ch 38
During assessment of a recently admitted client with right-sided heart failure, the nurse notes that the liver is enlarged and verifies by palpation and percussion. A student asks the nurse to explain how the liver and heart failure are related. Which is the nurse's best response?
In right-sided heart failure, there is high pressure in the inferior vena cava that backlogs blood into the liver
The nurse is reviewing laboratory results of a client who has liver failure. Which finding would place the client at increased risk for bleeding?
Increased prothrombin time
When caring for the client with hepatic failure, the nurse recognizes that which problem places the client at increased risk for bleeding?
Increased prothrombin time
The client reports something "wrong" with his gallbladder. Which manifestation does the nurse recognize that supports the client's concern?
Intolerance to greasy food; burping
A client is prescribed erythromycin for an infection. What manifestations will the nurse recognize that indicate the onset of drug-induced cholestasis?
Jaundice and pruritus
Which client is most likely to develop hepatocellular cancer?
A client who has been diagnosed with metastatic breast cancer
Which individual likely faces the highest risk of developing chronic pancreatitis?
A woman who has 6 to 8 alcoholic beverages each evening
A decrease in the serum level of which substance is suggestive of liver injury?
Albumin
Which of these substances should the nurse teach the client with pancreatitis to absolutely avoid?
Alcohol
The nurse is teaching a group of nursing students about alcohol-induced liver disease and the cytochrome P450 system (CYP P450). Which of these is correct for the nurse to include in the lesson?
Alcohol consumption enhances susceptibility to effects of drugs and toxins.
The nurse is caring for a client with hepatic encephalopathy who is receiving neomycin. Which of these does the nurse monitor to determine if a positive outcome to the medication has resulted?
Ammonia level
The nurse is caring for a client who is concerned he may have contracted hepatitis C from a sexual partner. Which of these is it correct for the nurse to teach the client about this disease?
Antibodies may be detected in the blood in 6 to 8 weeks.
A client is admitted with late manifestations of cirrhosis. Which clinical manifestations confirm this diagnosis? Select all that apply.
Hepatomegaly felt on deep palpation GI bleeding related to esophageal varices Splenomegaly with bleeding tendencies
The nurse is caring for a client with right upper quadrant pain secondary to acute choledocholithiasis. If the common bile duct becomes obstructed, which manifestation will the nurse expect?
Hyperbilirubinemia
When caring for the client with acute pancreatitis, which alterations does the nurse recognize is consistent with the disease?
Hyperglycemia
The nurse is caring for the client with pancreatic cancer. The nurse monitors the client for which complication?
Hyperglycemia due to inability to synthesize insulin
The nurse is caring for a client with hepatic disease whose skin has a yellowish discoloration. When documenting in the medical record, which entry is accurate for this assessment finding?
Icteric skin
A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs "more fluids in my vein." The nurse responds:
"Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water."
The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points?
"Gallstones have developed, which are typically composed of cholesterol."
Antibody testing has confirmed that a client is positive for hepatitis A virus (HAV). Which statement does the nurse apply as evidence that the client understands the new diagnosis?
"I don't know why I didn't bother to get vaccinated against this."
The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family?
"Your loved one may not look ill, but the virus is present in his blood."
A 24-year-old woman undergoing a screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which treatment is most likely to be effective for her?
Corticosteroids and immunosuppressant drugs
What is considered the normal amount of serum bilirubin found in the blood?
<1.5 mg/dL
Which client on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?
A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas present
Which factor is most strongly associated with the pathogenesis of gallstone formation?
Abnormalities or stasis of bile
A client has begun to display manifestations of hepatic encephalopathy. The family is concerned and asks the nurse what caused this condition to develop. Which is the best response by the nurse?
Accumulation of ammonia in the blood
A client with multiple pain-related injuries to the back, knees, and hips is admitted with acute liver failure. Upon procuring a medication list, the nurse notes that the client is taking several over-the-counter medications that contain a preparation known to be the drug that most commonly causes liver failure. Which drug is this?
Acetaminophen
The oncology nurse is teaching a group of nursing students about risk factors for pancreatic cancer. Which factors does the nurse include in the teaching session? Select all that apply.
Age over 50 years Chronic pancreatitis Cigarette smoking
The obstetric nurse is caring for a woman in the delivery room who has tested positive for the HBsAg. Which intervention does the nurse recognize is indicated?
Vaccination of the newborn with immunoglobulin
The client has right upper quadrant pain caused by acute choledocholithiasis. The health care provider suspects the common bile duct is obstructed, based on which flowing lab value?
Bilirubin 15 mg/dL (256.56 µmol/L) (high)
A client presents with epigastric pain, a mild fever, nausea, and vomiting. His history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely?
Calculous cholecystitis
When caring for the client with pancreatic cancer, for which of these signs and symptoms does the nurse assess?
Central abdominal pain, jaundice, and weight loss
A client with a history of chronic pancreatitis asks about potential long-term complications. Which response by the nurse would be most accurate?
Clients can develop signs of diabetes and malabsorption.
A client is admitted to a nursing unit with severe edema. The nursing student caring for this client overhears the physician and a medical student talking about the client's albumin level. When discussing the flow of fluids into and out of cells, albumin plays a significant role in which pressure gradient?
Colloidal osmotic
The nurse is caring for a client with liver disease who has edema throughout the body. When reviewing the medical record, the nurse recognizes that which altered diagnostic test is consistent with development of edema?
