Prep-U Ch 49 Med Surg

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

Destruction of the patient's liver tumor

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace?

Disposing of sharps appropriately and not recapping needles

A patient complaining of shortness of breath is admitted with the diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor?

*Albumin*-With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity.

A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient's care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence.

1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.

Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction

A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.

Alterations in mood Agitation Insomnia

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

Acetaminophen Ketoconazole Valproic acid

Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

Alcoholic cirrhosis

Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?

Ammonia

Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction?

Asterixis

The nurse is completing a morning assessment on a patient with cirrhosis. Which datum obtained by the nurse will be of most concern?

Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the patient has hepatic encephalopathy and, if untreated, a hepatic coma may occur

During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?

Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation.

When caring for a client with cirrhosis, which of the following symptoms should a nurse report immediately? Select all that apply.

Change in mental status Signs of GI bleeding

A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate?

Liver disorder

Which of the following would be the least important assessment in a patient diagnosed with ascites?

Foul-smelling breath would not be considered an important assessment for this patient

Which of the following would be the most important nursing assessment in a patient diagnosed with ascites?

Daily measurement and recording of abdominal girth and body weight are essential to assess the progression of ascites and its response to treatment

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.

Enlarged liver size Ascites Hemorrhoids

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is ________.

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 patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions?

Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma.

A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy.

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin

A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority?

Implementation of infection-control measures

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply.

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

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.

Instructing the client to remove salty and salted foods from the diet Administering prescribed spironolactone (Aldactone) Assisting with placement of a transjugular intrahepatic portosystemic shunt

A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?

Keep patient NPO until the patient's gag reflex returns.

A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what?

Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications?

Metabolism of medications the malfunctioning liver cannot metabolize many substances

A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem?

Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. *Assessments related to ascites are daily weights and abdominal girths*

Which of the following the are early manifestations of liver cancer? Select all that apply.

Pain Continuous aching in the back

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which of the following nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply.

Potential for infection Acute pain and discomfort Alterations in respiratory function

A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response?

Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.

A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patient's continuing care, the nurse should prioritize which of the following risk diagnoses?

Risk for Infection Related to Immunosuppressant Use

Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?

Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased BP, and decreased urine output

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention?

Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses

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?

Tachycardia and tachypnea

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges.

When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately?

The nurse should report any change in mental status immediately because they indicate secondary complications. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis

A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose.

Which type of positioning should be utilized for a patient undergoing a paracentesis?

The patient should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patient's treatment?

The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patient's likely fear of death, which is a realistic possibility.

Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis?

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

Which of the following diagnostic studies definitely confirms the presence of ascites?

Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites

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

Vasopressin (Pitressin)- it produces constriction of the splanchnic arterial bed and decreases portal pressure

Which of the following medications is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin may be the initial therapy for esophageal varices, because it constricts the splanchnic arterial bed and decreases portal hypertension

Which of the following indicates an overdose of lactulose?

Watery diarrhea

Which of the following is an age-related change of the hepatobiliary system?

*Decreased blood flow*, decreased drug clearance capability, increased presence of gallstones, and a steady decrease in size and weight of the liver.

A nurse is teaching a patient about the types of chronic liver disease. The patient's teaching is determined to be effective based on the correct identification of which of the following types of cirrhosis caused by scar tissue surrounding the portal areas?

*Alcoholic cirrhosis*-the scar tissue characteristically surrounds the portal areas, is most frequently caused by chronic alcoholism and is the most common type of cirrhosis

A patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate?

*On the right side*-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

Louisa Collins, a 52-year-old high school science teacher, is your client on the medical-surgical floor at the hospital where you practice nursing. She is undergoing diagnostics to determine what is causing her liver disorder. As you discuss her condition, Louisa asks questions pertaining to liver physiology and cellular function. Which liver cells perform most of the liver's metabolic functions?

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

The nurse is teaching a patient 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 patient chooses which of the following food choices from the menu?

The patient with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia levels.The patient's ascites indicates that a low-sodium diet is needed