Liver Disease

The nurse is reviewing the record of a client admitted to the nursing unit and notes that the client has a history of Laënnec's cirrhosis. Which question related to the client's history would be most important to ask? 1."Do you abuse alcohol?" 2."Do you have any known cardiac disease?" 3."Does your type of employment cause you to have exposure to chemicals?" 4."Have you ever been told that you have had obstruction to your biliary ducts?"

1."Do you abuse alcohol?"

A client has just had a hemorrhoidectomy. Which nursing interventions are appropriate for this client? Select all that apply. 1.Administer stool softeners as prescribed. 2.Instruct the client to limit fluid intake to avoid urinary retention. 3.Encourage a high-fiber diet to promote bowel movements without straining. 4.Apply cold packs to the anal-rectal area over the dressing until the packing is removed. 5.Help the client to a Fowler's position to place pressure on the rectal area and decrease bleeding.

1.Administer stool softeners as prescribed. 3.Encourage a high-fiber diet to promote bowel movements without straining. 4.Apply cold packs to the anal-rectal area over the dressing until the packing is removed.

A client with viral hepatitis states, "I am so yellow." What is the most appropriate nursing action? 1.Assist the client in expressing feelings. 2.Restrict visitors until the jaundice subsides. 3.Perform most of the activities of daily living for the client. 4.Provide information to the client only when he or she requests it.

1.Assist the client in expressing feelings.

The nurse is caring for a client with a low thrombin level as a result of liver dysfunction. Based on this finding it is most important for the nurse to monitor the client for signs and symptoms of which potential complication? 1.Bleeding 2.Infection 3.Dehydration 4.Malnutrition

1.Bleeding

The nurse is caring for a client with biliary obstruction. The nurse interprets that obstruction of which passage is related to the client's condition? 1.Cystic duct 2.Liver canaliculi 3.Common bile duct 4.Right hepatic duct

1.Cystic duct

The nurse is reviewing the results of serum laboratory studies for a client admitted for suspected hepatitis. Which laboratory finding is most associated with hepatitis, requiring the nurse to contact the primary health care provider? 1.Elevated serum bilirubin level 2.Below normal hemoglobin concentration 3.Elevated blood urea nitrogen (BUN) level 4.Elevated erythrocyte sedimentation rate (ESR)

1.Elevated serum bilirubin level

A client is admitted to the hospital with acute viral hepatitis. Which sign or symptom should the nurse expect to note based on this diagnosis? 1.Fatigue 2.Pale urine 3.Weight gain 4.Spider angiomas

1.Fatigue

The nurse has been caring for a client who required a Sengstaken-Blakemore tube because other treatment measures for esophageal varices were unsuccessful. The primary health care provider (PHCP) arrives on the nursing unit and deflates the esophageal balloon. Which assessment finding by the nurse is the most important and should be reported to the PHCP immediately? 1.Hematemesis 2.Bloody diarrhea 3.Swelling of the abdomen 4.An elevated temperature and a rise in blood pressure

1.Hematemesis

The nurse is teaching the client with viral hepatitis about the stages of the disease. The nurse should explain to the client that the second stage of this disease is characterized by which specific assessment findings? Select all that apply. 1.Jaundice 2.Flu-like symptoms 3.Clay-colored stools 4.Elevated bilirubin levels 5.Dark or tea-colored urine

1.Jaundice 3.Clay-colored stools 4.Elevated bilirubin levels 5.Dark or tea-colored urine

The nurse is caring for an older client. The nurse should anticipate that medication dosages will be further adjusted if the client has dysfunction of which organ? 1.Liver 2.Stomach 3.Pancreas 4.Gallbladder

1.Liver

The nurse is caring for a client with common bile duct obstruction. The nurse should anticipate that the primary health care provider (PHCP) will prescribe which diet for this client? 1.Low fat 2.High protein 3.High carbohydrate 4. Low in water-soluble vitamins

1.Low fat

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? 1.Malaise 2.Dark stools 3.Weight gain 4.Left upper quadrant discomfor

1.Malaise

The nurse is creating a plan of care for a client with cirrhosis and ascites. Which nursing actions should be included in the care plan for this client? Select all that apply. 1.Monitor daily weight. 2.Measure abdominal girth. 3.Monitor respiratory status. 4.Place the client in a supine position. 5.Assist the client with care as needed.

1.Monitor daily weight. 2.Measure abdominal girth. 3.Monitor respiratory status. 5.Assist the client with care as needed.

