Chapter 49: Assessment and Management of Patients With Hepatic Disorders

A liver biopsy

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?

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?

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?

Paracentesis

A nurse is gathering equipment and preparing to assist with a sterile bedside procedure to withdraw fluid from a client's abdomen. The procedure tray contains the following equipment: trocar, syringe, needles, and drainage tube. The client is placed in he high Fowler position and a blood pressure cuff is secured around the arm in preparation for which procedure?

"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?

Right upper quadrant

In what location would the nurse palpate for the liver?

Hemolytic

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?

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?

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?

Endoscopic retrograde cholangiopancreatography (ERCP)

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Hepatic encephalopathy

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Vaccine

Which of the following is the most effective strategy to prevent hepatitis B infection?

Maintaining the airway

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?

Hemolytic

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

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?

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?

Watery diarrhea

Which condition indicates an overdose of lactulose?

Increased appetite and thirst

Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes?

"Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated."

A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse?

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?