Liver Disease Ch.49 E2
A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate? a) Liver disorder b) Gallbladder disease c) Bile overproduction d) Glucose underproduction
• Pain • 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 is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding? a) A slightly enlarged liver with palpably hard edges b) A nonpalpable liver c) Similar liver size and texture as in younger adults d) A slightly decreased size of the liver
A slightly decreased size of the liver Explanation: The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges.
A patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate? a) On the left side b) Trendelenburg c) On the right side d) High Fowler's
right In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the patient on his left side is not indicated. Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy. High Fowler's position is not indicated for the patient after liver biopsy.
Which type of deficiency results in macrocytic anemia? a) Folic acid b) Vitamin C c) Vitamin K d) Vitamin A
Folic acid Correct Explanation: Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.
During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus? a) Wearing a condom during sexual contact b) Avoiding chemicals that are toxic to the liver c) Following proper hand-washing techniques d) Limiting alcohol intake
Following proper hand-washing techniques Correct Explanation: Avoiding contact with the hepatitis E virus through good hygiene, including hand-washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-oral route, principally through contaminated water in areas with poor sanitation. Consequently, none of the other listed preventative measures is indicated.
Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Foul-smelling breath b) Weight c) Palpation of abdomen for a fluid shift d) Measurement of abdominal girth
Foul-smelling breath Correct Explanation: Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.
Which of the following symptoms will a nurse observe most commonly in clients with pancreatitis? a) Increased and painful urination b) Increased appetite and weight gain c) Severe, radiating abdominal pain d) Black, tarry stools and dark urine
Severe, radiating abdominal pain Correct Explanation: The most common symptom in clients with pancreatitis is severe midabdominal to upper abdominal pain, radiating to both sides and straight to the back.
Which of the following is the recommended dietary treatment for a client with chronic cholecystitis? a) Low-residue diet b) Low-fat diet c) High-fiber diet d) Low-protein diet
You selected: Low-fat diet Correct 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 low-fat diet is recommended because a malfunctioning gallbladder will not secrete sufficient bile to breakdown dietary fats.
A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy? a) Stage 4 b) Stage 2 c) Stage 3 d) Stage 1
You selected: Stage 3 Correct Explanation: Patients in the third stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased deep tendon reflexes, rigidity of extremities, marked EEG abnormalities. Patients in stages 1 and 2 exhibit clinical symptoms that are not as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of deep tendon reflexes, flaccidity of extremities, and EEG abnormalities.
A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient's presentation? a) "To the best of your knowledge, are your immunizations up to date?" b) "Have you ever worked in an occupation where you might have been exposed to toxins?" c) "How many alcoholic drinks do you typically consume in a week?" d) "Has anyone in your family ever experienced symptoms similar to yours?"
"How many alcoholic drinks do you typically consume in a week?" Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status, occupational risks, and family history are also relevant considerations, but alcohol use is a more common etiologic factor in liver disease.
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? a) Rest and watchful waiting b) A regimen of antiviral medications c) Administration of immune globulins d) Administration of fresh-frozen plasma (FFP)
A regimen of antiviral medications Correct Explanation: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP are not indicated.
A nurse is amending a patient's plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient's care plan? a) Administration of beta-adrenergic blockers as ordered b) Vitamin B12 injections as ordered c) Mobilization with assistance at least 4 times daily d) Administration of diuretics as ordered
Administration of diuretics as ordered Correct Explanation: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following? a) Ammonia b) Bicarbonate c) Alcohol d) Calcium
Ammonia Correct Explanation: Lactulose (Cephulac) is administered to reduce serum ammonia levels. Cephulac does not influence calcium, bicarbonate, or alcohol levels.
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease? a) Asterixis b) Constructional apraxia c) Palmar erythema d) Fetor hepaticus
Asterixis Correct Explanation: The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetor hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.
