Patho Ch 44Dynamic Study Module Liver Failure

The nurse prepares teaching for a patient with nonalcoholic fatty liver disease. Which recommendation should the nurse include in this teaching? ANSWER I DON'T KNOW YET Unselected "Take diuretic medications as prescribed." Unselected "Begin fluid restriction." Unselected "Stop drinking alcohol." Correct THE CORRECT ANSWER "Begin a weight-loss program."

"Begin a weight-loss program." The most common cause of nonalcoholic fatty liver is obesity. Weight loss will promote stabilization and resolution of the condition. Fluid restriction is more appropriate in the management of ascites. Alcohol is not a factor in the development of nonalcoholic fatty liver. Diuretic medications are not indicated in the management of nonalcoholic fatty liver.

The public health nurse is creating a campaign to prevent acute liver failure. Which factor should the nurse include as the leading cause of acute liver​ failure? A. Alcohol abuse B. Acetaminophen C. NSAID use D. Viruses

B. Acetaminophen ​ Rationale: Acetaminophen is the most common cause of acute liver failure. Viruses can cause acute liver​ failure, but these infections no longer outnumber acetaminophen cases. NSAIDs are not a common cause of liver failure. Alcohol abuse is more likely to cause chronic than acute liver failure.

The nurse is caring for a client with nonalcoholic fatty liver disease. Which risk factor should the nurse expect to find when reviewing the​ client's medical​ history? A. Illicit drug use B. Obesity C. Hepatitis E infection D. Diabetes

B. Obesity ​Rationale: The top risk factor for nonalcoholic fatty liver disease is obesity. Diabetes is a risk factor for liver carcinoma. Illicit drug use and hepatitis E are not linked to nonalcoholic fatty liver disease.

A patient with new onset jaundice is diagnosed with hepatitis A. Which question should the nurse ask the patient? ANSWER I DON'T KNOW YET Unselected "Where you doing anything unusual about 75 days ago?" Unselected "Where you traveling anywhere about 180 days ago." Correct THE CORRECT ANSWER "Can you recall where you were approximately 30 days ago?" Unselected "Since it takes about 60 days for the illness to develop, where were you at that time?"

"Can you recall where you were approximately 30 days ago?" The incubation period for hepatitis A infection is 30 days, so the patient was likely exposed 30 days ago. The incubation period for hepatitis B is 28-180 days. The incubation period for hepatitis C is 35-72 days. The incubation period for hepatitis D is 30-180 days. The incubation period for hepatitis E is 15-60 days.

A patient with hepatitis B asks why HIV testing is being done. Which response should the nurse make to this patient? ANSWER I DON'T KNOW YET Unselected "Treatment is affected when a person is HIV positive." Correct THE CORRECT ANSWER "Hepatitis B and HIV have the same modes of transmission." Unselected "Hepatitis B infection can lead to the development of HIV infection." Unselected "Being HIV-positive could have something to do with how hepatitis B was contracted."

"Hepatitis B and HIV have the same modes of transmission." HIV and hepatitis B have similar modes of transmission, so a patient with hepatitis B virus (HBV) infection should automatically be tested for HIV. Being HIV-positive will not affect the treatment of HBV infection but may be a consideration in future infections. Being HIV-positive does not increase the likelihood of acquiring hepatitis B. Hepatitis B does not evolve into HIV.

A patient with hepatitis B asks how the disease developed. Which response should the nurse make to the patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "Hepatitis B is transmitted by way of direct contact with contaminated blood or bodily fluid." Unselected "Hepatitis B is transmitted by way of intravenous drug use." Unselected "Hepatitis B is transmitted in contaminated food or water." Unselected "Hepatitis B is transmitted through percutaneous skin contact."

"Hepatitis B is transmitted by way of direct contact with contaminated blood or bodily fluid." Hepatitis B is transmitted in blood and body fluids. Sexual transmission and perinatal transmission are also possible. Though hepatitis B can also be transmitted through percutaneous skin exposure and intravenous drug abuse, these behaviors typically result in hepatitis C infection. Hepatitis A is spread in contaminated food or water.

