Liver Practice Questions

The physican has determine the client with Hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

1 Hepatitis A is the correct answer because it is transmitted by the oral-fecal route, via contaminated food or food handlers. B, C, and D are transmitted most commonly via infected body fluids

The nurse is providing discharge instructions for a client with cirrhosis. Which of the following statements best indicates that the client has understood the teaching? 1. "I should eat a high-protein, high-carbohydrate diet to provide energy." 2. "It is safer for me to take acetaminophen (Tylenol) for pain instead of aspirin." 3. "I should avoid constipation to decrease chances of bleeding." 4. "If I get enough rest and follow my diet, it is possible for my cirrhosis to be cured."

3. Clients with cirrhosis should be instructed to avoid constipation and straining at stool to prevent hemorrhage. The client with cirrhosis has bleeding tendencies because of the liver's inability to produce clotting actors. A low-protein and high carbohydrate diet is recommended. Clients with cirrhosis should not take acetaminophen (Tylenol), which is potentially hepatotoxic. Aspirin also should be avoided in esophageal varices are present. Cirrhosis is a chronic disease.

A health care provider who has not been immunized for hepatitis B is exposed to the hepatitis B virus (HBV) through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include: a. Baseline hepatitis B antibody testing now and in 2 months. b. Active immunization with hepatitis B vaccine. c. Hepatitis B immune globulin (HBIG) injection. d. Both the hepatitis B vaccine and HBIG injection.

D The recommended treatment for exposure to hepatitis B in unvaccinated individuals is to receive both HBIG and the hepatitis B vaccine, which would provide temporary passive immunity and promote active immunity. Antibody testing may also be done, but this would not provide protection from the exposure.

Which priority teaching information should the nurse discuss with the client to help prevent contracting hepatitis. A? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.

1 Would be appropriate for prevention of hepatitis A.

A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for further teaching? 1. "A condom should be used for sexual intercourse." 2. "I can never drink alcohol again." 3. "I won't go back to work right away." 4. "My close friends should get the vaccine."

2 To prevent transmission of hepatitis, a condom is advised during sexual intercourse and vaccination of the partner. Alcohol should be avoided because it is detoxified in the liver and may interfere with recover. Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually

A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? 1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)

4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.

A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? A. Sexual contact with an infected partner. B. Contaminated food. C. Blood transfusion. D. Illegal drug use.

B Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.

The nurse is reviewing the lab results for a pt with cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be presribed for this pt? Low-protein High-protein Moderate-fat High-carb

Low-protein diet Protein provided by the diet is transported to the liver via the portal vein. The liver breaks down protein, which results in the formation of ammonia.

The client with cirrhosis receives 100 mL of 25% serum albumin IV. Which finding would best indicate that the albumin is having its desired effect? 1. Increased urine output. 2. Increased serum albumin level. 3. Decreased anorexia. 4. Increased ease of breathing.

1 Normal serum albumin is administered to reduce ascites. Hypoalbuminemia, a mechanism underlying ascites formation, results in decreased colloid osmotic pressure. Administering serum albumin increases the plasma colloid osmotic pressure, which causes fluid to flow from the tissue space into the plasma. Increased urine output is the best indication that the albumin is having the desired effect. An increased serum albumin level and increased ease of breathing may indirectly imply that the administration of albumin is effect in relieving the ascites. However, it is not as direct an indicator as increased urine output. Anorexia is not affected by the administration o albumin.

A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? 1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort"

1 Rationale: Hepatitis causes GI symptoms such as anorexia, nausea, right upper quadrant discomfort and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.

The nurse is performing an assessment on a client being evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia

1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatitis include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis.

Several children at a daycare center have been infected with hepatitis A virus. Which instruction by the nurse would reduce the risk of hepatitis A to the other children and staff members? 1. Hand washing after diaper changes 2. Isolation of the sick children 3. Use of masks during contact with the children 4. Sterilization of all eating utensils"

1 Rationale: children in day care centers are at risk for hepatitis A infection which is transmitted via fecal-oral route due to poor hand hygiene practices and poor sanitation. Isolation of sick children, use of mask during contact, and sterilization of all eating utensils would not be useful in breaking the chain of infection.