A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. For what complication is this patient at risk? a) Central nervous system damage b) Pigment stones in portal circulation c) Chronic jaundice d) Hepatomegaly
Central nervous system damage Correct Explanation: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for CNS damage. There are not specific risks of hepatomegaly or chronic jaundice resulting from high bilirubin.
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize? a) The patient will exercise three times a week. b) The patient will take immunosuppressive agents as required. c) The patient will obtain measurement of drainage from the T-tube. d) The patient will monitor for signs of liver dysfunction.
Correct response: The patient will take immunosuppressive agents as required. Explanation: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.
A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment? a) Destruction of the patient's liver tumor b) Destruction of a liver abscess c) Restoration of portal vein patency d) Reversal of metastasis
Destruction of the patient's liver tumor Correct Explanation: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.
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? a) Aspirate a sample of the drainage for culture. b) Document the presence of normal bile output. c) Promptly report this assessment finding to the primary care provider. d) Irrigate the drainage system with normal saline as ordered.
Document the presence of normal bile output. Correct Explanation: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.
Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Hemolytic b) Obstructive c) Hepatocellular d) Nonobstructive
Hemolytic Correct Explanation: Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations? a) Hepatitis C b) Portal hypertension c) Hepatic encephalopathy d) Esophageal varices
Hepatic encephalopathy Correct Explanation: The earliest symptoms of hepatic encephalopathy include minor mental changes and motor disturbances. The client appears slightly confused and unkempt and has alterations in mood and sleep patterns. The client tends to sleep during the day and have restlessness and insomnia at night. As hepatic encephalopathy progresses, the client may become difficult to awaken and completely disoriented with respect to time and place. With further progression, the client lapses into frank coma and may have seizures. Simple tasks, such as handwriting, become difficult.
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia? a) Warm moist skin b) Polyuria c) Hypotension d) Bradycardia
Hypotension Correct Explanation: Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.
A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse's priority? a) Implementation of infection-control measures b) Close monitoring of skin integrity and color c) Frequent assessment of the patient's psychosocial status d) Administration of antiretroviral medications
Implementation of infection-control measures Correct Explanation: Infection control is paramount following liver transplantation. This is a priority over skin integrity and psychosocial status, even though these are valid areas of assessment and intervention. Antiretrovirals are not indicated.
Liver Disease Chapt. 49 PrepU
Liver Disease Chapt. 49 PrepU
A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what? a) Liver transplantation b) Lobectomy c) IV administration of immune globulins d) Transfusion of packed red blood cells and fresh-frozen plasma (FFP)
Liver transplantation Correct 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 patient with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade therapy is used temporarily to control hemorrhage and stabilize the patient. In planning care, the nurse gives the highest priority to which of the following goals? a) Controlling bleeding b) Maintaining the airway c) Maintaining fluid volume d) Relieving the patient's anxiety
Maintaining the airway Correct 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 is 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.
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. Which of the following is an important education topic regarding ingestion of medications? a) The need for more frequently divided doses b) Metabolism of medications c) Medications will no longer be effective in clients with liver disease. d) The need for increased drug dosages
Metabolism of medications Correct Explanation: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.
A young patient with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The patient asks the nurse how long she needs to stay in the hospital. In planning care for the patient, the nurse identifies impaired psychosocial issues and assigns the highest priority to which of the following patient outcomes? a) Identifying the source of exposure to hepatitis b) Establishing a stable home environment c) Minimizing social isolation d) Reducing the spread of the disease
Minimizing social isolation Explanation: The nurse identifies psychosocial issues and concerns, particularly the effects of separation from family and friends if the patient is hospitalized during the acute and infective stages. Convalescence may be prolonged, with complete symptomatic recovery sometimes requiring 3 to 4 months or longer. Even if not hospitalized, the patient will be unable to attend school and/or work and must avoid sexual contact. Planning is required to minimize social isolation.
