Chapter 49: Assessment and Management of Patients With Hepatic Disorders

The mode of transmission of hepatitis A virus (HAV) includes which of the following? A.) Fecal-oral B.) Blood C.) Semen D.) Saliva

Answer: A.) Fecal-oral Rationale; The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.

Most of the liver's metabolic functions are performed by: A.) parenchymal cells. B.) Kupffer cells. C.) islets of Langerhans. D.) canaliculi cells.

Answer: A.) parenchymal cells.

In what location would the nurse palpate for the liver? A.) Left lower quadrant B.) Left upper quadrant C.) Right lower quadrant D.) Right upper quadrant

Answer: D.) Right upper quadrant

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: A.) Acetaminophen B.) Ibuprofen C.) Dextromethorphan D.) Benadryl

Answer: A.) Acetaminophen

Which condition indicates an overdose of lactulose? A.) Watery diarrhea B.) Constipation C.) Hypoactive bowel sounds D.) Fecal impaction

Answer: A.) Watery diarrhea

Which is an age-related change of the hepatobiliary system? A.) Increased drug clearance capability B.) Decreased blood flow C.) Enlarged liver D.) Decreased prevalence of gallstones

Answer: B.) Decreased blood flow

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? A.) Potassium B.) Vitamin K C.) Vitamin B D.) Oral bile acids

Answer: B.) Vitamin K

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? A.) Hemolytic B.) Hepatocellular C.) Obstructive D.) Nonobstructive

Answer: A.) Hemolytic

Which of the following is the most effective strategy to prevent hepatitis B infection? A.) Vaccine B.) Barrier protection during intercourse C.) Covering open sores D.) Avoid sharing toothbrushes

Answer: A.) Vaccine

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? A.) Thoracentesis B.) Abdominal paracentesis C.) Abdominal CT scan D.) Upper endoscopy

Answer: B.) Abdominal paracentesis

The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy? A.) Prone B.) Supine C.) Left-lateral Sims' D.) Upright

Answer: D.) Upright

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? A.) Riboflavin deficiency B.) Folic acid deficiency C.) Vitamin A deficiency D.) Vitamin K deficiency

Answer: D.) Vitamin K deficiency

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? A.) Hemolytic B.) Hepatocellular C.) Obstructive D.) Nonobstructive

Answer: A.) Hemolytic

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? A.) Hepatic encephalopathy B.) Portal hypertension C.) Asterixis D.) Cirrhosis

Answer: A.) Hepatic encephalopathy

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? A.) Pad the side rails on the bed B.) Apply soft wrist restraints C.) Raise all four side rails on the bed D.) Prevent visitors, so as not to agitate the client

Answer: A.) Pad the side rails on the bed

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? A.) Night blindness B.) Hypoprothrombinemia C.) Scurvy D.) Beriberi

Answer: C.) Scurvy

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: A.) The digestion of dietary and blood proteins. B.) Excessive diuresis and dehydration. C.) Severe infections and high fevers. D.) Excess potassium loss subsequent to prolonged use of diuretics.

Answer: A.) The digestion of dietary and blood proteins.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A.) severe abdominal pain radiating to the shoulder. B.) anorexia, nausea, and vomiting. C.) eructation and constipation. D.) abdominal ascites.

Answer: B.) anorexia, nausea, and vomiting. Rationale; Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

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

Answer: C.) 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? A.) Respiratory assessment related to increased thoracic pressure B.) Urinary output related to increased sodium retention C.) Peripheral vascular assessment related to immobility D.) Skin assessment related to increase in bile salts

Answer: A.) Respiratory assessment related to increased thoracic pressure

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? A.) The client's hepatic function is decreasing. B.) The client didn't take his morning dose of lactulose (Cephulac). C.) The client is relaxed and not in pain. D.) The client is avoiding the nurse.

Answer: A.) The client's hepatic function is decreasing.

Which is the most common cause of esophageal varices? A.) Jaundice B.) Portal hypertension C.) Ascites D.) Asterixis

Answer: B.) Portal hypertension Rationale: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

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? A.) Serum potassium level of 3.5 mEq/L B.) Loss of 2.2 lb (1 kg) in 24 hours C.) Serum sodium level of 135 mEq/L D.) Blood pH of 7.25

Answer: B.) Loss of 2.2 lb (1 kg) in 24 hours

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: A.) elevated liver enzymes and low serum protein level. B.) subnormal serum glucose and elevated serum ammonia levels. C.) subnormal clotting factors and platelet count. D.) elevated blood urea nitrogen and creatinine levels and hyperglycemia.

Answer: B.) subnormal serum glucose and elevated serum ammonia levels.

