PREP U Ch. 43

A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are: A. Cryoprecipitate and fresh frozen plasma B. Fresh frozen plasma and whole blood C. Platelets and packed RBCs D. Whole blood and albumin

A. Cryoprecipitate and fresh frozen plasma The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These products include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors.

Which of the following diagnostic studies definitely confirms the presence of ascites? A. Ultrasound of liver and abdomen B. Colonoscopy C. Computed tomography of abdomen D. Abdominal x-ray

A. Ultrasound of liver and abdomen Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites.

Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? A. Alcohol B. Ammonia C. Bicarbonate D. Calcium

B. Ammonia Lactulose (Cephulac) is administered to reduce serum ammonia levels. Cephulac does not influence calcium, bicarbonate, or alcohol levels.

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? A. Normal activities may be resumed in 1 month B. Normal activities may be resumed in 1 week C. Normal activities may be resumed in 2 weeks D. Normal activities may be resumed the day after surgery

B. Normal activities may be resumed in 1 week A prolonged recovery period usually is unnecessary. Most clients resume normal activities within 1 week.

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. Hepatocellular jaundice B. Obstructive jaundice C. Cirrhosis of the liver D. Hemolytic jaundice

B. Obstructive jaundice Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract.

A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching? A. Increase the amount of potassium in the diet B. The amount of protein is not restricted in the diet C. Increase the amount of magnesium in the diet D. Decrease the amount of fats in the diet

B. The amount of protein is not restricted in the diet Clients with hepatic encephalopathy and their families are advised that protein intake should not be restricted in hepatic encephalopathy, as was recommended in the past. Protein intake should be maintained at 1.2 to 1.5 g/kg per day.

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of this symptom is: A. Hepatitis B B. Hepatitis A C. Acute cholecystitis D. Pancreatitis

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

C. On the right side Immediately after the biopsy, assist the client to turn on to the right side; place a pillow under the costal margin, and caution the client to remain in this position. 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.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? A. Baked chicken with sweet potato french fries, cornbread, and tea B. Ham and cheese sandwich, baked beans, potatoes, and coffee C. Pancakes with butter and honey, and orange juice D. Omelet with green peppers, onions, mushrooms, and cheese, with milk

C. Pancakes with butter and honey, and orange juice Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration.

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

C. Vaccine 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.

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. A. Insulin B. Valproic acid C. Ketoconazole D. Acetaminophen E. Diazepam

D. Acetaminophen C. Ketoconazole B. Valproic acid Many medications (including acetaminophen, ketoconazole, and valproic acid) are responsible for hepatic dysfunction and disease. A thorough medication history should address all current and past prescription medications, over-the-counter medications, herbal remedies, and dietary supplements.

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? A. Yellow-green B. Blood tinged C. Black and tarry D. Clay-colored or whitish

D. Clay-colored or whitish Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract.

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

D. Sandostatin In an actively bleeding patient, medications are given initially because they can be obtained and given more quickly than other therapies. Sandostatin, a synthetic analog of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices and lacks the vasoconstrictive effects of vasopressin.

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

D. Vasopressin Vasopressin may be the initial therapy for esophageal varices because it produces constriction of the splanchnic arterial bed and decreases portal hypertension.

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply. A. Acute pain and discomfort B. Potential for infection C. Alterations in respiratory function

A. Acute pain and discomfort B. Potential for infection C. Alterations in respiratory function Monitor for potential for infection related to invasive procedure and poor physical condition. Monitor for pain related to extensive surgical incision. Monitor for alterations in respiratory function related to extensive surgical incisions, immobility, and prolonged anesthesia. Client is at risk for fluid volume deficit related to hemorrhage and loss of fluids.

