Chapter 58: Care of Patients with Liver Problems

SG#5 Patients with cirrhosis are susceptible to bleeding and easy bruising because there is a decrease in the production of bile in the liver preventing the absorption of which vitamin? a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K

d. Vitamin K

SG#17 The nurse who is assessing a patient with portal-systemic encephalopathy finds that the patient has fetor hepaticus, a positive Babinski's sign, and seizures, but no asterixis. The nurse identifies the patient as being in which stage of portal-systemic encephalopathy? a. Stage I prodromal b. Stage II impending c. Stage III stuporous d. Stage IV comatose

d.Stage IV comatose

SG#35 What is the priority focus in caring for a patient with advanced liver cancer? a. Hospice and end-of life care b. Getting placed on the liver transplant list c. Hepatic arterial infusion of chemotherapy d. Cryotherapy to freeze and destroy liver tumors

a. Hospice and end-of life care

SG#21 The patient with liver cancer will be discharged with a tunneled ascites drain. What statements by the patient indicate an understanding of the purpose of this device? Select all that apply a. "I will have this drain until I am able to get the tumor removed." b. "I will not remove more than 2000 mL of fluid at a time." c. "The drain will make breathing more comfortable for me after some fluid is removed." d. "After I drain off the extra fluid, I can remove the drain." e. "This drain will be useful to remove fluid from my belly when there is too much." f. "I will flush the tunneled ascites drain twice a day with normal saline."

b. "I will not remove more than 2000 mL of fluid at a time." c. "The drain will make breathing more comfortable for me after some fluid is removed." e. "This drain will be useful to remove fluid from my belly when there is too much."

SG#9 Which assessment finding indicates neurologic function deterioration in a patient with stage II cirrhosis? a. Fetor hepaticus b. Asterixis c. Palmar erythema d. Icterus

b. Asterixis

SG#12 A patient is scheduled for a procedure to place a stent in the biliary tract. For which procedure does the nurse provide patient teaching? a.Esophagogastroduodenoscopy (EGD) b.Endoscopic retrograde cholangiopancreatography (ERCP) c.Upper gastrointestinal (GI) series d.Cholangiogram

b.Endoscopic retrograde cholangiopancreatography (ERCP)

SG#41 The patient with cirrhosis is prescribed furosemide 60 mg orally each morning. Which patient care concept is at risk for this patient? a. Comfort b. Cellular regulation c. Immunity d. Fluid and electrolyte balance

d. Fluid and electrolyte balance

SG#45 The patient who needs a liver transplant asks the nurse where the livers come from. What is the nurse's best response? a. "Most commonly they come from family members" b. "Often they are harvested from cadavers" c. "Trauma victims are where most donor livers come from" d. "It is best if the liver comes from a blood relative"

c. "Trauma victims are where most donor livers come from"

SG#26 How many injections does a health care worker usually need to be protected with the hepatitis B vaccine? a. 1 b. 2 c. 3 d. 4

c. 3

SG#25 What is the major source of hepatitis B transmission to health care workers? a. Improper handwashing b. Needle sticks c. Touching contaminated surfaces d. Contact with infected stool

b. Needle sticks

13. A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

c. A 66-year-old who has a history of cirrhosis The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer.

SG#34 Which treatment offers the patient with liver cancer the possibility of long-term survival? a. Chemotherapy b. Selective internal radiation therapy c. Liver transplantation d. Hepatic arterial embolization

c. Liver transplantation

SG#43 The nurse is teaching a young woman about cirrhosis prevention by limiting alcohol intake. What is the nurse's best advice? a. "As few as two or three drinks per day over 10 years can lead to cirrhosis" b. "You should be alright as long as you drink less than five drinks per day" c. "Binge drinking, rather than drinking every day, reduces your risk for hepatitis or fatty liver" d. The amount of alcohol that causes cirrhosis does not vary by gender"

a. "As few as two or three drinks per day over 10 years can lead to cirrhosis"