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? A.) Straw-colored urine B.) Reduced hematocrit C.) Clay-colored stools D.) Elevated urobilinogen in the urine

Answer: C.) Clay-colored stools Rationale: Obstructive jaundice develops when a stone obstructs the flow of bile in the common bile duct. When the flow of bile to the duodenum is blocked, the lack of bile pigments results in a clay-colored stool. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

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? A.) Spironolactone B.) Cholestyramine C.) Lactulose D.) Kanamycin

Answer: C.) Lactulose Rationale: Lactulose is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients. Potassium-sparing diuretics such as spironolactone are used to treat ascites. Cholestyramine is a bile acid sequestrant and reduces pruritus. Kanamycin decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client? A.) "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs." B.) "You would not be scheduled for a transplant if there was a concern about rejection." C.) "The problem of rejection is not as common in liver transplants as in other organ transplants." D.) "It is easier to get a good tissue match with liver transplants than with other types of transplants."

Answer: A.) "You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs."

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? A.) "You must have the second one in 2 weeks and the third in 1 month." B.) "You must have the second one in 1 month and the third in 6 months." C.) "You must have the second one in 6 months and the third in 1 year." D.) "You must have the second one in 1 year and the third the following year."

Answer: B.) "You must have the second one in 1 month and the third in 6 months."

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? A.) Spironolactone B.) Vasopressin C.) Nitroglycerin D.) Cimetidine

Answer: B.) Vasopressin Rationale; Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? A.) Hepatitis B is transmitted primarily by the oral-fecal route. B.) Hepatitis A is frequently spread by sexual contact. C.) Hepatitis C increases a person's risk for liver cancer. D.) Infection with hepatitis G is similar to hepatitis A.

Answer: C.) Hepatitis C increases a person's risk for liver cancer.

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: A.) cirrhosis. B.) peptic ulcer disease. C.) appendicitis. D.) cholelithiasis.

Answer: A.) cirrhosis. Rationale: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

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? A.) Controlling bleeding B.) Maintaining the airway C.) Maintaining fluid volume D.) Relieving the client's anxiety

Answer: B.) Maintaining the airway Rationale; Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Maintaining the airway is the highest priority because oxygenation is essential for life. The airway can be compromised by possible displacement of the tube and the inflated balloon into the oropharynx, which can cause life-threatening obstruction of the airway and asphyxiation.

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: A.) spironolactone (Aldactone). B.) phytonadione (Mephyton). C.) furosemide (Lasix). D.) warfarin (Coumadin).

Answer: B.) phytonadione (Mephyton). Rationale: Prothrombin synthesis in the liver requires vitamin K. In cirrhosis, vitamin K is lacking, precluding prothrombin synthesis and, in turn, increasing the client's PT. An increased PT, which indicates clotting time, increases the risk of bleeding. Therefore, the nurse should expect to administer phytonadione (vitamin K1) to promote prothrombin synthesis. Spironolactone and furosemide are diuretics and have no effect on bleeding or clotting time. Warfarin is an anticoagulant that prolongs PT.

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? A.) Creatinine B.) Urobilinogen C.) Chloride D.) Albumin

Answer: D.) Albumin Rationale: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

Gynecomastia is a common side effect of which of the following diuretics? A.) Spironolactone B.) Furosemide C.) Vasopressin D.) Nitroglycerin (IV)

Answer: A.) Spironolactone

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. - Acetaminophen - Ketoconazole - Valproic acid - Diazepam - Insulin

Answer: - Acetaminophen - Ketoconazole - Valproic acid

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. - Jaundice - Petechiae - Ecchymoses - Cyanosis of the lips - Aphthous stomatitis

Answer: - Jaundice - Petechiae - Ecchymoses

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? A.) On the left side B.) Trendelenburg C.) On the right side D.) High Fowler

Answer: C.) On the right side

What is the recommended dietary treatment for a client with chronic cholecystitis? A.) low-fat diet B.) high-fiber diet C.) low-residue diet D.) low-protein diet

Answer; A.) low-fat diet

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.) A liver biopsy B.) A CT scan C.) A prothrombin time D.) Platelet count

Answer: A.) A liver biopsy

A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? A.) Hemolytic jaundice B.) Hepatocellular jaundice C.) Obstructive jaundice D.) Cirrhosis of the liver

Answer: C.) Obstructive jaundice

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. - Infection at school - Suboptimal sanitary habits - Consumption of sewage-contaminated water or shellfish - Sexual activity - Ingestion of undercooked beef

Answer: - Infection at school - Suboptimal sanitary habits - Consumption of sewage-contaminated water or shellfish - Sexual activity

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? A.) Transjugular intrahepatic portosystemic shunting (TIPS) B.) Vasopressin (Pitressin) C.) Sclerotherapy D.) Balloon tamponade

Answer; A.) Transjugular intrahepatic portosystemic shunting (TIPS) Rationale: A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of patients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications? A.) metabolism of medications B.) need for increased drug dosages C.) need for more frequently divided doses D.) medications becoming ineffective in clients with liver disease

Answer; A.) metabolism of medications

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? A.) Report the condition to the physician immediately. B.) Measure abdominal girth according to a set routine. C.) Provide the client with nonprescription laxatives. D.) Ask the client about food intake.

Answer; B.) Measure abdominal girth according to a set routine.