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: A. B B. E C. C D. A

A. B 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.

When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? A. Caput medusae B. Cutaneous spider angioma C. Palmar erythema D. Gynecomastia

A. Caput medusae Caput medusa is a term used to denote the appearance of dilated veins over the client's abdomen.

A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones? A. Chenodiol B. Tacrolimus C. Cyclosporine D. Pancreatin

A. Chenodiol Chenodiol suppresses hepatic synthesis of cholesterol and cholic acid to dissolve gallstones. It is administered orally to dissolve gallstones and may require long-term therapy for effectiveness.

A client is admitted for suspected GI disease. Assessment data reveal muscle, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: A. Cirrhosis B. Appendicitis C. Peptic ulcer disease D. Cholelithiasis

A. Cirrhosis 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.

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. A. Hemorrhoids B. Accelerated behaviors and mental processes C. Enlarged liver size D. Ascites E. Excess storage of vitamin C

A. Hemorrhoids C. Enlarged liver size D. Ascites Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location.

A client was admitted to a critical care unit with esophageal varices and a precarious physical condition. What predisposes the client to have bleeding varices? Select all that apply. A. Little protective tissue to protect fragile veins B. Rough food C. Straining at stool D. Chemical irritation E. Decreased portal pressure

A. Little protective tissue to protect fragile veins B. Rough food C. Straining at stool D. Chemical irritation The varices are at risk for bleeding if they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation. Straining at stool may cause the varices to bleed.

The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem? A. Perform passive ROM exercises four times a day B. Arrange for a low air loss bed C. Reposition the client every 4 hours D. Restrict dietary protein intake

B. Arrange for a low air loss bed Initiating the use of an alternating-pressure mattress or low air loss bed decreases the risk for skin breakdown due to prolonged pressure on bony prominences. The other answers do not apply.

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. Lactulose C. Kanamycin D. Cholestyramine

B. Lactulose Lactulose is administered to detoxify ammonium and to act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients.

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? A. Excess fluid volume B. Imbalanced nutrition: less than body requirements C. Ineffective breathing pattern D. Fatigue

C. Ineffective breathing pattern In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences.

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 this disorder? A. MRI B. Coagulation studies C. Liver biopsy D. Radioisotope liver scan

C. Liver biopsy A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure.

A client who has worked for a company that produces paint and varnishing compounds for 24 years is visiting the clinic reporting chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of the skin and sclera. The client reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis is the likely cause of the client's symptoms? A. Respiratory B. Alcoholic C. Postnecrotic D. Biliary

C. Postnecrotic Postnecrotic cirrhosis results from destruction of liver cells secondary to infection (e.g., hepatitis), metabolic liver disease, or exposure to hepatotoxins or industrial chemicals.

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? A. Gynecomastia and testicular atrophy B. Dyspnea and fatigue C. Purpura and petechiae D. Ascites and orthopnea

C. Purpura and petechiae 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.

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? A. Interferon alpha 2b, recombinant B. Ursodiol C. Tacrolimus D. Chenodiol

C. Tacrolimus In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used.

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. warfarin (Coumadin) B. furosemide (Lasix) C. spironolactone (Aldactone) D. phytonadione (Mephyton)

D. phytonadione (Mephyton) 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.

A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy? A. Stage 1 B. Stage 2 C. Stage 3 D. Stage 4

B. Stage 2 The signs listed in the question plus disorientation, mood swings, and increased drowsiness are all indicators of stage 2 hepatic encephalopathy. Refer to Table 25-2 in the text.

Which position should be used for a client undergoing a paracentesis? A. Upright at the edge of the bed B. Prone C. Supine D. Trendelenburg

C. Supine The client undergoing paracentesis should be placed in a supine or lateral decubitus position per the National Center for Biotechnology Information.

The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase? A. Clay-colored stools B. LFTs approaching normal C. Rash D. Jaundice

C. Rash During the prodromal or preicteric phase, the following signs and symptoms would be noted: urticaria; nausea; vomiting; anorexia; fever; malaise; arthralgia; headache; right upper quadrant (RUQ) discomfort; enlargement of the spleen, liver, and lymph nodes; weight loss; and rash.