SG#8 The nurse is assessing a male patient with cirrhosis. Which male-specific characteristics does the nurse expect to find? Select all that apply a. Gynecomastia b. Testicular atrophy c. Ascites d. Impotence e. Spider angiomas f. Petechiae

a. Gynecomastia b. Testicular atrophy d. Impotence

SG#42 Which factors may lead to hepatic encephalopathy in patients with cirrhosis? Select all that apply a. High-protein diet b. Hypervolemia c. Infection d. Constipation e. Hyperkalemia f. Use of illicit drugs

a. High-protein diet c. Infection d. Constipation f. Use of illicit drugs

4. A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

a. How frequently do you drink alcohol? b. Have you ever had sex with a man? e. Were you previously incarcerated? When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

SG#28 Which laboratory test result indicates permanent immunity to hepatitis A? a. Immunoglobulin G (IgG) antibodies b. Immunoglobulin M (IgM) antibodies c. A positive enzyme-linked immunosorbent assay (ELISA) d. The presence of anti-HAV antibodies

a. Immunoglobulin G (IgG) antibodies

16. A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic.

a. Instruct the client to sit in as upright a position as possible. The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.

SG#1 A patient with decompensated cirrhosis is at risk for which complications? Select all that apply a. Jaundice b. Esophageal varices c. Coagulation defects d. Hepatitis A virus (HAV) e. Spontaneous bacterial peritonitis f. Ascites

a. Jaundice b. Esophageal varices c. Coagulation defects e. Spontaneous bacterial peritonitis f. Ascites

5. A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? Select all that apply a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

a. Oxygen therapy c. Feet elevated on pillows d. Daily weights Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the clients stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

SG#39 Which patients would not be considered candidates for a liver transplant? Select all that apply a. Patient with metastatic tumors b. Patient with type 2 diabetes c. Patient with severe respiratory disease d. Patient with chronic liver disease e. Patient with advanced cardiac disease f. Patient who is unable to follow instructions

a. Patient with metastatic tumors c. Patient with severe respiratory disease e. Patient with advanced cardiac disease f. Patient who is unable to follow instructions

SG#15 A patient will undergo an abdominal paracentesis. Which factor provides an additional safety measure? a. The procedure is performed using ultrasound. b. The procedure is performed at the bedside. c. A trocar is inserted into the peritoneal cavity. d. General anesthesia is administered

a. The procedure is performed using ultrasound.

3. A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg

a. Urine output via indwelling urinary catheter is 20 mL/hr Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

10. A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication.

a. Use a pill organizer to ensure you take this medication as prescribed. Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.

SG#27 Which actions will help prevent viral hepatitis in health care workers? Select all that apply a. Wash hands before and after each patient b. Needleless systems c. Use contact and respiratory precautions d. After exposure to hepatitis A, get immunoglobulin (Ig) e. Report all cases of hepatitis to the health department f. Wear gloves during all patient contact

a. Wash hands before and after each patient b. Needleless systems d. After exposure to hepatitis A, get immunoglobulin (Ig) e. Report all cases of hepatitis to the health department

SG#16 The student nurse is caring for a patient with cirrhosis. Which action by the student nurse causes the supervising nurse to intervene? a. Uses a straight-edge razor to shave the patient b. Monitors for orthostatic changes of blood pressure c. Avoids intramuscular injections d. Uses a toothette for oral care

a.Uses a straight-edge razor to shave the patient

SG#13 The nurse is teaching a patient with cirrhosis about nutrition therapy. Which statement by the patient indicates teaching has been effective? a. "I will only use table salt with my dinner meal." b. "I will read the sodium content labels on all food and beverages." c. "I will avoid the use of vinegar." d. "I will not take vitamin supplements."

b. "I will read the sodium content labels on all food and beverages."

