Ch 43: Assessment and Management of Patients with Hepatic Disorders

Asterixis

Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction? Ascites Dialysis Asterixis Paracentesis

Folic acid

Which type of deficiency results in macrocytic anemia? Vitamin C Vitamin K Vitamin A Folic acid

Hemolytic

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? Obstructive Hemolytic Hepatocellular Nonobstructive

Ecchymoses Jaundice Petechiae

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the likelihood of liver problems? Select all that apply. Aphthous stomatitis Cyanosis of the lips Ecchymoses Jaundice Petechiae

Albumin

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? Bilirubin Hemoglobin Albumin Temperature

Hepatic encephalopathy

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

High-dose corticosteroids

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? High-dose corticosteroids Liver transplantation Paracentesis Azathioprine

On the right side

A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? On the right side Trendelenburg On the left side High Fowler

Octreotide

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? Propranolol Lactulose Octreotide Spironolactone

Liver biopsy

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? Coagulation studies Radioisotope liver scan Magnetic resonance imaging Liver biopsy

Normal activities may be resumed in 1 week.

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 1 month. Normal activities may be resumed in 1 week. Normal activities may be resumed the day after surgery. Normal activities may be resumed in 2 weeks.

subnormal serum glucose and elevated serum ammonia levels.

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

Vitamin K

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 Oral bile acids Vitamin K Vitamin B

Reduce fluid accumulation and venous pressure.

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

Albumin

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? Chloride Urobilinogen Albumin Creatinine

Spironolactone

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

Liver resection

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? Radiation Chemotherapy Liver resection Laser hyperthermia

Vitamin A

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? Vitamin A Vitamin K Thiamine Riboflavin

Clay-colored stools

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? Reduced hematocrit Clay-colored stools Straw-colored urine Elevated urobilinogen in the urine

The client's hepatic function is decreasing.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? The client's hepatic function is decreasing. The client is relaxed and not in pain. The client is avoiding the nurse. The client didn't take his morning dose of lactulose (Cephulac).

Document the presence of normal bile output.

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.

Transjugular intrahepatic portosystemic shunting (TIPS)

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

Loss of 2.2 lb (1 kg) in 24 hours

A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? Blood pH of 7.25 Loss of 2.2 lb (1 kg) in 24 hours Serum potassium level of 3.5 mEq/L Serum sodium level of 135 mEq/L

Liver transplantation

A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what? Liver transplantation Lobectomy IV administration of immune globulins Transfusion of packed red blood cells and fresh-frozen plasma (FFP)

"You must have the second one in 1 month and the third in 6 months."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? "You must have the second one in 1 month and the third in 6 months." "You must have the second one in 2 weeks and the third in 1 month." "You must have the second one in 6 months and the third in 1 year." "You must have the second one in 1 year and the third the following year."

Right lateral decubitus position

After undergoing a liver biopsy, a client should be placed in which position? Supine position Prone position Right lateral decubitus position Semi-Fowler's position

The digestion of dietary and blood proteins.

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: Excessive diuresis and dehydration. Excess potassium loss subsequent to prolonged use of diuretics. Severe infections and high fevers. The digestion of dietary and blood proteins.

Acetaminophen

An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is: Ibuprofen Dextromethorphan Acetaminophen Benadryl

Scurvy

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? Scurvy Hypoprothrombinemia Beriberi Night blindness

Right upper quadrant

In what location would the nurse palpate for the liver? Right upper quadrant Right lower quadrant Left upper quadrant Left lower quadrant

Hemolytic

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? Obstructive Hepatocellular Hemolytic Nonobstructive

Lactulose

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? Lactulose Cholestyramine Spironolactone Kanamycin

Abdominal paracentesis

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? Abdominal CT scan Abdominal paracentesis Upper endoscopy Thoracentesis

Endoscopic retrograde cholangiopancreatography (ERCP)

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? Endoscopic retrograde cholangiopancreatography (ERCP) Cholecystectomy Abdominal x-ray Colonoscopy

Purpura and petechiae

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 Ascites and orthopnea Dyspnea and fatigue Purpura and petechiae

Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risk for injury related to altered clotting mechanisms Disturbed body image related to changes in appearance, sexual dysfunction, and role function

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. Urinary incontinence related to general debility and muscle wasting Altered nutrition, more than body requirements, related to decreased activity and bed rest Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risk for injury related to altered clotting mechanisms Disturbed body image related to changes in appearance, sexual dysfunction, and role function

"How often do you drink alcohol?"

The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? "What type of over-the-counter pain reliever do you use?" "Does your work expose you to chemicals?" "Have you had an infection recently?" "How often do you drink alcohol?"

Respiratory assessment related to increased thoracic pressure

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

visible distended veins rapid weight gain increased abdominal girth stretch marks

What does the nurse recognize as clinical manifestations consistent with ascites? Select all that apply. visible distended veins rapid weight gain increased abdominal girth foul-smelling breath stretch marks

Pad the side rails on the bed

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

low-fat diet

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

Measure abdominal girth according to a set routine.

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

Watery diarrhea

Which condition indicates an overdose of lactulose? Fecal impaction Constipation Hypoactive bowel sounds Watery diarrhea

Vasopressin

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

Daily measurement of weight and abdominal girth

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

Ultrasound of liver and abdomen

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

Vaccine

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