Liver Prep-U (mastery 1-8)

A client is admitted to the hospital with acute hemorrhage from esophageal varices. What medication should the nurse anticipate administering that will reduce pressure in the portal venous system and control esophageal bleeding? A. Octreotide (Sandostatin) B. Vasopressin (Pitressin) C. Epinephrine D. Vitamin K

A R: Acute hemorrhage from esophageal varices is lifethreatening. Resuscitative measures include administration of IV fluids and blood products. IV octreotide(Sandostatin) is started as soon as possible. Sandostatin is preferred because of fewer side effects. Octreotide reduces pressure in the portal venous system and is preferred to the previously used agents, vasopressin (Pitressin) or terlipressin. Vitamin K promotes blood coagulation in bleeding conditions, resulting from liver disease.

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. Urobilinogen B. Albumin C. Chloride D. Creatinine

B R: 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.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is:

Alpha-interferon R:Alpha-interferon is a biologic response modifier that is highly effective for treatment of hepatitis B. The other antiviral agents are effective but not the preferred single-agent therapy.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

When assessing a client with cirrhosis of the liver, what stool characteristics is the client likely to report?

Clay-colored or whitish R: Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

acute cholecystitis R:Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk? A. Abstain from drinking alcohol. B. Avoid intake of sodium-rich food. C. Use aspirin at least once a day. D. Increase intake of potassium-rich food.

A R:A soft diet and elimination of alcohol, aspirin, and other locally irritating substances minimize the risk for developing esophageal varices. Intake of sodium- or potassium-rich food has no effect on the formation of varices.

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

A R:Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has? A. Hemolytic jaundice B. Bleeding esophageal varices C. Hepatic insufficiency D. Portal hypertension

B C: The patient with bleeding esophageal varices may present with hematemesis, melena, or general deterioration in mental or physical status and often has a history of alcohol abuse. Signs and symptoms of shock (cool clammy skin, hypotension, tachycardia) may be present. The scenario does not describe hemolytic jaundice, hepatic insufficiency, or portal hypertension.

A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client?

First, Vasopressin- constriction of splanchnic artery; then, Propranolol- decreases portal pressure R:In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Vasopressin (Pitressin) may be the initial mode of therapy in urgent situations, because it produces constriction of the splanchnic arterial bed and decreases portal pressure. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

The nurse is administering medications to a patient 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 (Cephulac) R: Lactulose (Cephulac) 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 (Aldactone) are used to treat ascites. Cholestyramine (Questran) is a bile acid sequestrant and reduces pruritus. Kanamycin (Kantrex) decreases intestinal bacteria and decreases ammonia but does not act as an osmotic agent.

Which assessment is the most important in a client diagnosed with ascites?

Measurement of abdominal girth R:Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the client diagnosed with ascites. Foul-smelling breath would not be considered an important assessment for this client.

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 R:A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency?

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:

The digestion of dietary and blood proteins. R:Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of:

Two 6 oz glasses of wine. R:Intake of 60 g/day for men and 30 g/d for women (10 g of alcohol is equivalent to 1 oz of bourbon, 12 ounces of beer, or 4 ounces of red wine) is sufficient to cause liver injury.

Which position should be used for a client undergoing a paracentesis?

Upright at the edge of the bed R: The client should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool. The Fowler position should be used for the client confined to bed.

Which of the following is the most effective strategy to prevent hepatitis B infection?

Vaccine R: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin R: Vasopressin may be the initial therapy for esophageal varices because it produces constriction of 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 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?

Both forms of the hepatitis B vaccine are administered intramuscularly in three doses; the second and third doses are given 1 and 6 months, respectively, after the first dose.

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? A. bradycardia and bradypnea B. bradycardia and tachypnea C. tachycardia and tachypnea D. tachycardia and bradypnea

C R: With shock, the sympathetic nervous system "SNS" is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia; and the respiratory system, causing tachypnea. Tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.

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

D R: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.

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Endoscopic retrograde cholangiopancreatography (ERCP) R: ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

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

A R:Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?

Spironolactone (Aldactone) R: For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

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

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

B F: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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

C R:Gynecomastia is a common side effect caused by spironolactone. Pitressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

Which of the following laboratory test results would the nurse associate with obstructive jaundice? A. Decreased unconjugated bilirubin B. Increased indirect bilirubin C. Decreased conjugated bilirubin D. Increased direct bilirubin

D R: With obstructive jaundice, direct or conjugated bilirubin levels would be increased. Indirect or unconjugated bilirubin levels would be increased with hemolytic jaundice. Both conjugated and unconjugated bilirubin levels would be elevated with hepatocellular jaundice.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?

