Liver ( I hardly knew her) -ATI

5. A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

ANS: D Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.

4. In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? * Increased blood pressure, increased respiratory rate * Decreased blood pressure, increased heart rate * Increased respiratory rate, increased apical pulse, pallor * Tachypnea, diaphoresis, increased blood pressure

* Decreased blood pressure, increased heart rate Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the client's part. Awarded 0.0 points out of 1.0 possible points.

A nurse on a medical‑surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A.Initiate contact precautions. B.Weigh the client weekly. C.Measure abdominal girth 7.5 cm (3 in) above the umbilicus. D.Provide a high‑calorie, high‑carbohydrate diet.

A. Hepatitis B is transmitted via blood. Standard precautions are adequate. B. Daily weights are obtained to monitor fluid status. C. The client's abdominal girth is measured over the largest part of the abdomen, which will vary by client. D. CORRECT The client who has hepatitis B should have a diet high in calories and carbohydrates.

The nurse is providing teaching for a client scheduled for a paracentesis. Which statement by the client indicates the teaching has been successful? A. "I must not use the bathroom prior to the procedure." B. "I will lie on my stomach while the procedure is performed." C. "I will not be allowed to eat or drink anything the night before surgery." D. "The physician will likely remove 2 to 3 liters of fluid from my abdomen."

Answer: D Rationale: The client should void before the procedure to prevent injury to the bladder. The client will lie in bed with the head of the bed elevated during the procedure.

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? (Select all that apply.) A.Anorexia B.Change in orientation C.Asterixis D.Ascites E.Fetor hepaticus

A. Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. B. CORRECT A change in orientation indicates hepatic encephalopathy in a client who has advanced cirrhosis. C. CORRECT: Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy. D. Ascites can be present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. E. CORRECT: Fetor hepaticus, a fruity breath odor, is a finding of hepatic encephalopathy in the client who has advanced cirrhosis

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.) A.Diuretic B.Beta‑blocking agent C. Opioid analgesic D. Lactulose E.Sedative

A. CORRECT Diuretics facilitate excretion of excess fluid from the body in a client who has cirrhosis. B. CORRECT Beta‑blocking agents are prescribed for a client who has cirrhosis to prevent bleeding from varices. C. Opioid analgesics are metabolized in the liver. They should not be administered to a client who has cirrhosis. D. CORRECT Lactulose is prescribed for a client who has cirrhosis to aid in the elimination of ammonia in the stool. E. Sedatives are metabolized in the liver. They should not be administered to a client who has cirrhosis

18. A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous.

ANS: C Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the clients concerns by brushing off the clients comment. Attending AA may be appropriate, but this response doesnt address the clients concern. Making peace with the clients family may not be possible. This statement is not client-centered.

11. After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

9) The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A) Client with hepatitis A reporting severe and ongoing itching B) Client with severe ascites who has a temperature of 101.4° F (38° C) C) Client with cirrhosis who has had a 3-pound weight gain over 2 days D) Client with esophageal varices and mild right upper quadrant pain

B) Client with severe ascites who has a temperature of 101.4° F (38° C) Correct The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should call this client first. Itching is anticipated with jaundice, this client may be called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis may cause mild right upper quadrant pain; this client should be called after the client with severe ascites.

2. Which problem for a client with cirrhosis takes priority? A) Insufficient knowledge related to the prognosis of the disease process B) Discomfort related to the progression of the disease process C) Potential for injury related to hemorrhage D) Inadequate nutrition related to an inability to tolerate usual dietary intake

C) Potential for injury related to hemorrhage Correct Potential for injury related to hemorrhage is the priority client problem because this complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate nutrition are not priorities because these issues are not immediately life-threatening.

7. When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A Kidney failure B Refractory ascites C Fetor hepaticus D Paracentesis scheduled for today

Kidney failure Correct The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis, but may take neomycin when the procedure is complete, or with less than 30 mL of water, depending on hospital policy.

6.When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A- Vitamin K-containing products B- Potassium-sparing diuretics C- Non-absorbable antibiotics D- Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) Correct Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Non-absorbable antibiotics are used to decrease ammonia levels.