A patient with liver failure is experiencing worsening ascites. Which teaching should the nurse provide to this patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER "Limit salt in your diet." Unselected "Increase your intake of salt." Unselected "Increase fluid intake." Unselected "Maintain a high-protein diet."

"Limit salt in your diet." Sodium restriction and diuretic medications constitute the best way to manage ascites. Increasing fluid intake will most likely increase fluid retention in the abdomen. A high-protein diet will not affect ascites. Increasing salt intake will increase retention of fluid.

The nurse is instructing a community group about transmission of hepatitis A virus (HAV) infection. Which statement by a participant should be questioned? ANSWER I DON'T KNOW YET Unselected "Hepatitis A is spread by way of fecal-oral transmission." Correct THE CORRECT ANSWER "The incubation period lasts up to 6 months." Unselected "Hepatitis A is a self-limiting infection." Unselected "Fatality from infection is rare."

"The incubation period lasts up to 6 months." The incubation period for hepatitis A infection is 30 days. HAV is excreted in the feces of an infected person. The clinical course is self-limiting, and the disease is fatal only rarely. Hepatitis B incubation period spans 28-180 days. The incubation period for hepatitis C is 35-72 days.

A patient with liver disease asks why the skin now appears yellow. Which response should the nurse make to this patient? ANSWER I DON'T KNOW YET Unselected "The jaundice is caused by impaired bilirubin metabolism resulting from increased pressure in the portal circulation." Unselected "The jaundice is caused by impaired bilirubin metabolism resulting from impaired drainage of bile in the biliary system." Correct THE CORRECT ANSWER "The jaundice is the result of impaired bilirubin metabolism caused by the liver disease." Unselected "The jaundice is caused by impaired bilirubin metabolism resulting from a disease process that causes increased destruction of red blood cells."

"The jaundice is the result of impaired bilirubin metabolism caused by the liver disease." Jaundice is the green-yellow staining of tissues by bilirubin that results from impaired bilirubin metabolism. It is a cardinal sign of liver disease. Prehepatic jaundice results from any disorder that causes an increase in hemolysis, the destruction of RBCs. Posthepatic jaundice is caused by impaired drainage of bile in the biliary system. Portal hypertension is increased pressure in the portal circulation resulting from cirrhosis.

The nurse is caring for a client with alcoholic liver failure. Which finding should the nurse identify that demonstrate the effects of alcohol on the​ liver? (Select all that​ apply.) A. Fibrosis B. Mallory body formation C. Cirrhosis D. Evidence of cancer E. Steatohepatitis

A. Fibrosis B. Mallory body formation C. Cirrhosis E. Steatohepatitis Rationale: Fibrosis of the liver with progression to cirrhosis results from damage to the​ liver's cells. Steatohepatitis results from deposition of fats in the liver that leads to inflammation. Mallory body formation results from inflammation and the retention of keratin in the liver. Carcinoma of the liver is a risk with nonalcoholic fatty liver disease.

A client with liver cirrhosis is prescribed albumin. For which health problem is this treatment​ prescribed? A. Hepatorenal syndrome B. Cholestasis C. Portopulmonary syndrome D. Hepatopulmonary syndrome

A. Hepatorenal syndrome ​Rationale: Albumin infusions are used to expand the circulatory blood volume in the client with hepatorenal syndrome. This treatment is not indicated for​ cholestasis, portopulmonary​ syndrome, or hepatopulmonary syndrome.

A client with chronic liver disease has developed portal hypertension. Which disorder should the nurse associate with the progression of portal​ hypertension? (Select all that​ apply.) A. Splenomegaly B. Esophageal varices C. Hepatitis A D. Rectal varices E. Jaundice

A. Splenomegaly B. Esophageal varices D. Rectal varices​ Rationale: Portal hypertension is increased resistance of blood flow through the portal system of the​ liver, resulting in the development of rectal​ varices, splenomegaly, and esophageal varices. Jaundice is caused by the​ liver's inability to effectively clear bilirubin. Hepatitis A is caused by a​ virus, not by portal hypertension.