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? A. Angiography B. Electroencephalogram C. Ultrasonography D. MRI

C. Ultrasonography A ultrasonography will show the size of the abdominal organs and the presence of masses.

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

C. Use strict birth control methods 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 educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet? A. Peanut butter B. Pear C. Hot dog D. Sliced ham

B. Pear The goal of treatment for the patient with ascites, a complication of cirrhosis, is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for low-sodium (2-g sodium) diets should be avoided (Dudek, 2010). Peanut butter, a hot dog, and ham are all high in sodium. A pear is not.

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? A. Constipation for more than 2 days B. Anorexia for more than 3 days C. Weight loss of 2 pounds in 3 days D. Change in the client's handwriting and/or cognitive performance

D. Change in the client's handwriting and/or cognitive performance. 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.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: A. Cannot tolerate high-glucose concentration B. Are at risk for gallbladder contraction C. Can digest high-fat foods D. Are at risk for hepatic encephalopathy

A. Cannot tolerate high-glucose concentration Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage.

When caring for a client with cirrhosis, which symptoms should a nurse report immediately? Select all that apply. A. Change in mental status B. Anorexia and dyspepsia C. Diarrhea or constipation D. Signs of GI bleed

A. Change in mental status D. Signs of GI bleed The nurse reports any change in mental status or signs of GI bleeding immediately because they indicate secondary complications. Reference:

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

A. Clay-colored stools 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.

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

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

A. Maintaining the airway 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 is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? A. Octreotide B. Spironolactone C. Lactulose D. Propanolol

A. Octreotide Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage.

What initial measure can the nurse implement to reduce the risk of injury for a client with liver disease? A. Pad the side rails on the bed B. Apply soft wrist restraints C. Prevent visitors, so as not to agitate the client D. Raise all 4 side rails on the bed

A. Pad the side rails on the bed Padding the side rails can reduce injury if the client becomes agitated or restless.

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

A. Subnormal serum glucose levels and elevated serum ammonia levels 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.

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

A. TIPS 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 practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. A. There is a 70% chance that jaundice will occur B. Typically there is a spontaneous recovery C. There is a 50% risk that cirrhosis will develop D. Transmission of the virus is possible with oral-anal contact during sex E. The incubation period for this virus is up to 4 months

A. There is a 70% chance that jaundice will occur B. Typically there is a spontaneous recovery D. Transmission of the virus is possible with oral-anal contact during sex The incubation period for hepatitis A is 15 to 50 days, with an average of 28 days. The risk of cirrhosis occurs with hepatitis B.

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

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

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

B. "You must have the second one in 1 month and the third in 6 months." 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 preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? A. Infection with hepatitis G is similar to hepatitis A B. Hepatitis C increases a person's risk for liver cancer C. Hepatitis A is frequently spread by sexual contact D. Hepatitis B is transmitted primarily by oral-fecal route

B. Hepatitis C increases a person's risk for liver cancer Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer.

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement-milk thistle- to help heal the liver. Which is the most appropriate response by the nurse? A. "Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your PCP." B. "You should not use herbal supplements in conjunction with medical treatment." C. "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your PCP of any herbal remedies being used so drug interactions can be evaluated." D. "You can use milk thistle instead of the medications you have been prescribed."

C. "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your PCP of any herbal remedies being used so drug interactions can be evaluated." Many clients who have end-stage liver disease (ESLD) with cirrhosis use the herb milk thistle (Silybum marianum) to treat jaundice and other symptoms. This herb has been used for centuries because of its healing and regenerative properties in liver disease. Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. The natural compound SAM-e (s-adenosylmethionine) may improve outcomes of liver disease by improving liver function, possibly by enhancing antioxidant function. Herbal supplements are used in conjunction with medical treatment and medications.

