A. cirrhosis questions

a client serum ammonia level is elevated, and the doctor orders 30 mL of lactulose (cephulac). which of the following adverse effects of this drug should nurse expect to see A. increased urine output B. improved LOC C. increased bowel movements D. nausea and vomiting

C. lactulose increases intestinal motility, thereby trapping and expelling ammonia in the feces.

the nurse is providing discharge instructions for a client with cirrhosis. which of the following statements best indicates that the client has understood the teaching A. i should eat a high-protein, high carb diet to provide energy B. it is safer for me to take acetaminophen for pain instead of aspirin C. i should avoid constipation to decrease chances of bleeding D. if i get enough rest and follow my diet, it is possible for my cirrhosis to be cured

C. clients with cirrhosis has bleeding tendencies because of the liver's inability to produce clotting factors

a client has advanced cirrhosis of the liver. the client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. how should the nurse respond. A. he must have been eating too many foods with salt in them. Salt pulls water with it. B. the swelling in his ankles must have moved up closer to his heart so the fluid circulates better. C. he must have forgotten to take his daily water pill D. blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels.

D. Portal hypertension and hypoalbuminemia as a result of cirrhosis cause a fluid shift into the perioneal space causing ascites.

a client with cirrhosis vomits bright red blood and the physician suspects bleeding esophageal varices. the physician decides to insert a Sengstaken-Blakemore tube. the nurse should explain to the client that the tube acts by? A. providing a large diameter for effective gastric lavage B. applying direct pressure to gastric bleeding sites C. blocking blood flow to the stomach and esophagus D. applying direct pressure to the esophagus

D. a tube passing through the balloon allows for breathing

the client with cirrhosis has develop ascites. the nurse should recognize that the pathological basis for the development of ascites in clients with cirrhosis is portal hypertension and A. an excess serum sodium level B. an increased metabolism of aldosterone C. a decreased flow in hepatic lymph D. a decreased serum albumin level

D. ascites results from increased pressure in the venous system caused by low levels of serum albumin (which contributes to decreased colloid osmotic pressure

the nurse has an order to administer 2 oz of lactulose (cephulac) to a client who has cirrhosis. how many milliliters of lactulose should the nurse administer

60mL 30mL=1oz

the client who has esophageal varices is started on propranolol (inderal). the nurse explains to a new nurse orientee that this drug is ordered for this particular client to do which of the following A. prevent esophageal bleeding B. decrease systemic BP C. decrease portal hypertension D. decrease myocardial workload

A. Beta blockers exert multiple systemic effects. and decrease the occurrence of esophageal bleeding

what diet should be implemented for a client who is in the early stages of cirrhosis A. high-calorie, high-carb B. high-protein, low-fat C. low-fat, low-protein D. high-carb, low-sodium

A. Its preferred to provide adequate supply and nutrient in the "early stages"

the client with cirrhosis receives 100mL of 25% serum albumin IV. which of the following would best indicate that the albumin is having its desired effect. A. increased urine output B. increased serum albumin levels C. decreased anorexia D. increased ease of breathing

A. this increases the plasma colloid pressure, which causes the fluid to flow from the tissue space to the plasma.

which of the following health promotion activities would be appropriate for the nurse to suggest that the client with cirrhosis add to the daily routine at home? A. supplement the diet with daily multivitamins B. limit alcohol intake daily C. take a sleeping pill at bedtime D. limit contact with other people whenever possible

A. Suggest good healthcare promotion. client should be abstaining from alcohol, sedatives and barbiturates may not be able to be detoxed by impaired liver, and client does not need to limit contact (unless they are ill)

a client with cirrhosis has diarrhea after several doses of lactulose. which of the following interventions is appropriate for the nurse to implement A. monitor fluid and electrolyte balance B. monitor the serum ammonia level C. decrease the frequency of the lactulose dose D. perform skin care in the perineal are

C.

a client with cirrhosis is admitted to the hospital. which of the following assessments made by the nurse would indicate the development of portal hypertension A. hematemesis B. asterixis C. elevated BP D. confusion

A. cirrhosis increases the vascular pressure in the portal system and causes congestion in the spleen and develops varicosities in the esophagus

the nurse is preparing a client for a paracentesis. which of the following activities would be appropriate before the procedure A. have the client void immediately before the procedure B. place the client in a side-lying position C. initiate an IV line to administer sedatives D. place the client on NPO 6 hours before the procedure