The nurse is caring for a client with cirrhosis and ascites. Which clinical application of the disease should the nurse associate with this​ finding? A. The client is at increased risk for mortality. B. The peripheral vasculature is constricted. C. Infection is present. D. Liver function is returning to normal.

A. The client is at increased risk for mortality. ​Rationale: Ascites associated with cirrhosis is a poor clinical indicator associated with an increase of mortality at​ 56% within 3 years. Ascites does not indicate infection but increases susceptibility to infection. The liver has not returned to normal function when ascites is present. Vasodilation precedes ascites.

A client with liver failure has developed jaundice. Which finding should the nurse anticipate when assessing this​ client? A. Yellow skin B. Poor capillary refill C. Pale mucous membranes D. Blue nail beds

A. Yellow skin ​Rationale: Jaundice causes a yellowing of the skin. Blue nail​ beds, poor capillary​ refill, and pale mucous membranes could reflect poor perfusion and poor oxygenation.

A patient with a history of drug abuse experiences a sudden onset of confusion and coagulopathy. For which condition should the nurse assess this patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Acute liver failure Unselected Hepatitis Unselected Portal hypertension Unselected Ascites

Acute liver failure Acute liver failure is most frequently seen with a history of drug abuse. Manifestations include sudden confusion and coagulopathy. Manifestations of hepatitis include symptoms of viral illness and chronic hepatic failure. Portal hypertension is marked by slow onset of symptoms. Ascites is fluid retention in the abdominal cavity.

The nurse is preparing discharge instructions for a patient with alcoholic liver disease. Which referral should the nurse include in this teaching? ANSWER I DON'T KNOW YET Unselected Weight Watchers Correct THE CORRECT ANSWER Alcoholics Anonymous Unselected Dietitian Unselected Al-Anon

Alcoholics Anonymous The nurse would refer the patient to Alcoholics Anonymous because of the report of excessive drinking. This group is dedicated to helping people quit drinking alcohol. Al-Anon is for family members of people with alcoholism and is designed to help break the codependent cycle of alcoholic relationships. Weight Watchers helps people who are overweight. A referral to a dietitian is warranted in newly diagnosed cases of diabetes or for people who are morbidly obese.

A patient has begun showing clinical signs of liver failure. Which statement best describes what this finding should indicate to the nurse? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Approximately 80-90% of the liver is affected. Unselected Only 20-30% of the liver is affected. Unselected Less than 10% of the liver is affected. Unselected About 50% of the liver is affected.

Approximately 80-90% of the liver is affected.

A patient is being treated for cirrhosis. The nurse should assess for which manifestation in this patient? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Ascites Unselected Peptic ulcers Unselected Hypertension Unselected Hepatitis

Ascites The most common complication of cirrhosis is ascites, a collection of excess fluid in the abdominal cavity. Hypertension is not a complication of cirrhosis of the liver. Peptic ulcers do not occur as a result of cirrhosis of the liver. Hepatitis is an infection of the liver that can result in poor liver function.

A patient with 84% liver necrosis is demonstrating encephalopathy. Which action should the nurse take first? ANSWER I DON'T KNOW YET Unselected Draw blood for liver enzymes Correct THE CORRECT ANSWER Assess for jaundice Unselected Ask for a prescription for intravenous fluids Unselected Monitor blood pressure

Assess for jaundice Between 80% and 90% of the liver is compromised before clinical manifestations of liver failure become apparent. Jaundice is a manifestation of liver failure. Liver enzymes most likely have already been completed to determine the degree of liver damage. Liver damage does not directly affect blood pressure. Intravenous fluids will depend upon the patient's fluid balance.

The nurse is caring for a patient with acute liver failure. Which assessment findings should the nurse immediately report to the healthcare provider? ANSWER I DON'T KNOW YET Unselected Flu-like symptoms Unselected Nausea and diarrhea Unselected Joint and right upper quadrant pain Correct THE CORRECT ANSWER Bleeding and confusion

Bleeding and confusion Coagulopathy and altered mental status are the hallmark clinical signs of acute liver failure. Flu-like symptoms, arthralgia, right upper quadrant abdominal pain, nausea, and diarrhea not manifestations of acute liver failure.

