Hepatic

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? Therapeutic paracentesis Diuretic therapy Albumin infusion Platelet infusions

albumin infusion Explanation: Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of postparacentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that the client is at risk for complications due to: low platelet count. low sodium level. decreased prothrombin time. low hemoglobin.

low platelet count. Prolonged prothrombin time (PT) and low platelet count place the client at high risk for hemorrhage. The client may receive intravenous (IV) administration of vitamin K or infusions of platelets before liver biopsy to reduce the risk of bleeding.

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching has been effective when the client chooses which food choice from the menu? Pancakes with butter and honey, and orange juice Ham and cheese sandwich, baked beans, potatoes, and coffee Omelet with green peppers, onions, mushrooms, and cheese with milk Baked chicken with sweet potato french fries, cornbread, and tea

Pancakes with butter and honey, and orange juice Teach clients to select a diet high in carbohydrates with protein intake consistent with liver function. The client should identify foods high in carbohydrates and within protein requirements (moderate to high protein in cirrhosis and hepatitis, low protein in hepatic failure). The client with acute hepatic encephalopathy is placed on a low-protein diet to decrease ammonia concentration. The other choices are all higher in protein. The client's ascites indicates that a low-sodium diet is needed, and the other choices are all high in sodium.

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 prothrombin time Platelet count A liver biopsy A CT scan

A liver biopsy

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor? Temperature Hemoglobin Bilirubin Albumin

Albumin

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: Baraclude Hepsera Alpha-interferon Epivir

Alpha-interferon

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? Anorexia for more than 3 days Change in the client's handwriting and/or cognitive performance Weight loss of 2 pounds in 3 days Constipation for more than 2 days

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

The results of a client's ammonia levels are normal, but the client is demonstrating asterixis. What should the nurse do? Ask the laboratory technician whether the sample appeared diluted. Check the source of the blood used for the ammonia levels. Assess the client again in 1 hour. Have the laboratory rerun the sample.

Check the source of the blood used for the ammonia levels.

client who has acute liver failure has developed cerebral edema. Which nursing interventions should be instituted? Select all that apply. Closely monitor the client's vital signs. Prepare to sedate the client chemically. Wrap the client in several warmed blankets. Position the client flat in bed. Instruct the client to cough and take a deep breath every hour.

Closely monitor the client's vital signs. Prepare to sedate the client chemically.

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? Urinary output changes Electrolytes level changes Liver enzyme changes Electrocardiogram changes

Electrocardiogram changes

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 Endoscopic retrograde cholangiopancreatography (ERCP) Abdominal x-ray Cholecystectomy

Endoscopic retrograde cholangiopancreatography (ERCP)

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

Hepatic encephalopathy

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. Hepatitis A is frequently spread by sexual contact. Hepatitis B is transmitted primarily by the oral-fecal route. Infection with hepatitis G is similar to hepatitis A.

Hepatitis C increases a person's risk for liver cancer.

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? Liver transplantation Azathioprine Paracentesis High-dose corticosteroids

High-dose corticosteroids

A client with right upper quadrant pain and weight loss is diagnosed with liver cancer. For which treatment will the nurse prepare the client when it is determined that the disease is confined to one lobe of the liver? Laser hyperthermia Chemotherapy Radiation Liver resection

Liver resection Surgical resection is the treatment of choice when liver cancer is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. The use of external-beam radiation for the treatment of liver tumors has been limited by the radiosensitivity of normal hepatocytes and the risk of destruction of normal liver parenchyma. Studies of clients with advanced cases of liver cancer have shown that the use of systemic chemotherapeutic agents leads to poor outcomes. Laser hyperthermia has been used to treat hepatic metastases.

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

Measure abdominal girth according to a set routine.

A 14-year-old students presents at the school nurse's office and asks, "Is it okay if I take an aspirin? My throat is sore." How should the nurse respond? "Do your parents let you take aspirin?" "Are you allergic to anything?" "Yes, but only take one tablet." "No, children and young people should not take aspirin

No, children and young people should not take aspirin."

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when the client will be able to resume normal activities. What information should the nurse provide? Normal activities may be resumed in 2 weeks. Normal activities may be resumed the day after surgery. Normal activities may be resumed in 1 month. Normal activities may be resumed in 1 week.

Normal activities may be resumed in 1 week.

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease? Apply soft wrist restraints Raise all four side rails on the bed Prevent visitors, so as not to agitate the client Pad the side rails on the bed

Pad the side rails on the bed

A client has acute liver failure. The nurse would assess for which skin changes? Select all that apply. Presence of pruritus Poor wound healing Pale mucous membranes Dark-brownish discolorations on the chest Presence of petechiae

Pale mucous membranes Presence of petechiae Presence of pruritus

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

Purpura and petechiae

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? Electroencephalography Radioisotope liver scan Magnetic resonance imaging Angiography

Radioisotope liver scan

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

Spironolactone

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

Spironolactone (Aldactone)

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 decrease responsiveness to diuretic therapy? Supine Left-lateral Sims' Prone Upright

Upright In patients with ascites, an upright posture is associated with activation of the renin-angiotensin-aldosterone system and sympathetic nervous system (Porth & Matfin, 2009). This causes reduced renal glomerular filtration and sodium excretion and a decreased response to loop diuretics.