A nurse is developing a care plan for a client with hepatic encephalopathy. Which of the following are goals for the care for this client? Select all that apply. 1. Preventing constipation. 2. Administering lactulose to reduce blood ammonia levels. 3. Monitoring coordination while walking. 4. Checking the pupil reaction. 5. Providing food and fluids high in carbohydrate. 6. Encouraging physical activity.

1, 2, 3, 4, 5. Constipation leads to increased ammonia production. Lactulose is a hyper-osmotic laxative that reduces blood ammonia by acidifying the colon contents, which removes non ionic ammonia from the colon to the blood while promoting its migration from the blood to the colon. Hepatic encephalopathy is considered a toxic or metabolic condition that causes cerebral edema; it affects a person's coordination and pupil reaction to light and accommodation. Food and fluids high in carbohydrates should be given because the liver is not synthesizing and storing glucose. Because exercise produces ammonia as a byproduct o metabolism, physical activity should be limited, not encouraged.

A client with cirrhosis is receiving lactulose. During the assessment, the nurse notes increased confusion and asterixis. The nurse should: 1. Assess for gastrointestinal (GI) bleeding. 2. Hold the lactulose. 3. Increase protein in the diet. 4. Monitor serum bilirubin levels

1. Assess for gastrointestinal (GI) bleeding. Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Asterixis is a characteristic symptom of increased ammonia levels. Increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed in the diet increase protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurological symptoms are worsening. Bilirubin is associated with jaundice.

The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. Which of the following would be an indication that hepatic encephalopathy is developing? 1. Decreased mental status. 2. Elevated blood pressure. 3. Decreased urine output. 4. Labored respirations.

1. Decreased mental status. The client should be monitored closely for changes in mental status. Ammonia has a toxic effect on central nervous system tissue and produces an altered level of consciousness, marked by drowsiness and irritability. If this process is unchecked, the client may lapse into coma. Increasing ammonia levels are not detected by changes in blood pressure, urine output, or respirations.

Which of the following positions would be appropriate for a client with severe ascites? 1. Fowler's. 2. Side-lying. 3. Reverse Trendelenburg. 4. Sims

1. Fowler's. Ascites can compromise the action of the diaphragm and increase the client's risk of respiratory problems. Ascites also greatly increases the risk of skin breakdown. Frequent position changes are important, but the preferred position is Fowler's. Placing the client in Fowler's position helps facilitate the client's breathing by relieving pressure on the diaphragm. The other positions do not relieve pressure on the diaphragm.

What diet should be implemented for a client who is in the early stages of cirrhosis? 1. High-calorie, high-carbohydrate. 2. High-protein, low-fat. 3. Low-fat, low-protein. 4. High-carbohydrate, low-sodium.

1. High-calorie, high-carbohydrate. For clients who have cirrhosis without complications, a high-calorie, high-carbohydrate diet is preferred to provide an adequate supply o nutrients. In the early stages of cirrhosis, there is no need to restrict at, protein, or sodium.

A college student is required to be inoculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D

2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.

The client is admitted to the hospital with viral hepatitis, complaining of ""no appetite"" and ""losing my taste for food."" What instruction should the nurse give the client to provide adequate nutrition? 1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferbly only three large meals daily

2 Rationale: Although no specific diet is required to treat viral hepatitis, it is recommended that clients consume a low-fat diet because fat may be poorly tolerated because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.

The RN is providing discharge information to a client with hepatitis B. The RN instructs the client to prevent transmission via: 1. Airborne pathogens 2. Blood and body secretions 3. Skin contact 4. Fecal and oral routes

2 Hepatitis b is transmitted via blood and body secretions. The RN instructs the client to prevent transmission through correct use of latex condoms, and by not sharing personal care items that may have blood on them. Diseases such as pneumonia are spread by airborne pathogens, Hepatitis A is spread by fecal and oral routes. Hepatitis B is not transmitted by skin contact.

What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions

2 Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood

The female nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1.Notify the infection control nurse. 2.Cleanse the area with soap and water. 3.Request post-exposure prophylaxis. 4.Check the hepatitis status of the client.

