may be the initial therapy for esophageal varices because it constricts 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.
When caring for a client with cirrhosis, which symptom(s) should the nurse report immediately? a. Fatigue and weight loss b. Change in mental status c. Anorexia and dyspepsia d. Diarrhea or constipation
b. When caring for a client with cirrhosis, the nurse should report any change in mental status immediately because they indicate secondary complications. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy
c. A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan? a. Increased potassium intake b. Fluid restriction to 2 L per day c. Reduction in sodium intake d. High-protein, low-fat diet
c. Clients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no need for fluid restriction or increased protein intake.
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a. Hepatitis B is transmitted primarily by the oral-fecal route. b. Hepatitis A is frequently spread by sexual contact. c. Hepatitis C increases a person's risk for liver cancer. d. Infection with hepatitis G is similar to hepatitis A.
c. Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.
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. Hemolytic jaundice b. Hepatocellular jaundice c. Obstructive jaundice d. Cirrhosis of the liver
c. 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 patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? a. Vasopressin (Pitressin) b. Epinephrine c. Octreotide (Sandostatin) d. Glucagon
c. Octreotide (Sandostatin), a synthetic analogue of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding.
Diagnostic testing has revealed that a client's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this client's plan of care will focus on what intervention? a. Cryosurgery b. Liver transplantation c. Lobectomy d. Laser hyperthermia
c. Surgical resection is the treatment of choice when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures are not performed at the same frequency as a lobectomy. Laser hyperthermia is a nonsurgical treatment for liver cancer.
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? a. "Have you had an infection recently?" b. "Does your work expose you to chemicals?" c. "How often do you drink alcohol?" d. "What type of over-the-counter pain reliever do you use?"
c. The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? a. Hemolytic jaundice b. Hepatic insufficiency c. Bleeding esophageal varices d. Portal hypertension
c. The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension.
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine? a. The hepatitis A vaccine b. Albumin infusion c. The hepatitis A and B vaccines d. An immune globulin injection
d. For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of immune globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Albumin confers no therapeutic benefit.
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. d. cryoprecipitate and fresh frozen plasma.
d. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, these products aren't specifically used to treat hemostasis. Although platelets may be helpful, the best answer is cryoprecipitate and fresh frozen plasma.
During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in: a. Thiamine b. Vitamin C. c. Riboflavin d. Vitamin K
d. A vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.
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. Therapeutic paracentesis c. Platelet infusions d. Albumin infusion
d. 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.
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a. Colonoscopy b. Abdominal x-ray c. Cholecystectomy d. Endoscopic retrograde cholangiopancreatography (ERCP)
d. ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response? a. "You could have gotten it by using I.V. drugs." b. "You must have received an infected blood transfusion." c. "You probably got it by engaging in unprotected sex." d. "You may have eaten contaminated restaurant food."
d. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. a. fluid accumulation b. venous pressure c. blood coagulation d. fluid output
a, b Methods of treating portal hypertension aim to reduce venous pressure and fluid accumulation.
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. a. Acetaminophen b. Ketoconazole c. Valproic acid d. Diazepam e. Insulin
a, b, c Many medications (including acetaminophen, ketoconazole, and valproic acid) are responsible for hepatic dysfunction and disease. A thorough medication history should address all current and past prescription medications, over-the-counter medications, herbal remedies, and dietary supplements.
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a. "How did this happen? I've been faithful my entire marriage." b. "I'll be very careful when preparing food for my family." c. "I'll wash my hands often." d. "I'll take all my medications as ordered."
a. The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? a. Polyuria b. Bradycardia c. Hypotension d. Warm moist skin
c. Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.
Which of the following laboratory test results would the nurse associate with obstructive jaundice? a. Increased indirect bilirubin b. Decreased unconjugated bilirubin c. Decreased conjugated bilirubin d. Increased direct bilirubin
d. With obstructive jaundice, direct or conjugated bilirubin levels would be increased. Indirect or unconjugated bilirubin levels would be increased with hemolytic jaundice. Both conjugated and unconjugated bilirubin levels would be elevated with hepatocellular jaundice.
