Chapter 43 Assessment and Management of Patients with Hepatic Disorders

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 - A prothrombin time - Platelet count - A CT scan

A liver biopsy Explanation: A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

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: - Benadryl - Acetaminophen - Ibuprofen - Dextromethorphan

Acetaminophen Rationale: 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. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

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 - Urobilinogen - Creatinine - Chloride

Albumin Explanation: 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. Creatinine, urobilinogen, and chloride are normally found in urine.

Types of Cirrhosis

Alcoholic: most common type and is most frequently caused by chronic alcoholism and leads to malnutrition Postnecrotic: late result of viral hepatitis Biliary: results from prolonged bile duct obstruction, inflammation, and infection

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 - Anorexia for more than 3 days - Weight loss of 2 pounds in 3 days - Constipation for more than 2 days

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

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

Clay-colored stools Explanation: 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. In obstructive jaundice, urine tends to be dark amber (not straw-colored) as a result of soluble bilirubin in the urine. Hematocrit levels aren't affected by obstructive jaundice. Because obstructive jaundice prevents bilirubin from reaching the intestine (where it's converted to urobilinogen), the urine contains no urobilinogen.

Cirrhosis

Compensated - presents often times with vague symptoms - may be discovered secondary to a routine physical examination - Vascular spiders, reddened palms, morning indigestion, flatulent dyspepsia, abdominal pain, firm, enlarger liver Decompensated - results from failure of the liver to synthesize proteins , and clotting factors - ascites, jaundice, muscle wasting, weight loss, clubbing of fingers, hypotension, sparse body hair

Which is an age-related change of the hepatobiliary system? - Decreased prevalence of gallstones - Increased drug clearance capability - Enlarged liver - Decreased blood flow

Decreased blood flow Explanation: 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 nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? - Aspirate a sample of the drainage for culture. - Promptly report this assessment finding to the primary provider. - Irrigate the drainage system with normal saline as prescribed. - Document the presence of normal bile output.

Document the presence of normal bile output. Rationale: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration? - Electrocardiogram changes - Liver enzyme changes - Urinary output changes - Electrolytes level changes

Electrocardiogram changes Explanation: Vasopressin (Pitressin) is administered during the management of an urgent situation with an acute esophageal bleed because of its vasoconstrictive properties in the splanchnic, portal, and intrahepatic vessels. This medication also causes coronary artery constriction that may dispose clients with coronary artery disease to cardiac ischemia; therefore, the nurse observes the client for evidence of chest pain, ECG changes, and vital sign changes. Vasopressin will does not infer with urinary output, electrolytes, or liver enzymes.

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? - Elevated white blood cell count - Elevated alpha-fetoprotein - Decreased alkaline phosphatase levels - Decreased AST levels

Elevated alpha-fetoprotein Explanation: 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 nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones? - Colonoscopy - Abdominal x-ray - Endoscopic retrograde cholangiopancreatography (ERCP) - Cholecystectomy

Endoscopic retrograde cholangiopancreatography (ERCP) Explanation: ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder.

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? - Excrete bile - Convert urea into ammonia - Break down coagulation factors - Breakdown amino acids

Excrete bile Explanation: The liver forms and excretes bile, synthesizes amino acids from the breakdown of proteins, converts ammonia into urea, and synthesizes the factors needed for blood coagulation.

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? - Obstructive - Nonobstructive - Hemolytic - Hepatocellular

Hemolytic Explanation: 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. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? - Portal hypertension - Asterixis - Cirrhosis - Hepatic encephalopathy

Hepatic encephalopathy Explanation: Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? - Infection with hepatitis G is similar to hepatitis A. - Hepatitis A is frequently spread by sexual contact. - Hepatitis C increases a person's risk for liver cancer. - Hepatitis B is transmitted primarily by the oral-fecal route.

Hepatitis C increases a person's risk for liver cancer. Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? - High-dose corticosteroids - Paracentesis - Azathioprine - Liver transplantation

High-dose corticosteroids Explanation: Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdraw fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis.

The assessment of a client admitted with increased ascites related to cirrhosis reveals the following: pulse 86 beats per minute and weak, respirations 28 breaths per minute, blood pressure 130/88 mm Hg, and pulse oximetry 90%. Which nursing diagnosis should receive top priority? - Fatigue - Ineffective breathing pattern - Imbalanced nutrition: less than body requirements - Excess fluid volume

Ineffective breathing pattern Explanation: 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 respiratory rate and low oxygen saturation would indicate the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what? - Transfusion of packed red blood cells and fresh-frozen plasma (FFP) - IV administration of immune globulins - Lobectomy - Liver transplantation

Liver transplantation Explanation: Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery.