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? A. Jaundice B. Fatigue during ambulation C. Irritability and drowsiness D. Pruritus of the arms and legs

C. Irritability and drowsiness Although all the options are associated with hepatitis B, the onset of irritability and drowsiness suggests a decrease in hepatic function. To detect signs and symptoms of disease progression, the nurse should observe for disorientation, behavioral changes, and a decreasing level of consciousness and should monitor the results of liver function tests, including the blood ammonia level. If hepatic function is decreased, the nurse should take safety precautions.

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome? A. Identifying the source of exposure to hepatitis B. Establishing a stable home environment C. Minimizing social isolation D. Reducing the spread of the disease

C. Minimizing social isolation The nurse identifies psychosocial issues and concerns, particularly the effects of separation from family and friends if the client is hospitalized during the acute and infective stages. Convalescence may be prolonged, with complete symptomatic recovery sometimes requiring 3 to 4 months or longer. Even if not hospitalized, the client will be unable to attend school and/or work and must avoid sexual contact. Planning is required to minimize social isolation.

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 be very careful when preparing food for my family." D. "I'll take all my medications as ordered."

A. "How did this happen? I've been faithful my entire marriage." 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.

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 generally be limited to the equivalent of: A. 1 drink B. 2 drinks C. 3 drinks D. 4 drinks

A. 1 drink Current guidelines from the CDC and the Dietary Guidelines for Americans define moderate alcohol consumption as up to one drink per day for women and up to two drinks per day for women. Current guidelines from the Canadian Centre on Substance Use and Addiction are up to 10 drinks per week with no more than 2 drinks per day for women and up to 15 drinks per week with no more than 3 drinks per day for men. A drink is commonly defined as 12 ounces of 5% alcohol content beer or cider, 5 ounces of wine, and 1.5 ounces of 80 proof distilled alcohol. Reference:

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. A. Disturbed body image related to changes in appearance, sexual dysfunction, and role function B. Activity intolerance related to fatigue, general deniability, muscle wasting and discomfort C. Risk for injury related to altered clotting mechanisms

A. Disturbed body image related to changes in appearance, sexual dysfunction, and role function B. Activity intolerance related to fatigue, general deniability, muscle wasting and discomfort C. Risk for injury related to altered clotting mechanisms Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased gastrointestinal motility, and anorexia.

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? A. ERCP B. Cholecystectomy C. Abdominal x-ray D. Colonoscopy

A. ERCP ERCP locates stones that have collected in the common bile duct.

A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. A. Instructing the client to remove salty and salted foods from the diet B. Assisting with placement of TIPS C. Mobilizing the client every 2 hours D. Administering prescribed spironolactone E. Taking the client's weight every 3-4 days

A. Instructing the client to remove salty and salted foods from the diet B. Assisting with placement of TIPS D. Administering prescribed spironolactone

Which of the following the are early manifestations of liver cancer? Select all that apply. A. Pain B. Vomiting C. Jaundice D. Increased appetite E. Continuous aching in the back F. Fever

A. Pain E. Continuous aching in the back Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back.

Most of the liver's metabolic functions are performed by: A. Parenchymal cells B. Kupffer cells C. Islet of Langerhans D. Canaliculi cells

A. Parenchymal cells The parenchymal cells perform most of the liver's metabolic functions.

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 A. Petechiae B. Ecchymoses C. Cyanosis of the lips D. Jaundice E. Aphthous stomatitis

A. Petechiae B. Ecchymoses D. Jaundice A client was admitted to a critical care unit with esophageal varices and a precarious physical condition. What predisposes the client to have bleeding varices? Select all that apply.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? A. Radioisotope liver scan B. Angiography C. MRI D. EEG

A. Radioisotope liver scan A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction.

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

A. Scurvy Scurvy may result from a vitamin C deficiency. Night blindness, hypoprothrombinemia, and beriberi do not result from a vitamin C deficiency.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should A. Wash her hands after touching the client

A. Wash her hands after touching the client To maintain enteric precautions, the nurse must wash her hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.