5. The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? * Provides enzymes necessary to digest dairy products * Reduces portal pressure * Promotes gastrointestinal (GI) excretion of ammonia * Decreases GI bleeding

Promotes gastrointestinal (GI) excretion of ammonia Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding. Awarded 0.0 points out of 1.0 possible points.

9. A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

3. A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg

ANS: A Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

10. A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication.

ANS: A Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.

15. After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

6. A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.

ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

2. A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful

1. A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling.

ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

19. A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here.

ANS: B Although family members may be afraid that they will contract hepatitis C, the nurse should educate the clients family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the clients status with the brother.

14. A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better.

ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

17. A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

12. An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

8. After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

6. An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

ANS: B, D Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion.

2. A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

13. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer.

4. A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

Which intervention will the nurse include in the plan of care for a client with severe liver disease? A. Encourage the client to eat a low-protein, high-carbohydrate diet. B. Administer Kayexalate enemas. C. Encourage the client to eat a high-protein, low-carbohydrate diet. D. Participate in frequent, vigorous physical activities.

Answer: A Rationale: The client with severe liver disease should eat a diet high in carbohydrates and calories with moderate amounts of fat and protein. Kayexalate enemas and frequent, vigorous physical activities should be avoided.

p. 1196, Physiological Integrity A client previously diagnosed with liver cirrhosis visits the medical clinic. What assessment findings does the nurse expect in this client? Select all that apply. A. Ecchymosis B. Soft abdomen C. Moist, clammy skin D. Jaundice E. Ankle edema F. Fever

Answer: A, D, E Rationale: Clients with advanced cirrhosis often have symptoms such as gastrointestinal (GI) bleeding, jaundice, ascites, and spontaneous bruising. They may also have dry skin, rashes, purpuric lesions (e.g., petechiae), warm and bright red palms of the hands, vascular lesions (spider angiomas), and peripheral dependent edema of the extremities and sacrum.

A nurse is caring for a client who has hepatitis C and will undergo a liver biopsy. DESCRIPTION OF PROCEDURE: NURSING INTERVENTIONS (PRE, INTRA, POST): POTENTIAL COMPLICATIONS: Identify one potential complication of the procedure.

DESCRIPTION OF PROCEDURE: A liver biopsy is a procedure to collect a sample of liver tissue for diagnostic testing. A needle is inserted in the intercostal space between the two right lower ribs and into the liver. An aspirate of liver tissue is then collected. NURSING ACTIONS (PRE, INTRA, POST) Preprocedure Explain the procedure to the client/family. Wittess informed consent. Ensure the client has been fasting since midnight. Administer medication as prescribed. Intraprocedure Assist the client into the supine position with the upper right quadrant of the abdomen exposed. Assist the client with relaxation techniques. Instruct the client to exhale and hold for at least 10 seconds while the needle is inserted. Instruct the client to resume breathing once the needle is withdrawn. Apply pressure to the puncture site. Postprocedure Assist the client to a right side‑lying position and maintain for several hours. Monitor vital signs. Assess for abdominal pain. Assess for bleeding from puncture site. POTENTIAL COMPLICATIONS Bleeding Bile peritonitis Pneumothorax