12. An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

b. Assess the client by gently palpating the abdomen for tenderness. The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

17. A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

b. Assist the client to void before the procedure. For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

SG#30 Which conditions place a patient at high risk for the development of fatty liver (steatosis)? Select all that apply a. Hypertension b. Diabetes mellitus c. Obesity d. Elevated lipid profile e. Alcohol abuse f. Hepatitis A

b. Diabetes mellitus c. Obesity d. Elevated lipid profile e. Alcohol abuse

SG#7 The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? a. Elevated sodium level b. Elevated ammonia level c. Increased blood urea nitrogen (BUN) d. Increased clotting time

b. Elevated ammonia level

SG#32 The nurse is assessing a patient with liver trauma and finds that the patient is confused with a blood pressure of 86/50 mm Hg; heart rate of 128/minute; and cool, clammy skin. What does the nurse suspect? a. Septic shock b. Liver hemorrhage c. Liver cancer d. GI bleeding

b. Liver hemorrhage

11. After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

c. I should eat plenty of fresh fruits and vegetables. The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

SG#37 The patient who had a liver transplant develops a heart rate of 134/minute, temperature of 102° F (38.8°C), jaundiced skin, and right upper quadrant pain. What does the nurse suspect? a. Liver infection b. Hypovolemic shock c. Liver transplant rejection d. Liver trauma from the transplant surgery

c. Liver transplant rejection

4. 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. Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

SG#2 What is the most common cause for Laennec's cirrhosis? a. Hepatitis C virus (HPC) b. Chronic biliary obstruction c. Autoimmune disorders d. Chronic alcoholism

d. Chronic alcoholism

5. 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 Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.

SG#19 The nurse is teaching a patient with cirrhosis about lactulose therapy. Which statement by the patient indicates the teaching has been effective? a. "This therapy will promote the removal of ammonia in my stool." b. "Constipation is a frequent side effect of this therapy." c. "I will know the therapy is working when I am less itchy." d. "The drug tastes bitter and is watery."

a. "This therapy will promote the removal of ammonia in my stool."

9. A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

a. A 20-year-old college student who has had several sexual partners Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

SG#14 When preparing a patient for paracentesis, what does the nurse do? Select all that apply a. Ask the patient to void before the procedure. b. Place the patient in the supine position. c. Weigh the patient before the procedure. d. Obtain the patient's heart rate. e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

a. Ask the patient to void before the procedure. c. Weigh the patient before the procedure. d. Obtain the patient's heart rate. e. Assess the patient's respiratory rate. f. Obtain the patient's blood pressure.

SG#44 The nurse is providing care for a patient with cirrhosis who has massive ascites and has developed hepatopulmonary syndrome. Which elements of nursing care are appropriate for this patient? Select all that apply a. Auscultate lungs every 4-8 hours for crackles b. Monitor the patient's oxygen saturation c. Elevate the head of the bead 15 degrees d. Apply oxygen therapy e. Weigh the patient every day f. Lower the patient's leg and feet

a. Auscultate lungs every 4-8 hours for crackles b. Monitor the patient's oxygen saturation d. Apply oxygen therapy e. Weigh the patient every day

7. A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory.

a. Diarrhea is expected; thats how your body gets rid of ammonia. The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

SG#40 The nurse is teaching a patient with cirrhosis about nutrition therapy. Which key points must the nurse include? Select all that apply a. Do not use table salt. b. Adding salt when cooking is acceptable. c. Eat small frequent meals. d. Drink supplemental liquids such as Ensure. e. Be sure to take a multivitamin every day. f. Avoid foods that are high in Vitamin K

a. Do not use table salt. c. Eat small frequent meals. d. Drink supplemental liquids such as Ensure. e. Be sure to take a multivitamin every day.