A client with cirrhosis has ascites and excess fluid volume. Which assessment findings does the nurse anticipate to note as a result of increased abdominal pressure? Select all that apply. 1.Orthopnea and dyspnea 2.Petechiae and ecchymosis 3.Inguinal or umbilical hernia 4.Poor body posture and balance 5.Abdominal distention and tenderness

1.Orthopnea and dyspnea 2.Petechiae and ecchymosis 3.Inguinal or umbilical hernia 5.Abdominal distention and tenderness

The nurse is caring for a client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the bestunderstanding of the material if the client states to increase intake of which food? 1.Pork 2.Milk 3.Chicken 4.Broccoli

1.Pork

A client with cirrhosis is beginning to show signs of hepatic encephalopathy. The nurse should plan a dietary consultation to limit the amount of which ingredient in the client's diet? 1.Protein 2.Calories 3.Minerals 4.Carbohydrates

1.Protein

The primary health care provider has determined that a client has contracted hepatitis A based on flu-like symptoms and jaundice. Which statement made by the client supports this medical diagnosis? 1."I have had unprotected sex with multiple partners." 2."I ate shellfish about 2 weeks ago at a local restaurant." 3."I was an intravenous drug abuser in the past and shared needles." 4."I had a blood transfusion 30 years ago after major abdominal surgery."

2."I ate shellfish about 2 weeks ago at a local restaurant."

A sexually active young adult client has developed viral hepatitis. Which client statement indicates the need for further teaching? 1."I should avoid drinking alcohol." 2."I can go back to work right away." 3."My partner should get the vaccine." 4."A condom should be used for sexual intercourse."

2."I can go back to work right away."

A home care nurse visits a client who was recently diagnosed with cirrhosis. The nurse provides home care management instructions to the client. Which client statement indicates a need for further instruction? 1."I will obtain adequate rest." 2."I will take acetaminophen if I get a headache." 3."I should monitor my weight on a regular basis." 4."I need to include sufficient amounts of carbohydrates in my diet."

2."I will take acetaminophen if I get a headache."

The nurse who is caring for a client with a diagnosis of cirrhosis is monitoring the client for signs of portal hypertension. Which finding should the nurse interpret as a sign or symptom of portal hypertension? 1.Flat neck veins 2.Abdominal distention 3.Hemoglobin of 14.2 g/dL (142 mmol/L) 4.Platelet count of 600,000 mm3 (600 × 109/L)

2.Abdominal distention

The nurse should incorporate which in the dietary plan to ensure optimal nutrition for the client during the acute phase of hepatitis? Select all that apply. 1.Select foods high in protein content. 2.Consume multiple small meals throughout the day. 3.Select foods low in carbohydrates to prevent nausea. 4.Allow the client to select foods that are most appealing. 5.Eliminate fatty foods from the meal trays until nausea subsides. 6.Eat a nutritious dinner because it is typically the best tolerated meal of the day.

2.Consume multiple small meals throughout the day. 4.Allow the client to select foods that are most appealing. 5.Eliminate fatty foods from the meal trays until nausea subsides.

A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? 1.Select foods high in fat. 2.Increase intake of fluids, including juices. 3.Eat a good supper when anorexia is not as severe. 4.Eat less often, preferably only 3 large meals daily.

2.Increase intake of fluids, including juices.

A hospitalized client with liver disease has a dietary protein restriction. The nurse encourages intake of which source of complete proteins to maximize the availability of essential amino acids? 1.Nuts 2.Meats 3.Cereals 4.Vegetables

2.Meats

A client with viral hepatitis has no appetite, and food makes the client nauseated. Which nursing intervention is appropriate? 1.Encourage foods that are high in protein. 2.Monitor for fluid and electrolyte imbalance. 3.Explain that high-fat diets usually are better tolerated. 4.Explain that most daily calories need to be consumed in the evening hours.

2.Monitor for fluid and electrolyte imbalance.

The nurse is assessing a client with liver disease for signs and symptoms of low albumin. Which sign or symptom should the nurse expect to note? 1.Weight loss 2.Peripheral edema 3.Capillary refill of 5 seconds 4.Bleeding from previous puncture sites

2.Peripheral edema

The nurse is monitoring a client with cirrhosis of the liver for signs of hepatic encephalopathy. Which assessment finding would the nurse note as an early sign of hepatic encephalopathy? 1.Restlessness 2.Presence of asterixis 3.Complaints of fatigue 4.Decreased serum ammonia levels

2.Presence of asterixis

Lactulose is prescribed for a hospitalized client with a diagnosis of hepatic encephalopathy. Which assessment finding indicates that the client is responding to this medication therapy as anticipated? 1.Vomiting occurs. 2.The fecal pH is acidic. 3.The client experiences diarrhea. 4.The client is able to tolerate a full diet.