Decompression R: Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

A client with a history of IV drug use is being treated for hepatitis, and presents today with jaundice and arthralgias. This client most likely has hepatitis:

Hepatitis B R:The client's presentation is most similar to hepatitis B. Mode of transmission is from infected blood or plasma, needles, syringes, surgical or dental equipment contaminated with infected blood; also sexually transmitted through vaginal secretions and semen of carriers or those actively infected. Mode of transmission for hepatitis C is similar to HBV, although less severe and without jaundice. Mode of transmission for hepatitis A is the oral route from feces and saliva of infected persons. The mode of transmission for hepatitis E is similar to HAV.

The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching?

Limit foods high in protein R:Patients with hepatic encephalopathy and their families are advised about foods that are high in protein (e.g., meat, eggs), which may need to be limited in the diet for the short term to reduce production of ammonia.

When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. What intervention should the nurse consider?

Measure abdominal girth according to a set routine. R: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

Which assessments are important in a client diagnosed with ascites (3)?

Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the client diagnosed with ascites.

What is the recommended dietary treatment for a client with chronic cholecystitis?

low fat diet R:The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

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

A R: 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.

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. abdominal ascites. C. anorexia, nausea, and vomiting. D. eructation and constipation.

C R: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 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses?

Hep -C R: Transmission of hepatitis C occurs primarily through injection of drugs and through transfusion of blood products prior to 1992. Hepatitis A, B, and D are less likely to result from IV drug use.

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? A. Severe abdominal pain that radiates to the right shoulder B. Dull pain, points to epigastric area C. Sharp, stabbing pain in the left lower quadrant of the abdomen D. Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back

D R:The most common complaint of clients with pancreatitis is severe mid-abdominal to upper abdominal pain, radiating to both sides and straight to the back. The other answers are not pain that is usually associated with acute pancreatitis.

In actively bleeding patients with esophageal varices, the initial drug of therapy is usually: A. inderal B. Sandostatin C. Pitressin D. Corgard

C R:In an actively bleeding patient, medications are administered initially because other therapies take longer to initiate. Vasopressin (Pitressin) may be the initial mode of therapy, because it produces constriction of the splanchnic arterial bed and decreases portal pressure. It may be administered by IV infusion.

A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's:

Electrocardiogram. R: Vasopressin is administered during an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose patients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the patient for evidence of chest pain, ECG changes, and vital sign changes.

A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:

Level of Consciousness (LOC) R:In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? A. "How did this happen? I've been faithful my entire marriage." B. "I'll wash my hands often." C. "I'll take all my medications as ordered." D. "I'll be very careful when preparing food for my family."

A R:The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b (Intron A, Roferon-A) in combination with ribavirin (Rebetol). Which of the following instructions should a nurse provide this client? A. Use strict birth control methods. B. Avoid hot water baths or soaks. C. Maintain an exercise regimen. D. Avoid calcium-rich foods.

A R:A female client who has been prescribed recombinant interferon alpha-2b in combination with ribavirin should be instructed to use strict birth control methods. This is because ribavirin may cause birth defects. It is not essential for the client to avoid calcium-rich foods or hot baths or soaks. The client needs to maintain physical rest during therapy.

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

B R:If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

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

C R:Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.

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.

C R:In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the level of a client's consciousness. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

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 R:The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

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 R: A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure. Coagulation studies provide information about liver function but do not definitively confirm the diagnosis of cirrhosis. Magnetic resonance imaging and radioisotope liver scan help to support the diagnosis but do not confirm it. These tests provide information about the liver's enlarged size, nodular configuration, and distorted blood flow.

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. R: Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective.

A client has undergone a liver biopsy. Which postprocedure position is appropriate?

Right side R:In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the client on his left side is not indicated. Positioning the client in the Trendelenburg position may be indicated if the client is in shock, but is not the position designed for the client after liver biopsy. The high Fowler position is not indicated for the client after liver biopsy.

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?

The physician will use an ultrasound guided paracentesis R: Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions (Gordon, 2012). Ultrasound guidance may be indicated in some patients who are at high risk for bleeding because of an abnormal coagulation profile and in those who have had previous abdominal surgery and may have adhesions.

Which condition indicates an overdose of lactulose?

Watery diarrhea The client receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.