To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? a) Prevent visitors, so as not to agitate the patient b) Pad the side rails on the bed c) Raise all four side rails on the bed d) Apply soft wrist restraints
Pad the side rails on the bed Correct Explanation: Padding the side rails can reduce injury if the patient becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint and this would not be an initial measure to implement. Family and friends most generally assist in calming a patient.
A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a patient's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The patient is placed in a high Fowler's position and a BP cuff is secured around the arm in preparation for which of the following procedures? a) Abdominal ultrasound b) Paracentesis c) Dialysis d) Liver biopsy
Paracentesis Correct Explanation: Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a puncture or a small surgical incision through the abdominal wall under sterile conditions. Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise.
Which of the following terms describes the passage of a hollow instrument into a cavity for the withdrawal of fluid? a) Paracentesis b) Dialysis c) Ascites d) Asterixis
Paracentesis Correct Explanation: Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances.
Connie, a 60-year-old retired financial planner, is recently diagnosed with carcinoma of the pancreas. She has just met with her surgeon and feels overwhelmed by all the information she was given. She tells you that she is having the head of the pancreas removed; additionally, the surgeon is also removing the duodenum and stomach and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is Connie having performed? a) Total pancreatectomy b) Cholecystojejunostomy c) Radical pancreatoduodenectomy d) Distal pancreatectomy
Radical pancreatoduodenectomy Explanation: This surgical procedure involves removing the head of the pancreas, resecting the duodenum and stomach, and redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the jejunum. This surgical procedure is a rerouting of the pancreatic and biliary drainage systems, which may be done to relieve obstructive jaundice. This measure is considered palliative only. A pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may be total, in which case the entire organ is removed, usually along with the spleen, gallbladder, common bile duct, and portions of the small intestine and stomach. A distal pancreatectomy is a surgical procedure to remove the bottom half of the pancreas.
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction? a) Angiography b) Electroencephalogram (EEG) c) Magnetic resonance imaging (MRI) d) Radioisotope liver scan
Radioisotope liver scan Explanation: A radioisotope liver scan assesses liver size and hepatic blood flow and obstruction. An MRI is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An EEG is used to detect abnormalities that occur with hepatic coma.
Which of the following liver function studies is used to show the size of the liver and hepatic blood flow and obstruction a) MRI b) Angiography c) Radioisotope liver scan d) EEG
Radioisotope liver scan Explanation: A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction. A MRI is used to identify normal structures and abnormalities of the liver and biliary tree. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An EEG is used to detect abnormalities that occur with hepatic coma.
A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the patient's cognition and behavior. What is the nurse's most appropriate response? a) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy. b) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis. c) Implement interventions aimed at ensuring a calm and therapeutic care environment. d) Ensure that the patient's sodium intake does not exceed recommended levels.
Report this finding to the primary care provider due to the possibility of hepatic encephalopathy. Correct Explanation: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient's mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patient's physiologic deterioration.
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? a) Bradycardia and tachypnea b) Bradycardia and bradypnea c) Tachycardia and bradypnea d) Tachycardia and tachypnea
Tachycardia and tachypnea Correct Explanation: With shock, 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. Tachycardia is associated with shock, but the patient will have tachypnea, not bradypnea. Tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock. Although tachypnea is associated with shock, tachycardia, not bradycardia, occurs with shock.
Why should total parental nutrition (TPN) be used cautiously in clients with pancreatitis? a) Such clients can digest high-fat foods. b) Such clients are at risk for gallbladder contraction. c) Such clients are at risk for hepatic encephalopathy. d) Such clients cannot tolerate high-glucose concentration.
Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.
A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient's current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? a) Two to 3 soft bowel movements daily b) Significant increase in appetite and food intake c) Absence of blood or mucus in stool d) Absence of nausea and vomiting
Two to 3 soft bowel movements daily Correct Explanation: Lactulose (Cephulac) is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose does not address the patient's appetite, symptoms of nausea and vomiting, or the development of blood and mucus in the stool.