A patient is being treated for liver failure. For which assessment finding should the nurse contact the healthcare provider? ANSWER I DON'T KNOW YET Unselected Abdominal pain Unselected Spider angiomas Correct THE CORRECT ANSWER Bloody stools Unselected Peripheral edema

Bloody stools Blood in the patient's stools can indicate gastrointestinal bleeding. This finding should be reported to prevent complications of shock with severe blood loss. Spider angiomas, peripheral edema, and abdominal pain are common clinical manifestations in patients with cirrhosis of the liver.

A client with chronic liver disease has yellowing of the sclera and mucous membranes. Which laboratory value should the nurse expect to be​ increased? A. Red blood cells​ (RBC) B. White blood cells​ (WBC) C. Bilirubin D. Platelets

C. Bilirubin ​Rationale: Liver failure results in an inability to clear​ bilirubin, a​ by-product of red blood cell​ (RBC) breakdown, which results in​ jaundice, a yellowing of the​ skin, mucous​ membranes, and eyes. Platelets would likely decrease as liver function fails to support clotting mechanism of the body. RBCs are not​ increased, and an increase in white blood cells​ (WBCs) indicates infection.

The nurse is participating in a community health disease prevention program. Which intervention should the nurse teach to reduce risk of hepatitis A​ infection? A. Immunization B. Needle exchange programs C. Handwashing D. Barrier protection during sex

C. Handwashing​ Rationale: Hepatitis A is transmitted through the​ fecal-oral route. Handwashing prevents transmission. Hepatitis B transmission can be prevented through​ immunization, not sharing​ needles, and​ safe-sex practices.

The nurse is concerned about the development of ascites in a client with liver failure. Which action should the nurse take to validate this clinical​ manifestation? A. Testing the stool for melena B. Checking the last creatinine value C. Measuring the abdominal girth D. Obtaining a pulse oximetry reading

C. Measuring the abdominal girth ​Rationale: Abdominal girth is measured and monitored for​ increases, which indicate the development of ascites. Melena would be present in the setting of esophageal varices. Creatinine increase would be present in hepatorenal syndrome. Pulse oximetry should be the priority in hepatopulmonary syndrome.

A patient is found to have portal hypertension. Which underlying condition most likely contributed to the development of this health problem? ANSWER INCORRECT Unselected A high-fat diet Incorrect YOU WERE UNSURE AND INCORRECT Bleeding disorder Correct THE CORRECT ANSWER Cirrhosis Unselected High blood pressure

Cirrhosis The most common cause of portal hypertension is cirrhosis: a scarring of the liver that is caused by poor liver function. This results in decreased intrahepatic blood flow. Bleeding disorders and high blood pressure are conditions of the cardiovascular system. A high-fat diet may contribute to gallbladder dysfunction but is not associated with portal hypertension.

A client with cirrhosis has esophageal varices. For which intervention should the nurse​ prepare? A. Vasodilation B. Ultrasound C. Echocardiogram D. Band ligation

D. Band ligation​ Rationale: The client with esophageal varices is at risk of​ bleeding, for which the intervention is esophageal band ligation. Ultrasound may be performed at a later time to determine liver size. Vasoconstricting medication would be delivered to slow the bleeding. Echocardiogram is indicated for the client with cardiac dysfunction.

The client with cirrhosis asks how lesions developed in the esophagus. Which response should the nurse make to this​ client? A. ​"The esophagus has developed cancer related to the liver​ disease." B. ​"The esophageal lesions are unrelated to the disease of the​ liver." C. ​"Eating unhealthy food has created these​ lesions." D. ​"The compromised flow of blood through the liver has engorged the blood vessels of the​ esophagus."