p. 1207, Patient-Centered Care; Safety You are a nurse working in the emergency department (ED) of the local community hospital. You receive report from the night nurse regarding a 50-year-old man that has just returned to the United States from a month-long trip to the southern parts of Africa. For the past 2 weeks, he has been experiencing fevers on and off, malaise, anorexia, and mild abdominal discomfort. He has been taking acetaminophen (Tylenol) for fevers and abdominal discomfort. His past medical history is significant for elevated cholesterol for which he takes atorvastatin (Lipitor) every day. While reviewing his social history, you note that the patient reported that he is a nonsmoker, drinks 6 or 7 alcoholic drinks daily, is married, and has three children. He had his gallbladder removed when he was 43 years old. His current vital signs are blood pressure 126/82 mm Hg; heart rate 100 beats/min; respirations 22 breaths/min; temperature 101.0° F orally; pulse oximetry reading 98% on room air. The ED physician orders the following: Diet: nothing by mouth Labs: complete blood count and chemistry panel, urinalysis, blood cultures STAT electrocardiogram (ECG) and chest x-ray Start: 0.9% normal saline intravenously to run at 100 mL/hr The results of his recent laboratory work are: Lab Result Normal Range White blood cells 13,000 mm3 (4,000-12,000/mm3) Red blood cells 7.0 million/mm3 (3.5-5.5 million/mm3) Hemoglobin 18 g/dL (12-16 g/dL) Hematocrit 52% (36-46%) Sodium 135 mEq/L (135-145 mEq/L) Potassium 3.5 mEq/L (3.5-4.5 mEq/L) Magnesium 1.5 mEq/L (1.5-2.5 mEq/L) Serum aspartate aminotransferase (AST) 780 IU/L (10-34 IU/L) Serum alanine aminotransferase (ALT) 922 IU/L (10-40 IU/L) Blood urea nitrogen (BUN) 30 mg/dL (8-24 mg/dL) Creatinine 2.0 mg/dL 0.6-1.1 mg/dL Urinalysis Negative for blood, protein, glucose Blood culture Negative for any bacterial growth Electrocardiogram (ECG) Sinus tachycardia Chest x-ray Lung fields without any noted infiltrates or masses 1. In reviewing Mr. Goldman's laboratory values, which findings indicate abnormal liver function? 2. While reviewing Mr. Goldman's medical history, what information most likely increases his risk for abnormal liver function? 3. With further medical workup in the ED, the physician determines that Mr. Goldman is suffering from acute hepatitis A. The patient asks you how he contracted the virus. What is your best response? 4. You are educating the patient's family about receiving vaccinations against hepatitis. What information will you provide to promote their safety?

1. In reviewing the patient's laboratory values, which findings indicate abnormal liver function? Serum levels of AST and ALT indicate abnormal liver function. These are elevated because these enzymes are released into the blood during hepatic inflammation. 2. While reviewing the patient's medical history, what information most likely increases his risk for abnormal liver function? Drinking 6 to 7 alcoholic drinks per day increases the patient's risk for abnormal liver function. Certain types of hepatitis have been associated with international travel. 3. With further medical work-up in the emergency department, the physician determines that the patient has acute hepatitis A infection (HAV). The patient asks you how he contracted HAV. What is your best response? HAV is spread most often by the fecal-oral route by fecal contamination either from person-to-person contact (e.g., oral-anal sexual activity) or by consuming contaminated food or water. Common sources of infection include shellfish caught in contaminated water and food contaminated by food handlers infected with HAV. You can teach Mr. Goldman that he likely contracted the HAV during his recent trip to Africa. 4. You are educating the patient's family about receiving vaccinations against hepatitis. What information will you provide to promote their safety? Teach the patient and family that several HAV vaccines are available (e.g., Havrix and Vaqta). Both of these vaccines are made of inactivated HAV and are given in the deltoid muscle. They should receive the HAV vaccine before traveling to areas where the disease is common (e.g., Mexico, Caribbean) or if living or working in enclosed areas with others, such as college dormitories, correctional institutions, daycare centers, and long-term care facilities.

A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Limit physical activity B. Avoid alcohol. C. Take acetaminophen for comfort. D. Wear a mask when in public places. E. Eat small frequent meals

A. CORRECT Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B. B. CORRECT Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B. C. Acetaminophen is metabolized in the liver and should be avoided by the client who has hepatitis B. D. Hepatitis B is a blood‑borne disease. Wearing a mask is not necessary to prevent transmission to others. E. CORRECT The client who has hepatitis B should eat small frequent meals to promote improved nutrition due to the presence of anorexia.