A. the client should empty the bladder to prevent perforation

which of the following positions would be appropriate for a client with severe ascites A. Fowler's B. Side-lying C. reverse Trendeleburg D. Sims

A. Fowler's helps facilitate breathing by relieving pressure off the diaphragm

the nurse is assessing a client who is in the early stages of cirrhosis. which sign should the nurse anticipate finding? A. peripheral edema B. ascites C. anorexia D. jaundice

C. early signs include gastrointestinal symptoms such as anorexia, nausea, vomiting, and changes in BM

the nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. which of the following would be an indication the H.E. is developing? A. decreased mental status B. elevated BP C. decreased urine output D. labored respiration

A. ammonia has a toxic effect on the CNS

the client with cirrhosis of the liver asks the nurse why he has edema. the nurse would make which response to explain how edema results from pathophysiologic changes in cirrhosis A. the edema occurs because your liver produces fewer proteins that help draw fluid into the bloodstream B. the high osmotic pressure of proteins in your blood pushes fluids into the body tissue C. because of the liver disease, the kidneys are able to filter less fluid, so the body cannot excrete it as urine very easily D. your body is metabolizing sex hormones more quickly leading to fluid edema

A. the liver is responsible for the production of albumin, which maintains osmotic pressure

a nurse is caring for a client hepatic encephalopathy. how should the nurse direct care for this client? SELECT ALL A. preventing constipation B. administering lactulose (cephulac) C. monitoring coordination while walking D. checking pupil reaction E. providing foods and fluids high in carbohydrate F. encouraging physical activity

A. B. C. D. E. constipation leads to increased ammonia production. lactulose acidifies colon contents reducing blood ammonia. H.E. causes cerebral edema which can affect coordination and pupil reaction. high carb foods should be given because the liver is not synthesizing and storing glucose.

lactulose is ordered for the client with cirrhosis. which of the following serum lab test should the nurse monitor to determine if the drug is having its desired effect A. albumin B. ammonia C. sodium D. lactate

B. lactulose decreases the absorption of ammonia

a client with cirrhosis begins to develop ascites. Spironolactone (aldactone) is prescribed to treat the ascites. the nurse should monitor the client for which of the following drug-related adverse effects. A. constipation B. hyperkalemia C. irregular pulse D. dysuria

B. spironolactone is a potassium sparing diuretic

a client is to be discharged with a prescription for lactulose. the nurse teaches the client and the client's spouse how to administer this medication. which of the following statements would indicate that the client has understood the information. A. I'll take this with Maalox B. I'll mix it with apple juice C. I'll take it with laxative D. I'll mix the crushed tablets in some gelatin

B. the taste is a problem for some clients. mixing it with juice, water, or milk make it more palatable

a client with cirrhosis complains that his skin always feels itchy and that he "scratches himself raw" while he sleeps. the nurse should recognize that the itching is the result of which abnormality associated with cirrhosis. A. folic acid deficiency B. prolonged prothrombin time C. increased bilirubin levels D. hypokalemia

C. excess retained bilirubin produces an irritating effect on the peripheral nerves

about 30 minutes after a Sengstake-Blakemore tube is inserted, the nurse observes that the client appears to be having difficulty breathing. the nurse's first action should be to A. remove the tube B. deflate the esophageal portion of the tube C. determine whether the tube is obstructing airway D. increase the oxygen flow rate

C. no direct action should be taken until the condition is accurately diagnosed

a client with ascites and peripheral edema is at risk for impaired skin integrity. which of the following intervention should be implemented to prevent skin breakdown A. ROM exercises every 4 hours B. massage of the abdomen once a shift C. use of alternating air pressure mattress D. elevation of lower extremities

C. decreases pressure on the edematous tissue

the doctor orders oral neomycin as well as a neomycin enema for a client with cirrhosis. the nurse understands that the purpose of this therapy is to A. reduce abdominal pressure B. prevent straining during defecation C. block ammonia formation D. reduce bleeding within the intestine

C. it is administered to decrease bacterial action on protein in the intestines.

which of the following interventions should the nurse anticipate incorporating into the client's plan of care when hepatic encephalopathy initially develops? A. inserting a NG tube B. restricting fluids to 1000mL/day C. administering IV salt-poor albumin D. implementing a low-protein diet

D. reduces protein reduces ammonia formation