D. ​"The compromised flow of blood through the liver has engorged the blood vessels of the​ esophagus." Rationale: The compromised flow of blood through the​ stenotic, cirrhotic liver has impeded blood flow and engorged the blood vessels of the​ esophagus, resulting in varices. Food choices and cancer are not causes of varices. The portal hypertension of the diseased liver caused the esophageal varices.

A client with sustained autoimmune hepatitis develops chronic liver disease. Which factor increases the risk for this​ disease? (Select all that​ apply.) A. Genetic mutations B. Infection C. Female gender D. Cigarette smoking E. Medications

​A. Genetic mutations B. Infection C. Female gender E. Medications Rationale: Environmental factors such as infection and medications are linked to autoimmune hepatitis. Women are more​ susceptible, and there are genetic links to the disease. Smoking is not a known risk factor.

The nurse is caring for a patient with ascites. Which treatment should the nurse anticipate for this patient? ANSWER CORRECT Correct YOU WERE UNSURE AND CORRECT Diuretics and reduced-sodium diet Unselected Vitamin E supplements Unselected Special lights Unselected Insulin

Diuretics and reduced-sodium diet Reducing sodium in the diet and diuretic medications are appropriate treatments for ascites, because both measures reduce the amount of fluid that is retained in the abdominal cavity. Vitamin E supplements are more appropriate for alcoholic liver disease, and specialized lights are used in the treatment of neonatal jaundice. Insulin is not a treatment for ascites.

A patient with a history of drug abuse is diagnosed with acute liver failure that developed over the last few weeks. In addition to coagulopathy, for which manifestation should the nurse assess this patient? ANSWER INCORRECT Incorrect YOU WERE UNSURE AND INCORRECT Hepatitis Correct THE CORRECT ANSWER Encephalopathy Unselected Immunosuppression Unselected Jaundice

Encephalopathy Acute liver failure is the loss of hepatocyte function affecting almost the entire liver without the presence of cirrhosis. The damage occurs over days or weeks and is characterized by the hallmark signs of altered mental status and coagulopathy. Immune suppression, jaundice, and hepatitis are not manifestations of coagulopathy.

Which secondary disease process should the nurse identify as being associated with portal hypertension? ANSWER CORRECT Unselected Jaundice Unselected Hypertension Unselected Chest pain Correct YOU WERE UNSURE AND CORRECT Esophageal varices

Esophageal varices A secondary disease process associated with portal hypertension is esophageal varices. Esophageal varices develop as a result of increased portal hypertension. As the portosystemic gradient increases, there is decreased flow through the liver, resulting in increased pressure in the blood vessels lining the esophagus. Chest pain is associated with cardiac disease. Jaundice is a primary symptom of chronic hepatic alterations. Hypertension is not associated with portal hypertension.

A patient with newly diagnosed cirrhosis of the liver vomits bright red blood. Which should the nurse suspect is causing this patient's bleeding? ANSWER I DON'T KNOW YET Unselected Stomach ulcer Unselected Perforated bowel Unselected Gastrointestinal obstruction Correct THE CORRECT ANSWER Esophageal varices

Esophageal varices Esophageal varices develop as a result of increased portal hypertension. As the portosystemic gradient increases, there is decreased flow through the liver, resulting in increased pressure in the blood vessels lining the esophagus. As the size of the blood vessels increases, so does the risk of bleeding. It is unlikely that the bleeding is occurring because of a gastric ulcer, gastrointestinal obstruction, or a perforated bowel.

A patient is diagnosed with hepatitis B. For which comorbid condition should the nurse expect this patient to be tested? ANSWER CORRECT Unselected Nonalcoholic fatty liver Unselected Cirrhosis Correct YOU WERE UNSURE AND CORRECT HIV Unselected Acute liver failure

HIV People infected with hepatitis B, hepatitis C, or hepatitis D should be tested for co-infection with HIV because of its similar routes of transmission. Nonalcoholic fatty liver disease, acute liver failure, and cirrhosis are not spread by modes of transmission similar to those of hepatitis.