2 The nurse should first clean the needle stick with soap and water to help remove any virus that is on the skin

A client with jaundice has pruritus and areas of irritation from scratching. What measures can the nurse discuss to prevent skin breakdown? Select all that apply. 1. Avoid lotions containing calamine. 2. Add baking soda to the water in a tub bath. 3. Keep nails short and clean. 4. Rub the skin when it itches with knuckles instead of nails. 5. Massage skin with alcohol. 6. Increase sodium intake in diet.

2, 3, 4. Baking soda baths can decrease pruritus. Keeping nails short and rubbing with knuckles can decrease breakdown when scratching cannot be resisted, such as during sleep. Calamine lotions help relieve itching. Alcohol will increase skin dryness. Sodium in the diet will increase edema and weaken skin integrity.

Which of the following health promotion activities would be appropriate for the nurse to suggest that the client with cirrhosis add to the daily routine at home? 1. Supplement the diet with daily multivitamins. 2. Abstain from drinking alcohol. 3. Take a sleeping pill at bedtime. 4. Limit contact with other people whenever possible.

2. General health promotion measures include maintaining good nutrition, avoiding infection, and abstaining from alcohol. Rest and sleep are essential, but an impaired liver may not be able to detoxify sedatives and barbiturates. Such drugs must be used cautiously, if at all, by clients with cirrhosis. The client does not need to limit contact with others but should exercise caution to stay away from ill people.

A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related adverse effects? 1. Constipation. 2.Hyperkalemia. 3. Irregular pulse. 4. Dysuria.

2. Hyperkalemia. Spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, clients should be monitored closely or hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common adverse effects of spironolactone. An irregular pulse is not an adverse effects of spironolactone but could develop in serum potassium levels are not closely monitored

The home care nurse is visiting a client with a diagnosis of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the patient makes which on the following statements? 1. I am so sad that I am not able to hold my baby." 2." I will eat after my family eats." 3 "I will make sure that my children don't eat or drink after me." 4. "I'm glad that I don't have to get help taking care of my children."

3 1. Not spread by casual contact 2. Can eat together, but not share utensils 3. To prevent transmission, do not share eating utensils or drinking glasses, wash hands before eating and after using toilet 4. Alternate rest/activity to promote hepatic healing, mother of young children will need help"

The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? 1. Peripheral edema. 2. Ascites. 3. Anorexia. 4. Jaundice.

3 Early clinical manifestations of cirrhosis are subtle and usually include gastrointestinal symptoms, such as anorexia, nausea, vomiting, and changes in bowel patterns. These changes are caused by the liver's altered ability to metabolize carbohydrates, proteins, and fats. Peripheral edema, ascites, and jaundice are later signs of liver failure and portal hypertension

A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for ""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily:" 1. During sexual intercourse 2. By contact with infected body secretions. 3. Through fecal contamination of food or water. 4. Through kissing that involves contact with mucous membranes."

3 Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission.

The health care provider instructs a client with alcohol-induced cirrhosis to stop drinking alcohol. The expected outcome of this intervention is: 1. Absence of delirium tremors. 2. Having a balanced diet. 3. Improved liver function. 4. Reduced weight.

3 The goal o abstinence rom alcohol in clients with alcohol-induced cirrhosis is to improve the liver function; most clients have improved liver function when they abstain rom alcohol. Clients with cirrhosis do not necessarily have delirium tremors. Abstaining from alcohol may allow the client to improve nutritional status, but additional dietary counseling may be needed to achieve that goal. Clients with cirrhosis may have weight gain from ascites, but this is managed with diuretics

The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the physician of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? 1. Aldosterone. 2. Creatinine. 3. Potassium. 4. Protein.

3. Potassium. Hypokalemia is a precipitating actor in hepatic encephalopathy. A decrease in creati- nine results rom muscle atrophy; an increase in creatinine would indicate renal insufciency. With liver dysunction, increased aldosterone levels are seen. A decrease in serum protein will decrease colloid osmotic pressure and promote edema.

A client with ascites and peripheral edema is at risk for impaired skin integrity. To prevent skin breakdown, the nurse should: 1. Institute range-of-motion (ROM) exercise every 4 hours. 2. Massage the abdomen once a shift. 3. Use an alternating air pressure mattress. 4. Elevate the lower extremities.