SG#24 Which people are in need of immunization against hepatitis B (HBV)? Select all that apply a. People who have unprotected sex with more than one partner b. Men who have sex with men c. Any patient scheduled for a surgical procedure d. Firefighters e. Health care providers f. Patients prescribed immunosuppressant drugs

a. People who have unprotected sex with more than one partner b. Men who have sex with men d. Firefighters e. Health care providers f. Patients prescribed immunosuppressant drugs

SG#31 In performing an assessment on a patient with liver trauma, what does the nurse expect to find? Select all that apply a. Right upper quadrant pain b. Increased blood pressure c. Guarding of the abdomen d. Bradypnea e. Kehr's sign f. Abdominal rigidity

a. Right upper quadrant pain c. Guarding of the abdomen e. Kehr's sign f. Abdominal rigidity

SG#47 The nurse is caring for a patient with acute viral hepatitis. What is the major care concern at this time? a. Providing three small meals a day b. Alternating periods of activity with periods of rest c. Monitoring for the development of jaundiced skin d. Teaching the patient the importance of avoiding alcohol intake

b. Alternating periods of activity with periods of rest

2. A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

b. Elevated international normalized ratio (INR) e. Elevated serum ammonia f. Elevated prothrombin time (PT) Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

SG#36 Administration of which drug has greatly improved the success of organ transplants? a. Telaprevir b. Entecavir c. Tenofovir d. Cyclosporine

d. Cyclosporine

SG#33 What test result is the tumor marker for cancers of the liver? a. Decreased alkaline phosphatase b. Increased serum ammonia c. Decreased serum total bilirubin d. Increased alpha-fetoprotein (AFP)

d. Increased alpha-fetoprotein (AFP)

3. A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps.

a. Apply lotion to the clients dry skin areas. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the clients nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

SG#11 Which elevated laboratory test results indicate hepatic cell destruction? Select all that apply a. Elevated serum aspartate aminotransferase(AST) b. Elevated serum alanine aminotransferase(ALT) c. Elevated lactate dehydrogenase (LDH) d. Decreased serum total bilirubin e. Increased fecal urobilinogen f. Increased International Normalized Ratio(INR)

a. Elevated serum aspartate aminotransferase(AST) b. Elevated serum alanine aminotransferase(ALT) c. Elevated lactate dehydrogenase (LDH) f. Increased International Normalized Ratio(INR)

SG#29 Which antiviral drugs are given to patients with chronic hepatitis B virus? Select all that apply a. Lamivudine b. Entecavir c. Tenofovir d. Oral ribavirin e. Adefovir f. Telaprevir

a. Lamivudine b. Entecavir c. Tenofovir e. Adefovir

SG#23 When teaching a group of adult patients measures for preventing hepatitis A (HAV), which information does the nurse include? Select all that apply a. Perform proper hand washing, especially after handling shellfish. b. Receive immune globulin within 14 days if exposed to the virus. c. Receive the HAV vaccine before traveling to Mexico or the Caribbean. d. After exposure, HAV symptoms always let the patient know something is wrong. e. Receive the vaccine if working in a longterm care facility f. Avoid unprotected sex with a person who has HAV.

a. Perform proper hand washing, especially after handling shellfish. b. Receive immune globulin within 14 days if exposed to the virus. c. Receive the HAV vaccine before traveling to Mexico or the Caribbean. e. Receive the vaccine if working in a longterm care facility

1. An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

a. Policies related to consistent use of Standard Precautions c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

SG#4 When admitting the patient with cirrhosis, the nurse assesses for which conditions related to splenomegaly as possible complications of the disease? a. Thrombocytopenia b. Bleeding esophageal varices c. Hepatorenal syndrome d. Portal hypertensive gastropathy

a. Thrombocytopenia

6. An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? Select all that apply a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

b. Tachycardia d. Confusion Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion.

