211 Final- Cirrhosis

An elderly patient with several comorbidities has experienced a massive upper GI hemorrhage from esophageal varices. No treatment has been initiated yet. What signs and symptoms does the nurse expect? A) Tachycardia and hypotension B) Alert and oriented times 3 C) Mild anemia without hypoxemia D) Normal peripheral circulation

A) Tachycardia and hypotension

A triage nurse in the emergency department is assessing a client who presented with reports of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this client's presentation? A. "How many alcoholic drinks do you typically consume in a week?" B. "To the best of your knowledge, are your immunizations up to date?" C. "Have you ever worked in an occupation where you might have been exposed to toxins?" D. "Has anyone in your family ever experienced symptoms similar to yours?"

A. "How many alcoholic drinks do you typically consume in a week?"

A nurse is caring for a client with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the client has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? A. Asterixis B. Constructional apraxia C. Fetor hepaticus D. Palmar erythema

A. Asterixis

A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? A. Two to three soft bowel movements daily B. Significant increase in appetite and food intake C. Absence of nausea and vomiting D. Absence of blood or mucus in stool

A. Two to three soft bowel movements daily

A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care? A. Measurement of abdominal girth and body weight B. Assessment for variceal bleeding C. Assessment for signs and symptoms of jaundice D. Monitoring of results of liver function testing

B. Assessment for variceal bleeding

A client 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? A. Keep client NPO until the results of test are known. B. Keep client NPO until the client's gag reflex returns. C. Administer analgesia until post-procedure tenderness is relieved. D. Give the client a cold beverage to promote swallowing ability.

B. Keep client NPO until the client's gag reflex returns.

A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response? A. Ensure that the client's sodium intake does not exceed recommended levels. B. Report this finding to the primary provider due to the possibility of hepatic encephalopathy. C. Inform the primary provider that the client should be assessed for alcoholic hepatitis. D. Implement interventions aimed at ensuring a calm and therapeutic care environment.

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

A client 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 client's treatment? A. Decisional conflict B. Deficient knowledge C. Death anxiety D. Disturbed thought processes

C. Death anxiety

A client with esophageal varices is being cared for in the ICU. The varices have begun to bleed. The client has Ringer lactate at 150 cc/hr. infusing. The nurse should also anticipate what intervention? A. Positioning the client supine B. Administering diuretics C. Oxygen by nasal cannula D. Administering volume expanders

D. Administering volume expanders

A nurse is participating in the emergency care of a client who has just developed variceal bleeding. What intervention should the nurse anticipate? A. Infusion of intravenous heparin B. IV administration of albumin C. STAT administration of vitamin K by the intramuscular route D. IV administration of octreotide

D. IV administration of octreotide

A patient with severe cirrhosis has a new prescription for propranolol (Inderal). The nurse is confident the patient understands teaching regarding their new medication when the patient states which of the following? a. "This medicine will decrease my myocardial oxygen consumption" b. "This medicine will help lower my risk for bleeding in the esophagus" c. (blank option, didn't write it) d. (blank option, didn't write it)

b. "This medicine will help lower my risk for bleeding in the esophagus"

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

b. I need to avoid protein in my diet.

A critically ill patient with cirrhosis has developed hepatic encephalopathy. What is the most effective therapeutic management strategy? A) Surgical portosystemic shunt B) Increased nutritional protein C) Lactulose or neomycin enterally D) Sedation with midazolam (Versed)

C) Lactulose or neomycin enterally

A patient has an acute upper gastrointestinal hemorrhage secondary to esophageal varices. What is the underlying pathophysiology of this type of gastrointestinal hemorrhage? A) Helicobacter pylori infection of esophagus, stomach, and duodenum B) Prolonged stress from multiple causes C) Portal hypertension from cirrhosis or other liver disease D) Overwhelming infection of jejunum and ileum

C) Portal hypertension from cirrhosis or other liver disease

Intravenous vasopressin (Pitressin) has been ordered for a patient with recurrent esophageal varices causing upper gastrointestinal hemorrhage. What is the purpose of this therapy? A) Increases systemic blood pressure in shock B) Increases myocardial oxygen use and demand C) Reduces blood flow to the mesenteric circulation D) Causes constriction of the splanchnic arteries

D) Causes constriction of the splanchnic arteries

A patient with esophageal variceal bleeding unresponsive to endoscopic therapy is receiving a balloon tamponade tube. Which of the following is an appropriate nursing intervention related to this procedure? A) Warm the tube before the physician inserts it. B) Lower the head of the bed so that the patients feet are above his heart. C) Encourage the patient to cough. D) Clean and lubricate the patients nostrils.

D) Clean and lubricate the patients nostrils.

A patient with severe cirrhosis has hepatic encephalopathy. Appropriate interventions for this problem include: a. Monitoring of ALT and hemoglobin b. Monitoring of serum ammonia levels and limiting of protein c. Monitoring of Blood Urea Nitrogen levels (BUN), bilirubin and encouragement of high calorie diet d. Limiting of salt and encouragement of protein rich foods

b. Monitoring of serum ammonia levels and limiting of protein

A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous.

c. I will help you identify a support system.

Which assessment question is priority for the nurse to ask the client dx with end stage liver failure secondary to alcoholic cirrhosis? a. How many years have you been drinking alcohol b. Have you completed an advanced directive c. When did you have your last alcoholic drink d. What foods did you eat at your last meal?

c. When did you have your last alcoholic drink

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

d. Assess the client for airway patency.

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

d. Mid-sternal chest pain