3. Use an alternating air pressure mattress. Edematous tissue is easily traumatized and must receive meticulous care. An alternating air pressure mattress will help decrease pressure on the edematous tissue. ROM exercises are important to maintain joint function, but they do not necessarily prevent skin breakdown. When abdominal skin is stretched taut due to ascites, it must be cleaned very carefully. The abdomen should not be massaged. Elevation of the lower extremities promotes venous return and decreases swelling.

Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? 1) ""I will not drink any type of beer or mixed drink."" 2)""I will get adequate rest so I don't get exhausted."" 3) ""I had a big hearty breakfast this morning."" 4) ""I took some cough syrup for this nasty head cold.""

4 1) The client should avoid all alcohol to prevent further liver damage and promote healing. 2) Rest is needed for healing of the liver and to promote optimum immune function. 3) Clients with hepatitis need increased caloric intake so this is a good statement. 4)The client needs to understand some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore, this statement requires intervention

The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that the school nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.

4 1.Eating after each other should be discouraged it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution is not necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are transmitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oral route. Good hand washing helps to prevent its spread. TEST-TAKING HINTS: The test taker must realize that good hand washing is the most important action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seems

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: A.Urine output B. Abdominal girth C. Stool frequency D.Level of consciousness (LOC)

4 In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then builds up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and thus improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC. Monitoring urine output, abdominal girth, and stool frequency helps evaluate the progress of cirrhosis, not the effectiveness of lactulose.

A client has advanced cirrhosis of the liver. The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process? 1. "He must have been eating too many foods with salt in them. Salt pulls water with it." 2. "The swelling in his ankles must have moved up closer to his heart so the fluid circulates better." 3. "He must have forgotten to take his daily water pill." 4. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels.

4. Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels. Portal hypertension and hypo-albuminemia as a result of cirrhosis cause a fluid shit into the peritoneal space causing ascites. In a cardiac or kidney problem, not cirrhosis, sodium can promote edema formation and subsequent decreased urine output. Edema does not migrate upward toward the heart to enhance its circulation. Although diuretics promote the excretion of excess fluid, occasionally forgetting or omitting a dose will not yield the ascites found in cirrhosis o the liver

The nurse is reviewing the chart information for a client with increased ascites. The data include the following: temperature 37.2°C, heart rate 118, shallow respirations 26, blood pressure 128/76, and SpO2 89% on room air. Which action should receive priority by the nurse? 1. Assess heart sounds. 2. Obtain a prescription for blood cultures. 3. Prepare for a paracentesis. 4. Raise the head of the bed.

4. Raise the head of the bed Elevating the head o the bed will allow or increased lung expansion by decreasing the ascites pressing on the diaphragm. The client requires reassessment. A paracentesis is reserved or symptomatic clients with ascites with impaired respiration or abdominal pain not responding to other measures such as sodium restriction and diuretics. There is no indication or blood cultures. Heart sounds are assessed with the routine physical assessment.

A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: A. Prevent the absorption of ammonia from the bowel. B. Prevent hypoglycemia. C. Remove bilirubin from the blood. D. Mobilize iron stores from the liver

A Rationale: Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines.

Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A. Hepatitis A A. Hepatitis B C. Hepatitis C D. Hepatitis D

A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""

A Hepatitis A virus typically is transmitted by the oral-fecal route commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.

A client is admitted with ongoing symptoms of the flu. There are not other obvious signs of illness. This client should be tested for hepatitis because. A. She could have a anicteric hepatitis, which means no jaundice B. She has an allergy to shellfish C. She has a blood pressure of 90/50 D. She was living with a roommate who had similar symptoms"

A Rationale: A. Only about 25% percent of people with acute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised her liver function that is overlooked due to lack of jaundice.

A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: A. Pruritus is a common problem with jaundice in this phase. B. The patient is most likely to transmit the disease during this phase. C. Gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. Extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."

A The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

The pt with cirrhosis has increased abdominal girth from ascites. The nurse should know that this fluid gathers in the abdominal for which reasons? Select all that apply. A. There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. B. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention C. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity D. Osmoreceptors in the hypothalamus stimulate thirst, which causes the stimulation to take in fluid orally E. Overactivity of the enlarged spleen results in increased removal of blood cells from the circulation, which decreases the vascular pressure.

