Prep-U Assessment and Management of Patients with Hepatic Disorders chapter 43

4

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? 1. Creatinine 2. Urobilinogen 3. Chloride 4. Albumin

3

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? 1. Straw-colored urine 2. Reduced hematocrit 3. Clay-colored stools 4. Elevated urobilinogen in the urine

1

Which of the following diagnostic studies definitely confirms the presence of ascites? 1. Ultrasound of liver and abdomen 2. Abdominal x-ray 3. Colonoscopy 4. Computed tomography of abdomen

Portal hypertension

______ is a result of obstructed blood flow through the liver and results in ascites and esophageal varices.

1, 2, 3

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. 1. Jaundice 2. Petechiae 3. Ecchymoses 4. Cyanosis of the lips 5. Aphthous stomatitis

2

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? 1. "You must have the second one in 2 weeks and the third in 1 month." 2. "You must have the second one in 1 month and the third in 6 months." 3. "You must have the second one in 6 months and the third in 1 year." 4. "You must have the second one in 1 year and the third the following year."

1

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? 1. Hemolytic 2. Hepatocellular 3. Obstructive 4. Nonobstructive

1

A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? 1. Document the presence of normal bile output. 2. Irrigate the drainage system with normal saline as prescribed. 3. Aspirate a sample of the drainage for culture. 4. Promptly report this assessment finding to the primary provider.

1

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? 1. Hepatic encephalopathy 2. Portal hypertension 3. Asterixis 4. Cirrhosis

4

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: 1. severe abdominal pain radiating to the shoulder. 2. eructation and constipation. 3. abdominal ascites. 4. anorexia, nausea, and vomiting.

1

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? 1. A liver biopsy 2. A CT scan 3. A prothrombin time 4. Platelet count

1

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? 1. The client's hepatic function is decreasing. 2. The client didn't take his morning dose of lactulose (Cephulac). 3. The client is relaxed and not in pain. 4. The client is avoiding the nurse.

4

The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones? 1. Colonoscopy 2. Abdominal x-ray 3. Cholecystectomy 4. Endoscopic retrograde cholangiopancreatography (ERCP)

3

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? 1. Acetazolamide (Diamox) 2. Furosemide (Lasix) 3. Spironolactone (Aldactone) 4. Bumetanide (Bumex)

4

Which is an age-related change of the hepatobiliary system? 1. Decreased prevalence of gallstones 2. Increased drug clearance capability 3. Enlarged liver 4. Decreased blood flow

2

Which nursing assessment is most important in a client diagnosed with ascites? 1. Assessment of the oral cavity for foul-smelling breath 2. Daily measurement of weight and abdominal girth 3. Auscultation of abdomen 4. Palpation of abdomen for a fluid shift

1

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? 1. Reduce fluid accumulation and venous pressure. 2. Promote optimal neurologic function. 3. Cure the cirrhosis. 4. Treat the esophageal varices.

4

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? 1. Controlling bleeding 2. Relieving the client's anxiety 3. Maintaining fluid volume 4. Maintaining the airway

bilirubin

Hepatocellular jaundice is caused by the inability of damaged liver cells to clear normal amounts of _____ from the blood.

1, 2

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. 1. fluid accumulation 2. venous pressure 3. blood coagulation 4. fluid output

1.

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? 1. Transjugular intrahepatic portosystemic shunting (TIPS) 2. Vasopressin (Pitressin) 3. Sclerotherapy 4. Balloon tamponade

1

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? 1. Vitamin K deficiency 2. Vitamin A deficiency 3. Folic acid deficiency 4. Riboflavin deficiency

2

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? 1. Serum potassium level of 3.5 mEq/L 2. Loss of 2.2 lb (1 kg) in 24 hours 3. Serum sodium level of 135 mEq/L 4. Blood pH of 7.25

3

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? 1. Polyuria 2. Bradycardia 3. Hypotension 4. Warm moist skin

True

Lobectomy is the treatment of choice for hepatocellular carcinoma if it is confined to one lobe and liver function is adequate. True or Fasle

True

When fluid accumulates in the peritoneal cavity, the presence and extent of ascites are assessed by percussing the abdomen. True or False

2

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? 1. Report the condition to the physician immediately. 2. Measure abdominal girth according to a set routine. 3. Provide the client with nonprescription laxatives. 4. Ask the client about food intake.

1

Which condition indicates an overdose of lactulose? 1. Watery diarrhea 2. Constipation 3. Hypoactive bowel sounds 4. Fecal impaction

1

Which type of deficiency results in macrocytic anemia? 1. Folic acid 2. Vitamin C 3. Vitamin A 4. Vitamin K

2

hen performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? 1. Report the condition to the physician immediately. 2. Measure abdominal girth according to a set routine. 3. Provide the client with nonprescription laxatives. 4. Ask the client about food intake.

2

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: 1. elevated liver enzymes and low serum protein level. 2. subnormal serum glucose and elevated serum ammonia levels. 3. subnormal clotting factors and platelet count. 4. elevated blood urea nitrogen and creatinine levels and hyperglycemia.

4

In what location would the nurse palpate for the liver? 1. Left lower quadrant 2. Left upper quadrant 3. Right lower quadrant 4. Right upper quadrant

True

Primary liver tumors usually are associated with chronic liver disease, hepatitis B and C infections, and cirrhosis. True or False

3

The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority? 1. Fatigue 2. Excess fluid volume 3. Ineffective breathing pattern 4. Imbalanced nutrition: less than body requirements

False

The hepatitis A virus is transmitted primarily parenterally through percutaneous and permucosal routes. True or False

4

The mode of transmission of hepatitis A virus (HAV) includes which of the following? 1. Semen 2. Blood 3. Saliva 4. Fecal-oral

True

The most significant source of bleeding in a patient with cirrhosis is esophageal varices. True or False

3

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? 1. Spironolactone 2. Cholestyramine 3. Lactulose 4. Kanamycin

2

The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed? 1. Thoracentesis 2. Abdominal paracentesis 3. Abdominal CT scan 4. Upper endoscopy

1

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? 1. Hepatic encephalopathy 2. Esophageal varices 3. Hepatitis C 4. Portal hypertension

2

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? 1. Elevated white blood cell count 2. Elevated alpha-fetoprotein 3. Decreased AST levels 4. Decreased alkaline phosphatase levels

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? 1. Ursodiol 2. Tacrolimus 3. Chenodiol 4. Interferon alfa-2b, recombinant

3

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? 1. Furosemide 2. Acetazolamide 3. Spironolactone 4. Ammonium chloride

1

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: 1. The digestion of dietary and blood proteins. 2. Excessive diuresis and dehydration. 3. Severe infections and high fevers. 4. Excess potassium loss subsequent to prolonged use of diuretics.

1

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is: 1. Acetaminophen 2. Ibuprofen 3. Dextromethorphan 4. Benadryl

prothrombin

Patients with cirrhosis are at increased risk for bleeding and hemorrhage because of the decreased production of ______________ and the decreased ability of the diseased liver to synthesize the necessary substances for blood coagulation

Asterixix

_____ an involuntary flapping of the hands, may be seen in stage 2 encephalopathy.