Which of the following diagnostic studies definitely confirms the presence of ascites? a) Abdominal x-ray b) Colonoscopy c) Computed tomography of abdomen d) Ultrasound of liver and abdomen
Ultrasound of liver and abdomen Correct Explanation: Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites.
Which type of positioning should be utilized for a patient undergoing a paracentesis? a) Trendelenburg b) Prone c) Supine d) Upright at the edge of the bed
Upright at the edge of the bed Correct Explanation: The patient should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool. Fowler's position should be used by the patient confined to bed.
Which of the following medications are used to decrease portal pressure, halting bleeding of esophageal varices? a) Nitroglycerin b) Cimetidine (Tagamet) c) Spironolactone (Aldactone) d) Vasopressin (Pitressin)
Vasopressin (Pitressin) Correct Explanation: Vasopressin may be the initial therapy for esophageal varices, because it produces constriction of the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of Vasopressin. Aldactone and Tagamet do not decrease portal hypertension.
A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer's lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient? a) Arterial line b) Foley catheter c) Diuretics d) Volume expanders
Volume expanders Correct Explanation: Because patients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley catheter are likely to be ordered, but neither actively maintains the patient's volume.
Which of the following indicates an overdose of lactulose? a) Fecal impaction b) Hypoactive bowel sounds c) Constipation d) Watery diarrhea
Watery diarrhea Correct Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.
A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is ________. a) hepatitis B b) pancreatitis c) hepatitis A d) acute cholecystitis
acute cholecystitis Gallstones are more frequent in women, particularly women who are middle-aged and obese. With acute cholecystitis, clients usually are very sick with fever, vomiting, tenderness over the liver, and severe pain that may radiate to the back and shoulders. The patient profile and symptoms are suggestive of acute cholecystitis.
A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient's care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma. a) 3, 1, 2, 5, 4 b) 1, 2, 5, 4, 3 c) 1, 2, 3, 4, 5 d) 2, 3, 1, 4, 5
1, 2, 3, 4, 5 Correct Explanation: Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant.
A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient's plan of care? a) Measurement of abdominal girth and body weight b) Assessment for signs and symptoms of jaundice c) Assessment for variceal bleeding d) Monitoring of results of liver function testing
Assessment for variceal bleeding Explanation: Esophageal varices are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.
Which of the following is an age-related change of the hepatobiliary system? a) Liver enlargement b) Decreased prevalence of gallstones c) Increased drug clearance capability d) Decreased blood flow
Decreased blood flow Correct Explanation: Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gallstones, and a steady decrease in size and weight of the liver.
When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately? a) Anorexia and dyspepsia b) Change in mental status c) Fatigue and weight loss d) Diarrhea or constipation
Change in mental status Correct Explanation: When caring for a patient with cirrhosis, the nurse should report any change in mental status immediately because they indicate secondary complications. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.
A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following? a) Administration of immunosuppressive drugs during the first weeks after transplantation b) Real-time monitoring of vascular changes in the hepatic system c) Continuous monitoring for portal hypertension d) Delivery of a continuous chemotherapeutic dose
Delivery of a continuous chemotherapeutic dose Explanation: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter does not monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system.
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient's liver? a) Place hand under the right lower abdominal quadrant and press down lightly with the other hand. b) Hold hand 90 degrees to right side of the abdomen and push down firmly. c) Place the left hand over the abdomen and behind the left side at the 11th rib. d) Place hand under right lower rib cage and press down lightly with the other hand.
Place hand under right lower rib cage and press down lightly with the other hand. Correct Explanation: To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.
The most common cause of esophageal varices includes which of the following? a) Ascites b) Asterixis c) Portal hypertension d) Jaundice
Portal hypertension Correct 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.
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a) Riboflavin b) Vitamin K c) Thiamine d) Vitamin A
Vitamin A Correct Explanation: Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.
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) Accelerated behaviors and mental processes c) Excess storage of vitamin C d) Enlarged liver size e) Hemorrhoids
• Ascites • Enlarged liver size • Hemorrhoids Correct 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.