A patient with ascites is at risk for which systemic complication? ANSWER I DON'T KNOW YET Unselected Congestive heart failure Correct THE CORRECT ANSWER Hepatorenal failure Unselected Esophageal varices Unselected Hypertension

Hepatorenal failure Hepatorenal failure is a functional renal failure that occurs as a result of portal hypertension and is almost always associated with ascites. Hypertension is not a result of ascites. Esophageal varices can be complicated by portal hypertension but not by ascites. Congestive heart failure does not occur as a result of ascites, but dyspnea may occur as a result of excess fluid.

The nurse suspects that a patient with liver failure is deteriorating. Which assessment finding causes the nurse to make this clinical determination? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Increased abdominal girth Unselected Improved appearance of jaundice Unselected Decreased liver enzyme levels Unselected Increased urine output

Increased abdominal girth Measurement of abdominal girth is a key indicator of the status of ascites. Increased abdominal girth indicates a progression of liver failure. The other findings would not be associated with worsening liver failure.

A neonate is being treated with special lighting for jaundice. Which laboratory value should the nurse suspect caused this treatment to be prescribed? ANSWER I DON'T KNOW YET Correct THE CORRECT ANSWER Increased level of unconjugated bilirubin Unselected Increased conjugated bilirubin Unselected Decreased conjugated bilirubin Unselected Decreased level of unconjugated bilirubin

Increased level of unconjugated bilirubin An increased level of unconjugated bilirubin resulting in jaundice is common in newborns. Treatment includes therapy with special lighting. The lights would not be needed if the unconjugated bilirubin level is low. Primarily unconjugated hyperbilirubinemia causes neonatal jaundice.

A neonate is being treated with special lighting for jaundice. Which laboratory value should the nurse suspect caused this treatment to be prescribed? ANSWER CORRECT Unselected Decreased conjugated bilirubin Unselected Increased conjugated bilirubin Unselected Decreased level of unconjugated bilirubin Correct YOU WERE UNSURE AND CORRECT Increased level of unconjugated bilirubin

Increased level of unconjugated bilirubin An increased level of unconjugated bilirubin resulting in jaundice is common in newborns. Treatment includes therapy with special lighting. The lights would not be needed if the unconjugated bilirubin level is low. Primarily unconjugated hyperbilirubinemia causes neonatal jaundice.

A patient is diagnosed with nonalcoholic fatty liver disease. The nurse should assess this patient for which additional health problem? ANSWER I DON'T KNOW YET Unselected Type 2 diabetes Correct THE CORRECT ANSWER Metabolic syndrome Unselected Splenic failure Unselected Hypoglycemia

Metabolic syndrome Components of metabolic syndrome include hyperglycemia, dyslipidemia, and hyperinsulinemia. These are also components of nonalcoholic fatty liver disease. Insulin resistance is the key abnormality associated with nonalcoholic fatty liver disease that occurs as a result of obesity. Type 2 diabetes is not a factor in the development of nonalcoholic fatty liver disease. Splenic failure and hypoglycemia are not associated with this condition.

The nurse suspects that a patient with a history of alcoholism is experiencing mild alcoholic liver disease. Which findings cause the nurse to make this clinical determination? ANSWER I DON'T KNOW YET Unselected Crushing chest pain, jaundice, and shortness of breath Correct THE CORRECT ANSWER Nausea, vomiting, weight loss Unselected Profuse sweating, jaundice, and hypoglycemia Unselected Low-grade fever, acute abdominal pain, and fatigue

Nausea, vomiting, weight loss Symptoms of mild alcoholic liver disease may be nonspecific and can include nausea, vomiting, fever, anorexia, weight loss, abdominal pain, and fever. Crushing chest pain and shortness of breath may indicate that the patient is experiencing a cardiac emergency. Hypoglycemia is often associated with profuse sweating or cool, clammy skin.

