Ch 43 Assessment and managment with patients with hepatic
The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?
"How often do you drink alcohol?"
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
"You may have eaten contaminated restaurant food."
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?
A liver biopsy
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?
Abdominal paracentesis
Which of the following would the nurse expect to assess in a conscious client with hepatic encephalopathy?
Asterixis
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?
Change in the client's handwriting and/or cognitive performance
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?
Document the presence of normal bile output.
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?
Endoscopic retrograde cholangiopancreatography (ERCP)
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral
Which type of jaundice seen in adults is the result of increased destruction of red blood cells?
Hemolytic
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
Hepatitis C increases a person's risk for liver cancer.
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?
Hypotension
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?
Lactulose
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?
Liver biopsy
A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what?
Liver transplantation
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?
Maintaining the airway
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?
Measure abdominal girth according to a set routine.
A critically ill client is diagnosed with acute liver failure caused by an overdose of acetaminophen. Which treatment will the nurse anticipate being prescribed for the client?
N-acetylcysteine
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
Purpura and petechiae
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
Reduce fluid accumulation and venous pressure.
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient?
Respiratory assessment related to increased thoracic pressure
In what location would the nurse palpate for the liver?
Right upper quadrant
A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client?
Spironolactone
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?
Tacrolimus
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?
The client's hepatic function is decreasing.
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?
Vitamin A
Which condition indicates an overdose of lactulose?
Watery diarrhea
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
cirrhosis.
What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply.
increased abdominal girth rapid weight gain visible distended veins stretch marks
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:
subnormal serum glucose and elevated serum ammonia levels.
A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:
wash her hands after touching the client.