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 - Serum sodium level of 135 mEq/L - Serum potassium level of 3.5 mEq/L - Blood pH of 7.25

Loss of 2.2 lb (1 kg) in 24 hours Explanation: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

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? - Maintaining fluid volume - Controlling bleeding - Relieving the client's anxiety - Maintaining the airway

Maintaining the airway Explanation: 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.

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? - Provide the client with nonprescription laxatives. - Measure abdominal girth according to a set routine. - Report the condition to the physician immediately. - Ask the client about food intake.

Measure abdominal girth according to a set routine. Explanation: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

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? - An allergic reaction to the contrast media used during the liver biopsy - Normal postprocedural pain, with a change in the level of consciousness resulting from the pre-existing fever - Peritonitis from bleeding in the liver caused by the liver biopsy - Perforation of the colon caused by the liver biopsy

Peritonitis from bleeding in the liver caused by the liver biopsy Explanation: 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. It is rare to have a perforation of the colon after a biopsy. Liver biopsy doesn't involve the use of contrast media. The client's symptoms are not normal for a liver biopsy.

Which is the most common cause of esophageal varices? - Asterixis - Ascites - Jaundice - Portal hypertension

Portal hypertension Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

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? - Ascites and orthopnea - Gynecomastia and testicular atrophy - Dyspnea and fatigue - Purpura and petechiae

Purpura and petechiae Explanation: 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. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

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? - Clay-colored stools - Liver function tests approaching normal - Jaundice - Rash

Rash Explanation: 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. Jaundice and clay-colored stools would be characteristic of the icteric phase. Liver function tests returning to normal would be noted in the posticteric phase.

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? - Treat the esophageal varices. - Cure the cirrhosis. - Reduce fluid accumulation and venous pressure. - Promote optimal neurologic function.

Reduce fluid accumulation and venous pressure. Explanation: Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

After undergoing a liver biopsy, a client should be placed in which position? - Right lateral decubitus position - Semi-Fowler's position - Prone position - Supine position

Right lateral decubitus position Explanation: After a liver biopsy, the client is placed on the right side (right lateral decubitus position) to exert pressure on the liver and prevent bleeding. Semi-Fowler's position and the supine and prone positions wouldn't achieve this goal.

In what location would the nurse palpate for the liver? - Left lower quadrant - Right lower quadrant - Right upper quadrant - Left upper quadrant

Right upper quadrant Rationale: A palpable liver presents as a firm, sharp ridge with a smooth surface.

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

Scurvy

Gynecomastia is a common side effect of which of the following diuretics? - Furosemide - Vasopressin - Spironolactone - Nitroglycerin (IV)

Spironolactone Explanation: Gynecomastia is a common side effect caused by spironolactone. Vasopressin is used for bleeding esophageal varices and is not a diuretic. Nitroglycerin (IV) may be used with vasopressin to counteract the effects of vasoconstriction from the vasopressin.

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? - Ammonium chloride - Spironolactone - Furosemide - Acetazolamide

Spironolactone Explanation: The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss. Oral diuretic agents such as furosemide may be added but should be used cautiously because long-term use may induce severe hyponatremia (sodium depletion). Acetazolamide and ammonium chloride are contraindicated because of the possibility of precipitating hepatic encephalopathy and coma.

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? - Stage 3 - Stage 4 - Stage 1 - Stage 2

Stage 2

The nurse should teach the patient to assess for internal bleeding. What should the patient be monitoring? - Bleeding gums - Bruising - Stools

Stools

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern? - The client reports nausea and anorexia. - The skin on the client's abdomen has multiple spider-shaped blood vessels. - The client has gained 2 kg from the previous day. - The client's hands flap back and forth when the arms are extended.

The client's hands flap back and forth when the arms are extended. Explanation: Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and, if untreated, a hepatic coma may occur.

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 didn't take his morning dose of lactulose (Cephulac). - The client is relaxed and not in pain. - The client is avoiding the nurse. - The client's hepatic function is decreasing.

The client's hepatic function is decreasing. Explanation: The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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: - Severe infections and high fevers. - Excessive diuresis and dehydration. - The digestion of dietary and blood proteins. - Excess potassium loss subsequent to prolonged use of diuretics.

The digestion of dietary and blood proteins. Explanation: Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (i.e., bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia.

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 B - Potassium - Oral bile acids - Vitamin K

Vitamin K Explanation: Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency. Potassium would be given only if the client's serum potassium levels were low. Oral bile acids are not prescribed for a client with carcinoma of the head of the pancreas; they are given to dissolve gallstones. Vitamin B has no implications in the surgery.

Which condition indicates an overdose of lactulose? - Hypoactive bowel sounds - Fecal impaction - Watery diarrhea - Constipation

Watery diarrhea

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. Ascites b. Hemorrhoids c. Excess storage of vitamin C d. Accelerated behaviors and mental processes e. Enlarged liver size

a. Ascites b. Hemorrhoids e. Enlarged liver size Explanation: 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. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.