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? A. "Does your work expose you to chemicals?" B. "How often do you drink alcohol?" C. "Have you had an infection recently?" D. "What type of over-the-counter pain reliever do you use?"

B. "How often do you drink alcohol?" The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important.

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. Chloride B. Albumin C. Creatinine D. Urobilinogen

B. Albumin 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.

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. A. Decreased DTR's B. Alterations in mood C. Report of headache D. Insomnia E. Agitation

B. Alterations in mood E. Agitation D. Insomnia The earliest symptoms of hepatic encephalopathy include both mental status changes and motor disturbances. The client appears confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and has restlessness and insomnia at night. To assess for mental deterioration, the nurse will assess general behavior, orientation, and speech as well as cognitive abilities and speech patterns.

A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? A. Biliary colic B. Cholelithiasis C. Cholecystitis D. Hepatitis

B. Cholelithiasis Initially, with cholelithiasis clients experience belching, nausea, and right upper quadrant discomfort, with pain or cramps after high-fat meal. Symptoms become acute when a stone blocks bile flow from the gallbladder.

A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? A. Decreased alkaline phosphatase levels B. Elevated alpha-fetoprotein C. Decreased AST levels D. Elevated white blood cell count

B. Elevated alpha-fetoprotein Alpha-fetoprotein, a serum protein normally produced during fetal development, is a marker that, if elevated, can induce a primary malignant liver tumor. Total bilirubin and serum enzyme levels may be elevated. White blood cell count elevation would indicate an inflammatory response.

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

B. Fecal-oral 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.

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. A. Blood coagulation B. Fluid accumulation C. Venous pressure D. Fluid output

B. Fluid accumulation C. Venous pressure Methods of treating portal hypertension aim to reduce venous pressure and fluid accumulation.

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? A. Perforation of the colon caused by the liver biopsy B. Peritonitis from bleeding in the liver caused by the liver biopsy C. Normal post procedural pain, with a change in LOC resulting from pre-existing fever D. An allergic reaction to the contrast media used during the liver biopsy

B. Peritonitis from bleeding in the liver caused by the liver biopsy After any invasive procedure, the nurse must stay alert for complications in the affected region—in this case, the abdomen. This client exhibits classic signs and symptoms of peritonitis caused by blood or bile after the liver biopsy. There is a reason to suspect bleeding resulting from the liver biopsy. I

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

B. Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver.

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. Peripheral vascular assessment related to immobility D. Urinary output related to increased sodium retention

B. Respiratory assessment related to increased thoracic pressure. 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.

A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by: A. Reducing blood pressure in the portal B. Selective vasodilation of the portal system C. Constricting the splanchnic arteries D. Using a beta-adrenergic blocking action

B. Selective vasodilation of the portal system Sandostatin slows the flow of blood (via vasodilation) from internal organs to the portal system, thus reducing 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 is avoiding the nurse B. The client's hepatic function is decreasing C. The client didn't take his morning dose of lactulose D. The client is relaxed and not in pain

B. The client's hepatic function is decreasing The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction.

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? A. Vitamin K B. Vitamin A C. Riboflavin D. Thiamine

B. Vitamin A Vitamin A deficiency results in night blindness and eye and skin changes.

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. Vitamin K deficiency C. Vitamin A deficiency D. Folic acid deficiency

B. Vitamin K deficiency Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.

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

C. A liver biopsy A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure.

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. Dextromethorphan B. Ibuprofen C. Acetaminophen D. Benadryl

C. Acetaminophen Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: A. Hepsera B. Epivir C. Alpha-interferon D. Baraclude

C. Alpha-interferon Alpha-interferon is a biologic response modifier that is highly effective for treatment of hepatitis B.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A. Abdominal ascites B. Eructation and constipation C. Anorexia, nausea, and vomiting D. Severe abdominal pain radiating to the shoulder

C. Anorexia, nausea, and vomiting Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness.

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? A. Ataxia B. Fetor hepaticus C. Asterixis D. Constructional apraxia

C. Asterixis Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy (Fig. 49-13). Reference:

A client with acute pancreatitis has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, lab results indicate hypovolemia. What will the physician order to treat the large amount of protein-rich fluid that has been released into the client's tissues and peritoneal cavity? Select all that apply. A. Dextrose B. Sodium C. Diuretics D. Albumin

C. Diuretics D. Albumin Diuretics are given if circulating fluid is excessive. IV albumin may be given to pull fluid trapped in the peritoneum back into the circulation.