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect? A. Presence of immunoglobulin G antibodies (IgG) B. Presence of enzyme immunoassay (EIA) C. Aspartate aminotransferase (AST) 35 units/L D.Alanine aminotransferase (ALT) 15 IU/L

A. The presence of IgG is an expected laboratory finding in a client who has hepatitis A infection. B. CORRECT: The presence of EIA is an expected laboratory finding in a client who has a new diagnosis of hepatitis C. C. AST is elevated in clients who have hepatitis C infection; 35 units/L is within the expected reference range. D. ALT is elevated in clients who have hepatitis C infection; 15 units/L is within the expected reference range

5. A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

ANS: A, C, D Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the clients stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

3. A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps.

ANS: A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the clients nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

MULTIPLE RESPONSE 1. An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

3. How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? * Provides small frequent meals for the client * Suggests taking daily potassium supplements * Elevates the head of the bed in high-Fowler's position * Requests a bedside commode for the client

Requests a bedside commode for the client Lactulose therapy increases the frequency of stools, so a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet. Small frequent meals and elevating the head of the bed will not have any effect on the side effects of lactulose. Although lactulose produces excessive stools and could potentially result in loss of potassium, it is inappropriate for the nurse to suggest that the client take potassium supplements. Awarded 0.0 points out of 1.0 possible points.

A 60-year-old man is admitted to the emergency department (ED) with a report of vomiting bright red blood. He has had liver cirrhosis for the past 10 years and states that he has been drinking heavily since his wife died last year. His blood pressure is 106/68, and his pulse rate is 94. His abdomen is distended, and he is having some difficulty breathing; his respirations are 34 per minute. You are assigned to care for this patient. 1. What complications is this patient at risk for and why? What causes these complications? 2. What position will you place the patient in and why? What evidence supports your answer? Why do you think he has tachypnea? 3. The physician suspects that he has bleeding gastroesophageal varices. What laboratory tests will he likely request and why? 4. Vasopressin is prescribed for the patient, and several large-bore IV lines are started. What is the purpose of this drug for this patient? 5. How will you know if the drug was effective? 6. If the drug is not effective in treating the patient, what other options are available for his management?

1. What complications is this patient at risk for and why? What causes these complications? Because of his heavy drinking, this patient is at risk for bleeding esophageal varices. Variceal bleeding can occur spontaneously with no precipitating factors. However, any activity that increases abdominal pressure may increase the likelihood of a variceal bleed, including heavy lifting or vigorous physical exercise. In addition, chest trauma or dry, hard food in the esophagus can cause bleeding. 2. What position will you place the patient in and why? What evidence supports your answer? Why do you think he has tachypnea? Raise the head of the bed to high-Fowler's position to protect the patient's airway. Evidence can be found in credible databases such as CINAHL. He has tachypnea as a result of hemorrhage, which may be exacerbated by anxiety. 3. The physician suspects that he has bleeding gastroesophageal varices. What laboratory tests will he likely request and why? The physician will likely request red blood cell (RBC), hemoglobin, and hematocrit tests, and prothrombin time/international normalized ratio (PT/INR). Anemia may be reflected by decreased RBC, hemoglobin, and hematocrit values. PT/INR is prolonged because the liver decreases the production of prothrombin. The platelet count is low, resulting in a characteristic thrombocytopenia of cirrhosis. 4. Vasopressin is prescribed for the patient, and several large-bore intravenous (IV) lines are started. What is the purpose of this drug for this patient? Vasopressin is a vasoactive drug that will reduce blood flow through vasoconstriction to decrease portal pressure. 5. How will you know if the drug was effective? The patient's blood pressure should increase, and his respiratory rate should decrease. 6. If the drug is not effective in treating the patient, what other options are available for his management? Octreotide acetate (Sandostatin) may be used, as it suppresses secretion of gastrin, serotonin, and intestinal peptides which decreases GI blood flow to help with pressure reduction within the varices.

16. A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic.

ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.

7. A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory.

ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

4. A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

1) Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A) "Cirrhosis is a chronic disease that has scarred my liver." B) "The scars on my liver create problems with blood circulation." C) "Because of the scars on my liver, blood clotting and blood pressure are affected." D) "My liver is scarred, but the cells can regenerate themselves and repair the damage."

D) "My liver is scarred, but the cells can regenerate themselves and repair the damage." Correct Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent scars form in response to attempts by the cells to regenerate and create problems in blood circulation moving through the liver. Liver scarring will create problems with blood clotting, cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.