Exam 4 (Chapter 49) Assessment and MGMT of Pt's w/Hepatic Disorders

9. A patient who has had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices? a. Vasopressin (Pitressin) b. Epinephrine c. Octreotide (Sandostatin) d. Glucagon

c. Octreotide (Sandostatin)

11. The nurse is educating a patient who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the teaching? a. Decrease the amount of fats in the diet b. Increase the amount of potassium in the diet c. Decrease the amount of protein in the diet d. Increase the amount of magnesium in the diet

c. Decrease the amount of protein in the diet

2. 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 ascites is increasing? Select all that apply. a. Measure urine output every 8 hours b. Assassin document Vital Signs every 4 hours c. Measure abdominal girth daily d. Perform daily weights e. Monitor number of bowel movements per day

c. Measure abdominal girth daily d. Perform daily weights

1. The nurse is educating a patient with cirrhosis about the importance of maintaining a low sodium diet. What food item would be permitted on a low sodium diet? a. Peanut butter b. A pear c. Hot dogs d. Sliced ham

b. A pear

3. The nurse is concerned about a potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? a. Furosemide (Lasix) b. Spironolactone (Aldactone) c. Acetazolamide (Diamox) d. Bumetanide (Bumex)

b. Spironolactone (Aldactone)

Liver function tests are not abnormal until ___________% of the liver is revealed to be damaged.

70%

Hepatic lobectomy for cancer can be successful when the primary site is localized. Because of the regenerative capacity of the liver, a surgeon can remove up to ___________% of liver tissue.

90%

The majority of blood supply to the liver, which is rich in nutrients from the gastrointestinal tract, comes from the _________________________.

portal vein

The liver synthesizes prothrombin only if there is enough _________________.

vitamin K

Thiamine

Beriberi and polyneuritis

Vitamin C

Hemorrhagic lesions of scurvy

7. The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi Fowler's position. what is the nurses priority assessment of this patient? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention c. Peripheral vascular assessment related to immobility d. Skin assessment related to increase in bile salts

a. Respiratory assessment related to increased thoracic pressure

5. A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observes they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis? a. The physician will use an ultrasound guided paracentesis b. The Physician will not perform the procedure c. The Physician will proceed with the paracentesis at the bedside d. The Physician will have the nurse administer packed RBC's is prior to the paracentesis

a. The physician will use an ultrasound guided paracentesis

8. 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? a. 40 hours after the last dose of medication is given b. Until the gag reflex returns c. Until the patient expresses thirst d. 4/6 hours after the procedure

b. Until the gag reflex returns

15. A student accepted into a nursing program must begin receiving the Hepatitis B series of injections. The student asked when the next to injection should be administered. What is the best response by the instructor? a. You must have the second one in two weeks and the third in one month b. You must have the second one in one month and the third in six months c. You must have the second one in six months and the third in one year d. You must have the second one in one year and the third the following year

b. You must have the second one in one month and the third in six months

The two major complications of a liver biopsy are ________________ and ____________________.

bleeding, bile peritonitis

The substance necessary for the manufacture of bile salts by hepatocytes is ___________________.

cholesterol

Hepatocellular carcinoma is caused by ____________________, _________________, ___________________, and ___________________.

chronic liver disease, hepatitis B, hepatitis C, cirrhosis

6. What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? a. Diuretic therapy b. Therapeutic paracentesis c. Platelet infusions d. Albumin infusion

d. Albumin infusion

4. The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin-aldosterone and sympathetic nervous system and decreased responsiveness to diuretic therapy? a. Prone b. Supine c. Left lateral Sims d. Upright

d. Upright

The most common reason for liver transplantation is exposure to ________________.

hepatitis C

Vitamin K

hypoprothrombinemia

Pyridoxine

skin and neurologic changes

The mortality rate for hepatitis B can be as high as _________%.

10%

__________________, caused by contaminated needles shared by drug users, is also the most common reason for liver transplantation.

Hepatitis C

Folic acid

Macrocytic anemia

Vitamin A

Night blindness

____________________________________ is the most common single cause of death in patients with cirrhosis.

Ruptured esophageal varices

14. A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse expect the patient may be experiencing? a. Riboflavin deficiency b. Folic acid deficiency c. Vitamin A deficiency d. Vitamin K deficiency

d. Vitamin K deficiency

The leading cause of death after liver transplantation is ______________________.

infection

Riboflavin

mucous membrane lesions

10. A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? a. Transjugular intrahepatic portosystemic shunting (TIPS) b. Vasopressin (Pitressin) c. Sclerotherapy d. Balloon tamponade

a. Transjugular intrahepatic portosystemic shunting (TIPS)

13. 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? a. Watery diarrhea b. Vomiting c. Ringing in the ears d. Asterixis

a. Watery diarrhea

12. 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? a. Constructional apraxia b. Fetor hepaticus c. Ataxia d. Asterixis

d. Asterixis: tremor of the hand when the wrist is extended Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. Fetor hepaticus a characteristically disagreeable odor to the breath that is a sign of liver failure Ataxia describes a lack of muscle control during voluntary movements, such as walking or picking up objects.