The nurse is evaluating a patient with diabetes and hypertension for the risk of nonalcoholic fatty liver disease. For which other health problem should the nurse assess the patient? ANSWER CORRECT Unselected Hepatitis A Correct YOU WERE UNSURE AND CORRECT Obesity Unselected Ascites Unselected Renal failure

Obesity Obesity is the main contributor to the development of nonalcoholic fatty liver disease, although this condition is also seen in people who are not obese. Renal failure and hepatitis A are not contributing factors in nonalcoholic fatty liver disease. Ascites is fluid retention resulting from poor liver function.

The nurse is preparing a plan of care for a patient with cirrhosis. For which reason should the nurse include the monitoring of vital signs to this plan of care? ANSWER I DON'T KNOW YET Unselected Renal failure Correct THE CORRECT ANSWER Portal hypertension Unselected Acute liver failure Unselected Esophageal varices

Portal hypertension Cirrhosis is the most common cause of portal hypertension. Portal hypertension occurs as a result of decreased circulation to the liver. Acute liver failure is a sudden interruption in liver function, usually occurring as a result of drug ingestion. Esophageal varices may occur as a result of an increase in portal vein pressure, but portal hypertension is the cause. Renal failure—more specifically, hepatorenal failure—occurs as a result of decreased perfusion to the kidneys caused by ascites.

The nurse notes that the abdominal girth of a patient with ascites has increased by 1 inch over the last week. Which assessment finding should the nurse suspect is being caused by this change in girth? ANSWER I DON'T KNOW YET Unselected Hunger Unselected Muscle twitching Unselected Drooping eyelids Correct THE CORRECT ANSWER Shortness of breath

Shortness of breath With significant ascites, patients may also experience decreased appetite, abdominal discomfort, and dyspnea due to pressure from the abdominal fluid. Muscle twitching and drooping eyelids are not associated with ascites.

The nurse is caring for a neonate with jaundice. Which treatment should the nurse expect to be prescribed for this patient? ANSWER I DON'T KNOW YET Unselected Administration of diuretic medications Unselected Reduced sodium in the diet Correct THE CORRECT ANSWER Therapy with specialized lighting Unselected Paracentesis

Therapy with specialized lighting Therapy with specialized lighting (bili lights) is a commonly applied therapy for newborns. Administration of diuretic medications is appropriate for ascites, not neonatal jaundice. Paracentesis is used for severe ascites, not neonatal jaundice.

A patient with a toothache of 3 weeks' duration has severely increased liver enzymes and acute liver failure is diagnosed. Which contributing factor should the nurse identify as the most likely cause of the patient's illness? ANSWER I DON'T KNOW YET Unselected Tooth infection affecting liver function Correct THE CORRECT ANSWER Use of large amounts of acetaminophen for pain Unselected History of work in a daycare center Unselected Recent consumption of shellfish

Use of large amounts of acetaminophen for pain Acute liver failure is often associated with drug abuse, especially the use of large amounts of acetaminophen, which is hepatotoxic when taken in large doses. Working in a daycare center and eating contaminated shellfish are more likely risk factors for hepatitis A. Tooth infection does not affect liver function.

For which reason are outbreaks of hepatitis A virus (HAV) and hepatitis B virus (HBV) more easily controlled than outbreaks of other types of hepatitis? ANSWER I DON'T KNOW YET Unselected HAV and HBV are only found in certain parts of the world. Correct THE CORRECT ANSWER Vaccines against HAV and HBV are available. Unselected HAV and HBV are not easily transmitted. Unselected Those who have been exposed to HAV or HBV develop active immunity.

Vaccines against HAV and HBV are available. Vaccines against HAV and HBV are available. These viruses are highly contagious and easily transmitted. Immunity against these viruses is acquired, but a person who is infected can become a carrier. HAV and HBV are common in all parts of the world.

The nurse is preparing teaching on gender differences in alcoholic liver disease. Which information should the nurse include? ANSWER I DON'T KNOW YET Unselected Women are more likely to develop alcoholic liver disease. Unselected Women are more likely to be hospitalized for alcoholic liver disease. Correct THE CORRECT ANSWER Women are more susceptible to liver damage from alcohol. Unselected Alcohol impacts men and women equally.

