4660 Exam #2
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?
"How often do you drink alcohol?"
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?
"Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated."
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
"You may have eaten contaminated restaurant food"
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.
-Petechiae -Jaundice -Ecchymoses
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.
-Risk for injury related to altered clotting mechanisms -Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort -Disturbed body image related to changes in appearance, sexual dysfunction, and role function
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?
100 to 126 grams
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 liver biopsy
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:
Acetaminophen
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?
Albumin
The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?
Asterixis
Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?
Asterixis
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has?
Bleeding esophageal varices
A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention?
Discuss meals that include low-fat high-carbohydrate content
A patient receiving vasopressin for the management of active bleeding due to esophageal varices should be assessed for evidence of the drug's most serious complication. Therefore, the nurse should frequently check the patient's:
Electrocardiogram
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?
Endoscopic retrograde cholangiopancreatography (ERCP)
A 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses?
Hepatitis C
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
Hepatitis C increases a person's risk for liver cancer.
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?
Lactulose
What is the recommended dietary treatment for a client with chronic cholecystitis?
Low-fat diet
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?
Measure abdominal girth according to a set routine
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?
Reduce fluid accumulation and venous pressure
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?
The client's hepatic function is decreasing
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?
Vitamin A
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?
Vitamin K
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?
Watery diarrhea
A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response?
Decompression
Which type of deficiency results in macrocytic anemia?
Folic acid
A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?
Liver biopsy
Which symptoms will a nurse observe most commonly in clients with pancreatitis?
Severe, radiating abdominal pain
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:
Subnormal serum glucose and elevated serum ammonia levels
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply.
-Fluid accumulation -Venous pressure
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.)
-Measure abdominal girth daily -Perform daily weights
Which is an age-related change of the hepatobiliary system?
Decreased blood flow
The mode of transmission of hepatitis A virus (HAV) includes which of the following?
Fecal-oral
A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?
Hepatic Encephalopathy
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?
Loss of 2.2 lb (1 kg) in 24 hours
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications?
Metabolism of medications
A client has undergone a liver biopsy. Which postprocedure position is appropriate?
On the right side
What initial measure can the nurse implement to reduce risk of injury for a client with liver disease?
Pad the side rails on the bed
Which is the most common cause of esophageal varices?
Portal hypertension
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
Purpura and petechiae
A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed?
Radical pancreatuduodenectomy
After undergoing a liver biopsy, a client should be placed in which position?
Right lateral decubitus position
Gynecomastia is a common side effect of which of the following diuretics?
Spironolactone (Aldactone)
Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?
Spironolactone (Aldactone)
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
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:
The digestion of dietary and blood proteins
A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?
Until a gag reflex returns
Which position should be used for a client undergoing a paracentesis?
Upright at the edge of the bed
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?
Use strict birth control methods
Which of the following is the most effective strategy to prevent hepatitis B infection?
Vaccine
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
Vasopressin
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)
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?
"You must have the second one in 1 month and the third in 6 months."
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:
Cirrhosis
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?
Clay-colored or whitish
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?
Clay-colored stools
Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:
Cannot tolerate high-glucose concentration
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?
Change in the client's handwriting and/or cognitive performance
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?
Radioisotope liver scan