The nurse is caring for a client 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. Measure abdominal girth daily. b. Assess and document vital signs every 4 hours. c. Monitor number of bowel movements per day. d. Perform daily weights. e. Measure urine output every 8 hours.

a. Measure abdominal girth daily. d. Perform daily weights. e. Measure urine output every 8 hours. Explanation: 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. 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. Monitoring the number of bowel movements is not required, though the volume would be recorded as part of output.

Which of the following the are early manifestations of liver cancer? Select all that apply. a. Pain b. Vomiting c. Fever d. Continuous aching in the back e. Increased appetite f. Jaundice

a. Pain d. Continuous aching in the back Explanation: Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever and vomiting are not associated manifestations.

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. Typically there is a spontaneous recovery. b. Transmission of the virus is possible with oral-anal contact during sex. c. The incubation period for this virus is up to 4 months. d. There is a 50% risk that cirrhosis will develop. e. There is a 70% chance that jaundice will occur.

a. Typically there is a spontaneous recovery. b. Transmission of the virus is possible with oral-anal contact during sex. e. There is a 70% chance that jaundice will occur.

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply. a. stretch marks b. foul-smelling breath c. increased abdominal girth d. visible distended veins e. rapid weight gain

a. stretch marks c. increased abdominal girth d. visible distended veins e. rapid weight gain Explanation: The presence and extent of ascites are assessed by percussion of the abdomen. When fluid has accumulated in the peritoneal cavity, the flanks bulge when the patient assumes a supine position. Increased abdominal girth and rapid weight gain are common presenting symptoms of ascites. The patient may be short of breath and uncomfortable from the enlarged abdomen, and striae and distended veins may be visible over the abdominal wall. Foul-smelling breath is not a clinical manifestation of ascites.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: - anorexia, nausea, and vomiting. - abdominal ascites. - severe abdominal pain radiating to the shoulder. - eructation and constipation.

anorexia, nausea, and vomiting. Rationale: Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

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. Aphthous stomatitis b. Petechiae c. Cyanosis of the lips d. Ecchymoses e. Jaundice

b. Petechiae d. Ecchymoses e. Jaundice Explanation: The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas (bruises), spider angiomas, and palmar erythema. Cyanosis of the lips is indicative of a problem with respiratory or cardiovascular dysfunction. Aphthous stomatitis is a term for mouth ulcers and is a gastrointestinal abnormal finding.

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. a. Ingestion of undercooked beef b. Suboptimal sanitary habits c. Sexual activity d. Consumption of sewage-contaminated water or shellfish e. Infection at school

b. Suboptimal sanitary habits c. Sexual activity d. Consumption of sewage-contaminated water or shellfish e. Infection at school Explanation: Typically, a child or a young adult acquires the infection at school through poor hygiene, hand-to-mouth contact, or close contact during play. The virus is carried home, where haphazard sanitary habits spread it through the family. An infected food handler can spread the disease, and people can contract it by consuming water or shellfish from sewage-contaminated waters. Outbreaks have occurred in day care centers and institutions as a result of poor hygiene among people with developmental disabilities. Hepatitis A can be transmitted during sexual activity. It is not contracted through the consumption of undercooked beef.

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: - cholelithiasis. - appendicitis. - cirrhosis. - peptic ulcer disease.

cirrhosis. Explanation: 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. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

AST is found mainly in

heart, muscle, liver

What is the recommended dietary treatment for a client with chronic cholecystitis? - low-residue diet - high-fiber diet - low-fat diet - low-protein diet

low-fat diet Explanation: The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications.

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? - medications becoming ineffective in clients with liver disease - need for more frequently divided doses - need for increased drug dosages - metabolism of medications

metabolism of medications Rationale: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.

Most of the liver's metabolic functions are performed by: - islets of Langerhans. - parenchymal cells. - canaliculi cells. - Kupffer cells.

parenchymal cells.

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: - elevated liver enzymes and low serum protein level. - subnormal clotting factors and platelet count. - subnormal serum glucose and elevated serum ammonia levels. - elevated blood urea nitrogen and creatinine levels and hyperglycemia.

subnormal serum glucose and elevated serum ammonia levels. Explanation: 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. Elevated liver enzymes, low serum protein level, subnormal clotting factors and platelet count, elevated blood urea nitrogen and creatine levels, and hyperglycemia aren't as directly related to the client's level of consciousness.

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 - bradycardia and tachypnea - bradycardia and bradypnea - tachycardia and bradypnea

tachycardia and tachypnea Explanation: The compensatory stage is the first stage of shock. During this stage, the sympathetic nervous system (SNS) is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia, and the respiratory system, causing tachypnea. Thus, tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: - wash her hands after touching the client. - place the client in a private room. - wear a gown when providing personal care for the client. - wear a mask when handling the client's bedpan.

wash her hands after touching the client. Explanation: 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.