Liver Review Questions
19. 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) Implement interventions aimed at ensuring a calm and therapeutic care environment. b) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy. c) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis. d) Ensure that the patient's sodium intake does not exceed recommended levels.
B
4. 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) Medications will no longer be effective in clients with liver disease. b) Metabolism of medications c) The need for increased drug dosages d) The need for more frequently divided doses
B
24. A patient has an elevated serum ammonia level and is exhibiting mental status changes. The nurse should suspect which of the following conditions? a) Asterixis b) Portal hypertension c) Hepatic encephalopathy d) Cirrhosis
C
8. Which of the following indicates an overdose of lactulose? a) Constipation b) Hypoactive bowel sounds c) Watery diarrhea d) Fecal impaction
C
1. Which of the following is the most effective strategy to prevent hepatitis B infection? a) Vaccine b) Avoid sharing toothbrushes c) Barrier protection during intercourse d) Covering open sores
A
13. 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 four times daily. What desired outcome should the nurse relate to this pharmacologic intervention? a) Significant increase in appetite and food intake b) Absence of nausea and vomiting c) Absence of blood or mucus in stool d) Two to 3 soft bowel movements daily
D
21. 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) 2, 3, 1, 4, 5 d) 1, 2, 3, 4, 5
D
6. A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply. a) Annual vitamin B12 injections b) Consumption of a vitamin-rich diet c) Use of standard precautions d) Annual vitamin K injections e) Immunization
E
10. 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) Hepatic encephalopathy b) Hepatitis C c) Esophageal varices d) Portal hypertension
A
15. Which of the following would be the least important assessment in a patient diagnosed with ascites? a) Foul-smelling breath b) Weight c) Measurement of abdominal girth d) Palpation of abdomen for a fluid shift
A
22. 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) Constructional apraxia b) Fetor hepaticus c) Asterixis d) Palmar erythema
C
17. Which of the following terms describes the passage of a hollow instrument into the abdominal cavity for the withdrawal of fluid? a) Paracentesis b) Dialysis c) Asterixis d) Ascites
A
12. 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) Liver biopsy d) Dialysis
B
18. 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) "How many alcoholic drinks do you typically consume in a week?" b) "Has anyone in your family ever experienced symptoms similar to yours?" c) "Have you ever worked in an occupation where you might have been exposed to toxins?" d) "To the best of your knowledge, are your immunizations up to date?"
A
20. 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) Maintaining the airway b) Controlling bleeding c) Relieving the patient's anxiety d) Maintaining fluid volume
A
23. 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) A regimen of antiviral medications b) Administration of fresh-frozen plasma (FFP) c) Rest and watchful waiting d) Administration of immune globulins
A
5. In what location would the nurse palpate for the liver? a) Right upper quadrant b) Left lower quadrant c) Right lower quadrant d) Left upper quadrant
A
2. Which type of positioning should be utilized for a patient undergoing a paracentesis? a) Prone b) Upright at the edge of the bed c) Supine d) Trendelenburg
B
25. A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis? a) Finish all prescribed courses of antibiotics, regardless of symptom resolution. b) Adhere to dosing recommendations of OTC analgesics. c) Ensure that pharmacists regularly review drug regimens for potential interactions. d) Ensure that expired medications are disposed of safely.
B
3. A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse's risk of acquiring hepatitis C in the workplace? a) Wearing an N95 mask when providing care for patients on airborne precautions b) Disposing of sharps appropriately and not recapping needles c) Performing meticulous hand hygiene at the appropriate moments in care d) Adhering to the recommended schedule of immunizations
B
9. 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) Vitamin B12 injections as ordered b) Administration of diuretics as ordered c) Administration of beta-adrenergic blockers as ordered d) Mobilization with assistance at least 4 times daily
B
11. When caring for a patient with cirrhosis, which of the following symptoms should the nurse report immediately? a) Fatigue and weight loss b) Diarrhea or constipation c) Change in mental status d) Anorexia and dyspepsia
C
14. The mode of transmission of hepatitis A virus (HAV) includes which of the following? a) Saliva b) Semen c) Fecal-oral d) Blood
C
7. To reduce risk of injury for a patient with liver disease, what initial measure can the nurse implement? a) Apply soft wrist restraints b) Prevent visitors, so as not to agitate the patient c) Pad the side rails on the bed d) Raise all four side rails on the bed
C