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. A. Zinc storage B. Carbohydrate metabolism C. Glucose metabolism D. Protein metabolism E. Ammonia conversion

C. Glucose metabolism D. Protein metabolism E. Ammonia conversion Functions of the liver include the metabolism of glucose, protein, fat, and drugs; conversion of ammonia; storage of vitamins and iron; formation of bile; and excretion of bilirubin.

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

C. Hemolytic Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders.

In what location would the nurse palpate for the liver? A. LUQ B. LLQ C. RUQ D. RLQ

C. RUQ The liver may be palpable in the right upper quadrant. A palpable liver presents as a firm, sharp ridge with a smooth surface.

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? A. Instillation B. Lavage C. Gavage D. Decompression

D. Decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting.

A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response? A. "You must have received an infected blood transfusion." B. "You could have gotten it by I.V. drug use." C. "You probably got it by engaging in unprotected sex." D. "You may have eaten contaminated restaurant food."

D. "You may have eaten contaminated restaurant food." Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers.

A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? A. 16-49 grams B. 76-99 grams C. 50-75 grams D. 100-126 grams

D. 100-126 grams Daily protein intake should be maintained at 1.2 to 1.5 g/kg per day. To calculate protein intake, multiply the 84 kg by the low and high ranges: (84 kg × 1.2 = 100 g; 84 kg × 1.5 = 126 g). This client would require a daily protein range from 100 to 126 grams.

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 CT scan C. Upper endoscopy D. Abdominal paracentesis

D. Abdominal paracentesis Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain.

Which type of deficiency results in macrocytic anemia? A. Vitamin A B. Vitamin C C. Vitamin K D. Folic acid

D. Folic acid Folic acid deficiency results in macrocytic anemia.

A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? A. Portal hypertension B. Hepatitis C C. Esophageal varices D. Hepatic encephalopathy

D. Hepatic encephalopathy The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? A. Warm moist skin B. Polyuria C. Bradycardia D. Hypotension

D. Hypotension Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: A. Bile overproduction B. Gallbladder disease C. Glucose underproduction D. Liver disorder

D. Liver disorder Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: A. Low sodium level B. Decreased prothrombin time C. Low hemoglobin D. Low platelet count

D. Low platelet count Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

Which term describes the passage of a hollow instrument into a cavity to withdraw fluid? A. Ascites B. Dialysis C. Asterixis D. Paracentesis

D. Paracentesis Paracentesis may be used to withdraw fluid (ascites) if the accumulated fluid is causing cardiorespiratory compromise.

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

D. Spironolactone Gynecomastia is a common side effect caused by spironolactone.

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. Oral bile acids C. Vitamin B D. Vitamin K

D. Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.) A. Assess and document vital signs every 4 hours B. Monitor number of bowel movements per day C. Monitor daily weights D. Measure urine output every 8 hours E. Measure abdominal girth daily

E. Measure abdominal girth daily C. Monitor daily weights Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. 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.

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? A. Increased motor activity B. Asterixis C. Negative Babinski reflex D. Irritability

Hepatic encephalopathy is manifested by numerous central nervous system effects including: disorientation, confusion, personality changes, memory loss, a flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (referred to as fetor hepaticus), and lethargy to deep coma.

A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? A. Epinephrine B. Glucagon C. Ocreotide (Somatostatin) D. Vasopressin (Pitressin)

Octreotide (Sandostatin), a synthetic analogue of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin.