Assessment and Management of Patients with Hepatic Disorders CIRRHORIS PREP U STUDY GUIDE
sclerotherapy
chemical injection into a varicose vein that causes inflammation and formation of fibrous tissue, which closes the vein
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
cirrhosis
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.
Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Disturbed body image related to changes in appearance, sexual dysfunction, and role function
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?
Elevated alpha-fetoprotein
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?
Electrocardiogram changes
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?
"You must have the second one in 1 month and the third in 6 months."
A client with esophageal varices is scheduled to undergo injection sclerotherapy. Which of the following client statements indicates that the teaching was successful?
"I might need to have this procedure done again."
acute cholecystitis
inflammation of the gallbladder
Hepatocellular jaundice
is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood.
What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply.
increased abdominal girth rapid weight gain visible distended veins stretch marks
Postnecrotic cirrhosis results from
destruction of liver cells secondary to infection (e.g., hepatitis), metabolic liver disease, or exposure to hepatotoxins or industrial chemicals.
A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching?
The amount of protein is not restricted in the diet.
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
"You may have eaten contaminated restaurant food."
A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume?
100 to 126 grams
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?
Albumin
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?
Albumin
A patient is suspected to have pancreatic carcinoma and is having diagnostic testing to determine insulin deficiency. What would the nurse determine is an indicator for insulin deficiency in this patient? (Select all that apply).
An abnormal glucose tolerance Glucosuria Hyperglycemia
Octreotide (Sandostatin)
Antidiarrheal
The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem?
Arrange for a low air loss bed.
Which of the following laboratory test results would the nurse associate with obstructive jaundice?
Increased direct bilirubin
A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?
Cholelithiasis
biliary cirrhosis
Cirrhosis develops from chronic biliary obstruction, bile stasis, and inflammation, resulting in severe obstructive jaundice.scarring occurs in the liver around the bile ducts
postnecrotic cirrhosis
Cirrhosis occurs after massive liver necrosis. Cirrhosis results as a complication of hepatitis or exposure to hepatotoxins. Scar tissue causes destruction of liver lobules and entire lobes.there are broad bands of scar tissue, which are a late result of a previous acute viral hepatitis
posticteric phase
Liver function tests returning to normal would be noted
A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position?
On the right side
A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply.
Enlarged liver size Ascites Hemorrhoids
A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?
Excrete bile
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral
Which type of deficiency results in macrocytic anemia?
Folic acid
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply
Glucose metabolism Ammonia conversion Protein metabolism
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply.
Glucose metabolism Ammonia conversion Protein metabolism
The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?
Hemolytic
Which type of jaundice is the result of increased destruction of red blood cells?
Hemolytic
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?
Hypotension
The nurse is caring for a client with chronic pancreatitis. Which symptom would indicate the client has developed secondary diabetes?
Increased appetite and thirst
A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply
Infection at school Suboptimal sanitary habits Consumption of sewage-contaminated water or shellfish Sexual activity
icteric phase
Jaundice and clay-colored stools
A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply.
Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?
Irritability and drowsiness
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?
Maintaining the airway
A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome?
Minimizing social isolation
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?
Octreotide
Which of the following the are early manifestations of liver cancer? Select all that apply.
Pain Continuous aching in the back
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?
Pancakes with butter and honey, and orange juice
The nurse is caring for a client with acute pancreatitis who is admitted to the intensive care unit to monitor for pulmonary complications. What is the nurse's understanding of the pathophysiology of pulmonary complications related to pancreatitis?
Pancreatitis can elevate the diaphragm and alter the breathing pattern
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect?
Peritonitis from bleeding in the liver caused by the liver biopsy
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?
Radioisotope liver scan
The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase?
Rash
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
Reduce fluid accumulation and venous pressure.
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.
Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Disturbed body image related to changes in appearance, sexual dysfunction, and role
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone
A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?
Stage 2
A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?
Tacrolimus
In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection.
Tacrolimus and cyclosporine are two immunosuppressants that may be used.
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?
The client's hepatic function is decreasing
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:
The digestion of dietary and blood proteins.
A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?
The physician will use an ultrasound guided paracentesis
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy?
Upright
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin
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:
Vitamin K
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:
acute cholecystitis
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 client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:
anorexia, nausea, and vomiting.
HBV can be found
in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin
Cholecystitis
inflammation of the gallbladder
A client with a lengthy history of alcohol addiction is being seen for jaundice. What does the appearance of jaundice most likely indicate?
liver disorder
A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to:
low platelet count.