Which of the following is the most effective strategy to prevent hepatitis B infection? Barrier protection during intercourse Avoid sharing toothbrushes Vaccine Covering open sores

Vaccine

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? Cimetidine Vasopressin Spironolactone Nitroglycerin

Vasopressin

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? Potassium Vitamin K Vitamin B Oral bile acids

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? Vomiting Watery diarrhea Ringing in the ears Asterixis

Watery diarrhea

A physician orders lactulose (Cephulac), 30 ml three times daily, when a client with cirrhosis develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor: stool frequency. urine output. abdominal girth. level of consciousness (LOC).

level of consciousness (LOC).

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

low-fat diet

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. elevated blood urea nitrogen and creatinine levels and hyperglycemia. subnormal serum glucose and elevated serum ammonia levels. subnormal clotting factors and platelet count.

subnormal serum glucose and elevated serum ammonia levels. 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.

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? Spironolactone Cholestyramine Kanamycin Lactulose

Lactulose

The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed? Thoracentesis Abdominal CT scan Upper endoscopy Abdominal paracentesis

Abdominal paracentesis

A client has developed massive ascites. The nurse will monitor this client for the development of which priority finding? Increased temperature Difficulty breathing Diarrhea Diuresis

Difficulty breathing

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? Peanut butter A pear Sliced ham Hot dog

A pear

A client has hepatic encephalopathy (HE) that is currently grade I. Which reflex findings would the nurse expect if the client's HE progresses to grade II? Normal reflexes Reflexes are brisker than normal. Overall reflexes are diminished. Absence of reflexes A positive Babinski

A positive Babinski Reflexes are brisker than normal.

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? Urobilinogen Creatinine Albumin Chloride

Albumin

A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? Cholecystitis Hepatitis Cholelithiasis Biliary colic

Cholelithiasis

Which nursing assessment is most important in a client diagnosed with ascites? Daily measurement of weight and abdominal girth Auscultation of abdomen Palpation of abdomen for a fluid shift Assessment of the oral cavity for foul-smelling breath

Daily measurement of weight and abdominal girth

A client with alcoholic cirrhosis develops hematemesis. For which intervention will the nurse prepare this client? Blood transfusion Endoscopy Nasogastric tube insertion Magnetic resonance imaging

Endoscopy Endoscopy is used to identify the bleeding site, along with ultrasonography, computed tomography scanning, and angiography.

A patient who 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? Glucagon Octreotide (Sandostatin) Epinephrine Vasopressin (Pitressin)

Octreotide (Sandostatin)

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

Reduce fluid accumulation and venous pressure.

A client is bleeding from esophageal varices and requires placement of a Sengstaken-Blakemore tube. How should the nurse explain the use of this tube to the client's family? Select all that apply. "Your loved one will not be able to talk while this tube is in place." "This tube acts as a shunt to divert bleeding away from the lungs." "The physician will be placing the tube in a few minutes." "Using this tube eliminates the need for surgery." "This tube has a balloon on it that will be inflated to put pressure on the area that is bleeding."

The physician will be placing the tube in a few minutes." "This tube has a balloon on it that will be inflated to put pressure on the area that is bleeding."

Which of the following diagnostic studies definitely confirms the presence of ascites? Ultrasound of liver and abdomen Colonoscopy Computed tomography of abdomen Abdominal x-ray

Ultrasound of liver and abdomen

A nurse is developing an informational session about hepatitis B infection. Which information should the nurse include? Select all that apply. Hepatitis B is spread by contaminated food or water. Hepatitis B can be considered a sexually transmitted infection. A vaccination against hepatitis B is available. Hepatitis B is endemic in the United States. Hepatitis B is rarely seen in middle-aged adults.

A vaccination against hepatitis B is available. Hepatitis B can be considered a sexually transmitted infection.

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? Irrigate the drainage system with normal saline as prescribed. Promptly report this assessment finding to the primary provider. Aspirate a sample of the drainage for culture. Document the presence of normal bile output.

Document the presence of normal bile output.

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? Imbalanced nutrition: less than body requirements Fatigue Excess fluid volume Ineffective breathing pattern

Ineffective breathing pattern

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. Petechiae Cyanosis of the lips Aphthous stomatitis Jaundice Ecchymoses

Jaundice Petechiae Ecchymoses

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 Maintaining the airway Relieving the client's anxiety

Maintaining the airway

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome? Identifying the source of exposure to hepatitis Reducing the spread of the disease Establishing a stable home environment Minimizing social isolation

Minimizing social isolation

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? Tacrolimus Chenodiol Ursodiol Interferon alfa-2b, recombinant

Tacrolimus Explanation: In preparation for a liver transplant, a client receives immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used. Chenodiol and ursodiol are agents used to dissolve gallstones. Recombinant interferon alfa-2b is used to treat chronic hepatitis B, C, and D to force the virus into remission.

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. Severe infections and high fevers. Excess potassium loss subsequent to prolonged use of diuretics. Excessive diuresis and dehydration.

The digestion of dietary and blood proteins.