Women are more susceptible to liver damage from alcohol. Alcohol impacts men and women differently. Women are more susceptible to liver damage from alcohol than men. Men are more likely than women to develop alcoholic liver disease. Age, not gender, correlates to hospitalization for alcoholic liver disease.

A client attempts suicide by ingesting a large quantity of acetaminophen tablets. Which clinical manifestation should indicate acute liver​ failure? (Select all that​ apply.) A. Jaundice B. Coagulopathy C. Increased total bilirubin level D. Altered mental status E. Increased transaminases

​A. Jaundice B. Coagulopathy D. Altered mental status E. Increased transaminases Rationale: Although not all liver failure cases involve​ jaundice, when jaundice is​ noted, it is a sign of liver failure. Coagulopathy and altered mental status are the primary indications of acute liver failure. Increased transaminases would be seen in liver failure caused by acetaminophen. An increased total bilirubin level would align with viral liver​ failure; the bilirubin level would be low in a case of liver failure caused by acetaminophen.

he client with chronic liver failure has ascites. Which therapy should the nurse​ anticipate? A. Type and​ cross-match for blood transfusion. B. Decrease dietary intake of sodium. C. Hold oral diuretics. D. Increase oral fluids.

​B. Decrease dietary intake of sodium Rationale: The client with ascites would be placed on a sodium restriction of less than 2​ g/day to reduce fluid retention. Diuretics would be maximized to remove the excess fluid. Oral fluids might be restricted. Blood transfusion preparations would be appropriate for the client with esophageal varices.

he nurse is caring for a client with possible hepatitis D virus​ (HDV) infection. Which prescription should the nurse expect from the healthcare​ provider? A. Serum bilirubin level B. Hepatitis B serology C. Stool culture for hepatitis A D. Urine sample for urobilinogen

​B. Hepatitis B serology Rationale: HDV infection occurs as a coinfection with hepatitis B virus​ (HBV). Therefore, a HBV​ serology, along with HDV​ serology, will be prescribed to confirm presence of the infection. A stool culture for hepatitis A virus will not help confirm HDV. The presence of urobilinogen in the urine is indicative of hemolytic jaundice associated with cirrhosis. Increased serum bilirubin can indicate liver​ dysfunction, such as that in hepatitis and​ cirrhosis, but does not confirm a diagnosis of HDV infection.

The nurse is reviewing vital signs and laboratory findings in a newly admitted client. Which information relates most directly to a diagnosis of liver​ disease? A. Increased BUN B. Increased heart rate C. Increased​ AST, ALT, and alkaline phosphatase D. Increased WBC count

​C. Increased​ AST, ALT, and alkaline phosphatase Rationale: Increased aspartate aminotransferase​ (AST), alanine aminotransferase​ (ALT), and alkaline phosphatase are related directly to a diagnosis of liver disease. Increased BUN indicates kidney disease. An increased WBC count indicates an infection. An increased heart rate can be caused by a number of different conditions but is rarely a manifestation of liver disease.

The nurse is caring for a client with diabetes. Which teaching should the nurse provide to reduce this​ client's risk of developing nonalcoholic fatty liver​ disease? A. Stop smoking. B. Decrease sodium intake. C. Reduce to a healthy weight. D. Wash hands frequently.

​C. Reduce to a healthy weight. Rationale: Obesity and insulin resistance are linked to the development of nonalcoholic fatty liver​ disease, so the nurse should encourage the client to maintain a healthy weight. Smoking cessation and handwashing are good healthy​ habits, but they do not influence the development of nonalcoholic fatty liver disease. A​ reduced-sodium diet is instituted to treat​ ascites, not to prevent the development of nonalcoholic fatty liver disease.

The nurse is caring for a client with​ alcohol-related cirrhosis of the liver. Which manifestation should indicate that the client has developed complications with esophageal​ varices? A. Diarrhea B. Nausea C. Constipation D. Hematemesis

​D. Hematemesis Rationale: Hematemesis indicates bleeding esophageal​ varices, a complication of cirrhosis of the liver. Bleeding varices are not associated with​ nausea, diarrhea, or constipation.