Chapter 43: Assessment and Management of Patients with Hepatic Disorders

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? Hepatitis A is frequently spread by sexual contact. Infection with hepatitis G is similar to hepatitis A. Hepatitis B is transmitted primarily by the oral-fecal route. Hepatitis C increases a person's risk for liver cancer.

Hepatitis C increases a person's risk for liver cancer. Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

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

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

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? A prothrombin time A CT scan Platelet count A liver biopsy

A liver biopsy A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle. A prothrombin time and platelet count will assist with determining if the client is at increased risk for bleeding.

The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet? Sliced ham Peanut butter Hot dog A pear

A pear Explanation: The goal of treatment for the patient with ascites, a complication of cirrhosis, is a negative sodium balance to reduce fluid retention. Table salt, salty foods, salted butter and margarine, and all canned and frozen foods that are not specifically prepared for low-sodium (2-g sodium) diets should be avoided (Dudek, 2010). Peanut butter, a hot dog, and ham are all high in sodium. A pear is not.

The nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report? Yellow-green Black and tarry Blood tinged Clay-colored or whitish

Clay-colored or whitish Many clients report passing clay-colored or whitish stools as a result of no bile in the gastrointestinal tract. The other stool colors would not be indicators of obstructive jaundice but may indicate other GI tract disorders.

Which is an age-related change of the hepatobiliary system? Increased drug clearance capability Enlarged liver Decreased prevalence of gallstones Decreased blood flow

Decreased blood flow Explanation: Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the live

The mode of transmission of hepatitis A virus (HAV) includes which of the following? Semen Saliva Blood Fecal-oral

Fecal-oral The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.

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? Portal hypertension Esophageal varices Hepatitis C Hepatic encephalopathy

Hepatic encephalopathy 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

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? Hepatitis B is transmitted primarily by the oral-fecal route. Infection with hepatitis G is similar to hepatitis A. Hepatitis A is frequently spread by sexual contact. Hepatitis C increases a person's risk for liver cancer.

Hepatitis C increases a person's risk for liver cancer. Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C

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 Magnetic resonance imaging Liver biopsy Radioisotope liver scan

Liver biopsy A liver biopsy which reveals hepatic fibrosis is the most conclusive diagnostic procedure. Coagulation studies provide information about liver function but do not definitively confirm the diagnosis of cirrhosis. Magnetic resonance imaging and radioisotope liver scan help to support the diagnosis but do not confirm it. These tests provide information about the liver's enlarged size, nodular configuration, and distorted blood flow.

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 Liver resection Chemotherapy Laser hyperthermia

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

A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? Maintaining fluid volume Relieving the client's anxiety Maintaining the airway Controlling bleeding

Maintaining the airway 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 can be 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.

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. Measure abdominal girth according to a set routine. Report the condition to the physician immediately.

Measure abdominal girth according to a set routine. If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.

The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? Furosemide (Lasix) Bumetanide (Bumex) Spironolactone (Aldactone) Acetazolamide (Diamox)

Spironolactone (Aldactone) Potassium-sparing diuretic agents such as spironolactone or triamterene (Dyrenium) may be indicated to decrease ascites, if present; these diuretics are preferred because they minimize the fluid and electrolyte changes commonly seen with other agents.

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 is relaxed and not in pain. The client didn't take his morning dose of lactulose (Cephulac). The client's hepatic function is decreasing. The client is avoiding the nurse.

The client's hepatic function is decreasing. The decreased level of consciousness caused by an increased serum ammonia level indicates hepatic disfunction. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased level of consciousness this soon. These assessment findings don't indicate that the client is relaxed or avoiding the nurse.

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

Vasopressin Explanation: Vasopressin may be the initial therapy for esophageal varices because it constricts the splanchnic arterial bed and decreases portal hypertension. Nitroglycerin has been used to prevent the side effects of vasopressin. Spironolactone and cimetidine do not decrease portal hypertension.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: eructation and constipation. severe abdominal pain radiating to the shoulder. anorexia, nausea, and vomiting. abdominal ascites.

anorexia, nausea, and vomiting. Early hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn't radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: cholelithiasis. peptic ulcer disease. cirrhosis. appendicitis.

cirrhosis. Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.

A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications? need for increased drug dosages metabolism of medications medications becoming ineffective in clients with liver disease need for more frequently divided doses

metabolism of medications Explanation: Careful evaluation of the client's response to drug therapy is important because the malfunctioning liver cannot metabolize many substances.