2.The fecal pH is acidic.

A client is experiencing blockage of the common bile duct. Which food selection made by the client indicates the need for further teaching? 1.Rice 2.Whole milk 3.Broiled fish 4.Baked chicken

2.Whole milk

A client with viral hepatitis is having difficulty coping with the disorder. Which question by the nurse is the most appropriate in identifying the client's coping problem? 1."Do you have a fever?" 2."Are you losing weight?" 3."Have you enjoyed having visitors?" 4."Do you rest sometime during the day?"

3."Have you enjoyed having visitors?"

The nurse has given instructions to a client with hepatitis about postdischarge management during convalescence. The nurse determines that further teaching is needed if the client makes which statement? 1."I need to avoid alcohol and aspirin." 2."I should eat a high-carbohydrate, low-fat diet." 3."I can resume a full activity level within 1 week." 4."I need to take the prescribed amounts of vitamin K."

3."I can resume a full activity level within 1 week."

A client with viral hepatitis is discussing with the nurse the need to avoid alcohol and states, "I'm not sure I can avoid alcohol." What is the most appropriate nursing response? 1."I don't believe that." 2."Everything will be all right." 3."I'm not sure that I understand. Would you please explain?" 4."I think you should talk more with the primary health care provider about this."

3."I'm not sure that I understand. Would you please explain?"

A client seen in the ambulatory care clinic has ascites and slight jaundice. The nurse should assess the client for a history of chronic use of which medication? 1.Ibuprofen 2.Ranitidine 3.Acetaminophen 4.Acetylsalicylic acid

3.Acetaminophen

The nurse is developing a teaching plan for a client with viral hepatitis. The nurse should plan to include which information in the teaching session? 1.The diet should be low in calories. 2.Meals should be large to conserve energy. 3.Activity should be limited to prevent fatigue. 4.Alcohol intake should be limited to 2 ounces per day.

3.Activity should be limited to prevent fatigue.

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? 1.Dorsiflex the client's foot. 2.Measure the abdominal girth. 3.Ask the client to extend the arms. 4.Instruct the client to lean forward.

3.Ask the client to extend the arms.

The nurse manager is providing an educational session to nursing staff members about the phases of viral hepatitis. The nurse manager tells the staff that which clinical manifestation(s) are primary characteristics of the preicteric phase? 1.Pruritus 2.Right upper quadrant pain 3.Fatigue, anorexia, and nausea 4.Jaundice, dark-colored urine, and clay-colored stools

3.Fatigue, anorexia, and nausea

The nurse is caring for a client with altered protein metabolism as a result of liver dysfunction. Which finding should the nurse expect to note when reviewing the client's laboratory results? 1.Increased lactase level 2.Decreased albumin level 3.Increased ammonia level 4.Decreased lactic acid level

3.Increased ammonia level

The nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which nursing action is focused on the consequence of low albumin levels? 1.Evaluating for asterixis 2.Inspecting for petechiae 3.Palpating for peripheral edema 4.Evaluating for decreased level of consciousness

3.Palpating for peripheral edema

The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client? 1.Roast pork 2.Cheese omelet 3.Pasta with sauce 4.Tuna fish sandwich

3.Pasta with sauce

A client with cirrhosis complicated by ascites is admitted to the hospital. The client reports a 10-lb weight gain over the past 1½ weeks. The client has edema of the feet and ankles, and his abdomen is distended, taut, and shiny with striae. Which client problem is most appropriate at this time? 1.Difficulty with sleeping 2.Risk for skin breakdown 3.Difficulty with breathing 4.Excessive body fluid volume

4.Excessive body fluid volume

A client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which actions should the nurse plan to promote client safety? Select all that apply. 1.Monitor serum potassium levels. 2.Weigh client daily, and monitor trends. 3.Monitor for symptoms of fluid retention. 4.Provide the client with a soft toothbrush. 5.Instruct the client to use an electric razor. 6.Monitor all secretions for frank or occult blood.

4.Provide the client with a soft toothbrush. 5.Instruct the client to use an electric razor. 6.Monitor all secretions for frank or occult blood.

The nurse assists a primary health care provider in performing a liver biopsy. After the procedure, the nurse should place the client in which position? 1.Prone 2.Supine 3.Left side 4.Right side

4.Right side