Decreased albumin
A client who has been taking acetaminophen 1000 mg every 4 hours presents to the Urgent Care Center with increased abdominal pain, elevated ALT, AST, and bilirubin levels. The nurse suspects the client is experiencing:
Direct hepatotoxic reaction
A client newly diagnosed with pancreatic cancer is admitted to begin treatment. Which pain descriptors can be associated with adenocarcinomas of the pancreas?
Dull epigastric pain accompanied by back pain, worse when lying flat and relieved by sitting forward.
What manifestations will the nurse expect to find when assessing a client with cholestasis? Select all that apply.
Easy bruising Clay-colored stools Pruritus
Clients with chronic autoimmune hepatitis may display which clinical manifestations upon physical exam? Select all that apply.
Enlarged liver Jaundice
The nurse is caring for a client with hepatitis and jaundice. The nurse recognizes that without sufficient circulating bile salts the client will have intolerance to which ingested substance?
Fats
An ultrasound of a client with intermittent pain reveals gallbladder sludge. Which client history items are likely factors in the ultrasound result? Select all that apply.
Had lap band surgery 2 years ago and lost 100 pounds Recent pregnancy with a 6-month-old child at home Current prescription for a medicine to lower cholesterol
The nurse is caring for a client with hepatitis A who is tired of feeling ill. Which of these does the nurse convey to the client?
Hepatitis A symptoms last for 8 weeks.
When educating a client who has been experiencing some manifestations of liver disease about the lab/diagnostic procedures available, which procedure provides the most information about abdominal masses and possible staging of a liver cancer?
Laparoscopic liver biopsy
When caring for the client with portal hypertension and ascites, which dietary intervention does the nurse suggest to prevent the progression of fluid accumulation?
Limit intake of sodium.
What laboratory markers are most commonly used to diagnose acute pancreatitis?
Lipase and amylase
A nurse is reviewing laboratory results of a client with impaired liver function and anticipating which abnormal result indicating injury to liver cells?
Liver enzymes
The nurse is caring for a client with asterixis. Which assessment should the nurse make to help a diagnosis of hepatic encephalopathy?
Mental status
While teaching a family member about the development of hepatic encephalopathy, which cause is likely to be mentioned?
Neurotoxin accumulation
One of the jobs the liver performs is to export triglyceride. When the liver's capacity to export triglyceride is exceeded, excess fatty acids accumulate in the liver. To what disease do these excess fatty acids contribute?
Nonalcoholic fatty liver disease
A client has been admitted with hepatocellular jaundice as a result of taking medications. From the following list of medications in the client's home, which medications may place the client at high risk for developing hepatocellular jaundice? Select all that apply.
Oral contraceptives for birth control Anabolic steroids taken for body building Isoniazid for tuberculosis
When assessing a client with acute cholecystitis, the nurse anticipates the client's report of pain will be consistent with which description?
Pain in the right upper quadrant referred to the same shoulder
When teaching the client about the cause of acute pancreatitis, which of these points should be included in the teaching session?
Pancreatic enzymes are activated before leaving the pancreas, causing injury.
Which assessment does the nurse recognize is consistent with signs and symptoms of acute pancreatitis?
Periumbilical pain
A client's long-standing diagnosis of congenital hemolytic anemia often manifests itself with jaundice. What type of jaundice does this client most likely experience?
Prehepatic
A client in liver failure asks, "How does the liver process ammonia in healthy individuals?" Which explanation from the health care provider explains the mechanism how ammonia is removed from the blood by the liver?
Processes ammonia into urea, releasing it into the circulation
The nurse is caring for a client with viral hepatitis who has general malaise, easy fatigability, arthralgia, and anorexia. These manifestations correspond with what stage of the disease?
Prodromal period
When teaching a client about chronic pancreatitis, which of these does the nurse relate is the long term result of this condition?
Progressive destruction of the organ
A client is suspected of having the onset of alcoholic liver disease. The nurse should be assessing for which manifestation related to the necrosis of liver cells?
Rapid onset of jaundice
The nurse is performing a physical assessment of the gastrointestinal tract. In which area does the nurse place the hands for palpation of the liver?
Right upper quadrant
The nurse teaches the client that which of these contributed to the development of acute cholelithiasis?
Stasis of bile
A client is diagnosed with choledocholithiasis and acute suppurative cholangitis and is being rushed to surgery to prevent which possible complication?
The accumulation of purulent bile, which can cause sepsis.
When educating the public about hepatitis A, the nurse will stress which accurate teaching points? Select all that apply.
The onset of symptoms include high fever, malaise, abdominal pain, and jaundice. Persons working in various food industries like in a restaurant can pass on hepatitis A if they do not properly wash their hands after going to the toilet. Be careful if traveling to a foreign country since many countries do not require vaccination of their workers.
When caring for a client with primary biliary cirrhosis, which of these statements by the nurse will best teach the client about the cause of this problem?
There is autoimmune destruction of the bile ducts.
When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize that the pathogenesis begins with an inflammatory process whereby:
activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue.
The nurse is caring for a client with advanced liver disease who has ascites. Which treatment will the nurse anticipate being used for the daily management of ascites?
diuretics
A client has been diagnosed with alcohol-induced liver disease. He admits to the nurse, "I know what the lungs do, and I know what the heart does, but honestly, I have no idea what the liver does in the body." The nurse should tell the client that the liver:
metabolizes most components of food and also cleans the blood of bacteria and drugs.