What is the recommended dietary treatment for a client with chronic cholecystitis?
low-fat diet
The mode of transmission of hepatitis A virus (HAV)
occurs through fecal-oral route primarily through person to person contact and/or ingestion of fecal contaminated food or water
Nonobstructive jaundice
occurs with hepatitis.
Lactulose
osmotic laxative
Most of the liver's metabolic functions are performed by:
parenchymal cells.
A client who has worked for a company that produces paint and varnishing compounds for 24 years is visiting the clinic reporting chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of the skin and sclera. The client reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis is the likely cause of the client's symptoms?
postnecrotic
Hepatitis B virus (HBV) is transmitted
primarily through 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.
A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is:
subnormal serum glucose and elevated serum ammonia levels.
esophageal varices
swollen, varicose veins at the lower end of the esophagus
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?
tachycardia and tachypnea
compensated cirrhosis
the liver has significant scarring but performs essential functions without causing significant symptoms.is a general term given to the state of liver disease in which the liver continues to be able to function effectively.
prodromal or preicteric phase
urticaria; nausea; vomiting; anorexia; fever; malaise; arthralgia; headache; right upper quadrant (RUQ) discomfort; enlargement of the spleen, liver, and lymph nodes; weight loss; and rash.
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?
Abstain from drinking alcohol.
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.
Acetaminophen Ketoconazole Valproic acid
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?
Albumin infusion
A nurse is teaching a client about the types of chronic liver disease. The teaching is determined to be effective when the client correctly identifies which type of cirrhosis as being caused by scar tissue surrounding portal areas?
Alcoholic cirrhosis
The single modality of pharmacologic therapy for chronic type B viral hepatitis is:
Alpha-interferon
he single modality of pharmacologic therapy for chronic type B viral hepatitis is
Alpha-interferon
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.
Alterations in mood Agitation Insomnia
A client with a history of IV drug use is being treated for hepatitis, and presents today with jaundice and arthralgias. This client most likely has hepatitis:
B.
When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following?
Caput medusae
Which nursing assessment is most important in a client diagnosed with ascites?
Daily measurement of weight and abdominal girth
Which is an age-related change of the hepatobiliary system?
Decreased blood flow
When caring for the patient with acute pancreatitis, the nurse must consider pain relief measures. What nursing interventions could the nurse provide? (Select all that apply.)
Encouraging bed rest to decrease the metabolic rate Withholding oral feedings to limit the release of secretin Administering parenteral opioid analgesics as ordered
Mode of transmission for hepatitis C
is similar to HBV, although less severe and without jaundice
Mode of transmission for hepatitis A
is the oral route from feces and saliva of infected persons
Hemolytic jaundice
is the result of an increased destruction of red blood cells
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?
vitamin k
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?
High-dose corticosteroids
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?
Transjugular intrahepatic portosystemic shunting (TIPS)
hepatitis B. Mode of transmission
is from infected blood or plasma, needles, syringes, surgical or dental equipment contaminated with infected blood; also sexually transmitted through vaginal secretions and semen of carriers or those actively infected.
Transjugular intrahepatic portosystemic shunting (TIPS)
is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy
A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:
level of consciousness (LOC).
acute cholecystitis SIGNS AND SYMPTOMS
1. Abdominal pain: sudden onset of intense, RIGHT UPPER QUADRANT-- radiates to back or shoulder 2. Positive MURPHY'S SIGN-- tenderness on palpating RUQ 3. Classic presentation is "biliary colic" a pain that starts out from mild steadily increasing intensity 4. Recurrent attacks following meals (fatty) from 1-6 hours later (when we need more bile to emulsify fats) 5. Clinical findings only present during acute attack very sick with fever, vomiting, tenderness over the liver, and severe pain called biliary colic
Ursodeoxycholic acid (UDCA) has been used to dissolve small, radiolucent gallstones. Which duration of therapy is required to dissolve the stones?
6 to 12 months
Inflammation is confined to only the pancreas."
A nurse cares for a client with interstitial pancreatitis. What client teaching will the nurse include when planning care for the client?
The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?
The client's hands flap back and forth when the arms are extended.
A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply.
There is a 70% chance that jaundice will occur. Transmission of the virus is possible with oral-anal contact during sex. Typically there is a spontaneous recovery.
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:
cryoprecipitate and fresh frozen plasma
Cholecystitis S/S
colicky pain localizing in the upper right quadrant radiating to the right lower scapular region, nausea, vomiting, fever, juandice, clay colored stools, dark urine, pruritis
A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
wash her hands after touching the client.
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?
Hepatic encephalopathy
A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when the client will be able to resume normal activities. What information should the nurse provide?
Normal activities may be resumed in 1 week.