SG#10 Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP) when caring for a patient with cirrhosis experiencing pruritus? a. Apply lotion to soothe the patient's skin b. Use lots of soap and hot water to cleanse the skin c. Assess the patient for signs of skin infection d. Encourage the patient to use distraction to avoid scratching

a. Apply lotion to soothe the patient's skin

15. 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. Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

6. A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.

b. Less protein in the diet will help prevent confusion associated with liver failure. A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

SG#38 Which procedure uses energy waves to heat cancer cells and kill them? a. Cryotherapy b. Selective internal radiation therapy (SIRT) c. Hepatic artery embolization d. Radiofrequency ablation (RFA)

d. Radiofrequency ablation (RFA)

2. A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

b. Provide a low-sodium diet. A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

19. A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here.

b. Viral hepatitis is not spread through casual contact. Although family members may be afraid that they will contract hepatitis C, the nurse should educate the clients family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the clients status with the brother.

14. A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better.

b. You should go to the hospital immediately to have your new liver checked out. Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

18. 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. Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the clients concerns by brushing off the clients comment. Attending AA may be appropriate, but this response doesnt address the clients concern. Making peace with the clients family may not be possible. This statement is not client-centered.

8. After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.

b. I may have been exposed when we ate shrimp last weekend. The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.

SG#46 The patient who just had a liver transplant develops oozing around two IV sites as well as some new bruising. What is the nurse's best action? a. Apply pressure to the IV sites b. Measure the size of the bruises c. Document these findings as the only action d. Notify the surgeon immediately

d. Notify the surgeon immediately

1. A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling.

b. I take a lot of Tylenol for my arthritis pain. Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day ofmacetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

SG#6 Which key points does the nurse include when teaching the patient with cirrhosis and his family about drug therapy before discharge? Select all that apply a. "Do not take over-the-counter medications unless approved by your health care provider." b. "The beta blocker called propranolol (Inderal) will cause your heart rate to in- crease." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or light- headedness to your health care provider right away." f. Your health care provider may prescribe a potassium supplement to replace losses

a. "Do not take over-the-counter medications unless approved by your health care provider." c. "The lactulose syrup should cause you to have two to three bowel movements every day." d. "Take your furosemide (Lasix) early in the day so that it does not keep you up at night." e. "Report any muscle weakness or light- headedness to your health care provider right away." f. Your health care provider may prescribe a potassium supplement to replace losses

SG#18 Which statements about a patient with cirrhosis and esophageal varices are accurate? Select all that apply a. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. b. Bleeding esophageal varices are a medical emergency. c. Esophageal balloon tamponade is often used to control bleeding esophageal varices. d. A nonselective beta blocker such as propranolol (Inderal) is prescribed to prevent varices from bleeding. e. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation. f. The bleeding appears as dark coffee grounds in emesis or stool

a. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. b. Bleeding esophageal varices are a medical emergency. d. A nonselective beta blocker such as propranolol (Inderal) is prescribed to prevent varices from bleeding. e. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation.

SG#20 How is neomycin sulfate (Mycifradin) used to treat patients with cirrhosis? a. It treats the current infection the patient has. b. It prevents future infections of the liver. c. It restores normal function to the liver cells. d. It decreases the rate of ammonia production

d. It decreases the rate of ammonia production

SG#22 Which statements about hepatitis are accurate?Select all that apply a. Hepatitis D is the leading cause of cirrhosis and liver failure in the U.S. b. Hepatitis A is spread through the fecal- oral route. c. Hepatitis B can be transmitted through unprotected sexual intercourse. d. Hepatitis carriers have chronic obvious signs of hepatitis B. e. Hepatitis C is transmitted by casual contact or intimate household contact. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

b. Hepatitis A is spread through the fecal- oral route. c. Hepatitis B can be transmitted through unprotected sexual intercourse. f. Hepatitis D only occurs with hepatitis B to cause viral replication.

SG#3 The nurse is assessing a patient with massive ascites. What related complication must the nurse monitor for with this patient? a. Bleeding due to fragile, thin-walled veins b. Hematemesis due to absence of clotting factors c. Increased ascites due to sodium and water retention d. Bruising due to low platelet count

c. Increased ascites due to sodium and water retention