A, B, C Ascites related to cirrhosis is caused by decreased colloid oncotic pressure from the lack of albumin form liver inability to synthesize it and the portal hypertension shifts protein into peritoneal cavity, and hyperaldosteronism which increases sodium and fluid retention.

When caring for a pt with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions would be appropriate to achieve this outcome? Select all that apply. a. Use smallest gauge needle possible when giving injections or drawing blood. b. Teach pt to avoid straining at stool, vigorous blowing of nose, and coughing c. Advise pt to use soft-bristle toothbrush and avoid ingestion of irritating food. d. Apply gentle pressure for the shortest possible time period after performing venipuncture e. Instruct pt to avoid aspirin and NSAIDs to prevent hemorrhage when varices are present.

A, B, C, E Small gauge minimize risk of bleeding into tissues. Avoiding strain reduces hemorrhage Soft bristle reduce injury to highly vascular mucous membranes Apply gentle but prolonged pressure to venipuncture Aspirin and NSAIDs should not be used in pt with liver disease b/c they interfere w/ platelet aggregation, increasing bleeding risk

During an admission assessment, the nurse notes a client with hepatitis exhibits all of the following signs or symptoms. Which one is not related to hepatitis? A. Anorexia B. Bloody stools C. Dark urine D. Yellow sclera

B A. Anorexia is an expected assessment finding with hepatitis. B. Rectal bleeding is not related to hepatitis. Further assessment C. Dark urine is an expected assessment finding with hepatitis and is a result of increased serum bilirubin being excreted by the kidneys. D. Yellow sclera is a sign of jaundice and is an expected assessment finding with hepatitis. Jaundice is caused by increased serum bilirubin

The pt with advanced cirrhosis asks why his abdomen is so swollen. The nurse's best response is based on the knowledge that a. A lack of clotting factors promotes the collection of blood in the abdominal cavity b. Portal hypertension and hypoalbuminemia cause fluid shift into the peritoneal space. c. Decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel d. Bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

B Ascites is accumulation of serious fluid in peritoneal cavity. With portal hypertension, protein shifts from the blood into the lymph. When the lymph system is unable to carry excess, it leaks thru the liver into the peritoneal cavity. osmotic pressure of the proteins pulls additional fluid into cavity. Second mechanism of ascites if hypoalbuminemia from the liver unable to synthesize albumin, resulting in decreased colloidal oncotic pressure.

"A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: A. Avoid alcohol for the first 3 weeks B. Use a condom during sexual intercourse C. Have family members get an injection of immunoglobin D. Follow a low-protein, moderate-carbohydrate, moderate-fat diet

B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. d. Decreased erythrocycle sedimentation rate

B Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis

To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when? A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing

B hepatitis A is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.

The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? A. Dorsiflex the foot B. Measure abdominal girth C. Ask patient to extend the arms D. Instruct pt to lean forward

C Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread. It is the most common and reliable sign that encephalopathy is developing.

The nurse provides discharge instructions for a 64 y.o. women with ascites and peripheral edema related to cirrhosis. Which statement, if made by the pt, indicates teaching WAS effective? a. It is safe to take acetaminophen up to four times a day for pain b. Lactulose (cephulac) should be taken everyday to prevent constipation c. Herbs and other spices should be used to season my foods instead of salt d. I will eat foods high in potassium while taking spironolactone (aldactone)

C Low sodium diet is indicated for pt with ascites and edema related to cirrhosis

When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Excess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this pt by assessing what? A. Relief of constipation B. Relief of ab pain C. Decreased liver enzymes D. Decreased ammonia levels

D Hepatic encephalopathy is associated with elevated ammonia levels. Lactulose traps ammonia in the intestinal tract. It's laxative effect then expels ammonia from the colon, resulting in decreased ammonia levels, correcting hepatic encephalopathy.

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which of the following responses by the nurse is most appropriate? A) The hepatitis vaccine will provide immunity from this exposure and future exposures."" B) I am afraid there is nothing you can do since the patient was infectious before admission."" C) You will need to be tested first to make sure you don't have the virus before we can treat you."" D) An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure."""

D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.