Hepatic

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

a. Reduce fluid accumulation and venous pressure. Methods of treating portal hypertension aim to reduce fluid accumulation and venous pressure. There is no cure for cirrhosis; treating the esophageal varices is only a small portion of the overall objective. Promoting optimal neurologic function will not reduce portal hypertension.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? a. decompression b. instillation c. lavage d. gavage

a. decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting. Instillations in a nasogastric tube after surgery are done when necessary to promote patency; this is not the most common purpose of a nasogastric tube after surgery. Gavage is contraindicated after abdominal surgery until peristalsis returns. Lavage after surgery may be done to promote hemostasis in the presence of gastric bleeding, but this is not the most common purpose of a nasogastric tube after surgery.

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

c. Daily measurement of weight and abdominal girth Measuring and recording of abdominal girth and body weight daily are essential to assess the progression of ascites and its response to treatment.

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: a. bile overproduction. b. gallbladder disease. c. liver disorder. d. glucose underproduction.

c. liver disorder. Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder.

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? a. bradycardia and tachypnea b. bradycardia and bradypnea c. tachycardia and tachypnea d. tachycardia and bradypnea

c. tachycardia and tachypnea With shock, the sympathetic nervous system "SNS" is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia; and the respiratory system, causing tachypnea. Tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.

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

d. Vaccine The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? a. Polyuria b. Warm moist skin c. Hypotension d. Bradycardia

c. Hypotension Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased blood pressure; and decreased urine output.

Which is the most common cause of esophageal varices? a. Ascites b. Asterixis c. Jaundice d. Portal hypertension

d. Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses? a. Electroencephalogram b. Magnetic resonance imaging c. Angiography d. Ultrasonography

d. Ultrasonography

The nurse assesses a patient who is diagnosed with decompensated cirrhosis. Which of the following are clinical indicators consistent with that diagnosis? Select all that apply. a. Jaundice b. Clubbing of the fingers c. Vascular spiders d. A firm, enlarged liver e. Ascites f. Splenomegaly

a. Jaundice b. Clubbing of the fingers e. Ascites

Which type of jaundice is the result of increased destruction of red blood cells? a. Hepatocellular b. Hemolytic c. Nonobstructive d. Obstructive

b. Hemolytic Hemolytic jaundice is the result of an increased destruction of red blood cells. Hepatocellular jaundice is caused by the inability of damaged liver cells to clear normal amounts of bilirubin from the blood. Obstructive jaundice resulting from extrahepatic obstruction may be caused by occlusion of the bile duct from a gall stone, inflammatory process, tumor, or pressure from an enlarged organ. Nonobstructive jaundice occurs with hepatitis.

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? a. Colonoscopy b. Cholecystectomy c. Endoscopic retrograde cholangiopancreatography (ERCP) d. Abdominal x-ray

c. Endoscopic retrograde cholangiopancreatography (ERCP) ERCP locates stones that have collected in the common bile duct. A colonoscopy will not locate gallstones but only allows visualization of the large intestine. Abdominal x-ray is not a reliable locator of gallstones. A cholecystectomy is the surgical removal of the gallbladder

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a. Vomiting b. Ringing in the ears c. Watery diarrhea d. Asterixis

c. Watery diarrhea The patient receiving lactulose is monitored closely for the development of watery diarrhea stools, because they indicate a medication overdose. Serum ammonia levels are closely monitored as well.

A 33-year-old male patient with a history of IV heroin and cocaine use has been admitted to the medical unit for the treatment of endocarditis. The nurse should recognize that this patient is also likely to test positive for which of the following hepatitis viruses? a. Hepatitis D b. Hepatitis A c. Hepatitis B d. Hepatitis C

d. Hepatitis C Transmission of hepatitis C occurs primarily through injection of drugs and through transfusion of blood products prior to 1992. Hepatitis A, B, and D are less likely to result from IV drug use.

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority? a. Ineffective breathing pattern b. Fatigue c. Excess fluid volume d. Imbalanced nutrition: Less than body requirements

a. Ineffective breathing pattern In ascites, accumulation of large amounts of fluid causes extreme abdominal distention, which may put pressure on the diaphragm and interfere with respiration. If uncorrected, this problem may lead to atelectasis or pneumonia. Although fluid volume excess is present, the diagnosis Ineffective breathing pattern takes precedence because it can lead more quickly to life-threatening consequences. The nurse can deal with fatigue and altered nutrition after the client establishes and maintains an effective breathing pattern.

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? a. Black and tarry b. Clay-colored or whitish c. Yellow-green d. Blood tinged

b. 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 absolute indicators of cirrhosis of the liver but may indicate other GI tract disorders.

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? a. Convert urea into ammonia b. Excrete bile c. Breakdown amino acids d. Break down coagulation factors

b. Excrete bile The liver forms and excretes bile, synthesizes amino acids from the breakdown of proteins, converts ammonia into urea, and synthesizes the factors needed for blood coagulation.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? a. Asterixis b. Constructional apraxia c. Fetor hepaticus d. Ataxia

a. Asterixis Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy

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

b. Decreased blood flow 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 liver.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Nitroglycerin b. Vasopressin c. Cimetidine d. Spironolactone

b. Vasopressin 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.

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? a. Thoracentesis b. Abdominal CT scan c. Abdominal paracentesis d. Upper endoscopy

c. Abdominal paracentesis Abdominal paracentesis may be performed to remove ascitic fluid. Abdominal fluid is rapidly removed by careful introduction of a needle through the abdominal wall, allowing the fluid to drain. Fluid is removed from the lung via a thoracentesis. Fluid cannot be removed with an abdominal CT scan, but it can assist with placement of the needle. Fluid cannot be removed via an upper endoscopy.

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

b. Asterixis Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Paracentesis may be used to withdraw ascitic fluid if the fluid accumulation is causing cardiorespiratory compromise. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances

A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? Select all that apply. a. There is a 50% risk that cirrhosis will develop. b. There is a 70% chance that jaundice will occur. c. Typically there is a spontaneous recovery. d. Transmission of the virus is possible with oral-anal contact during sex. e. The incubation period for this virus is up to 4 months.

b. There is a 70% chance that jaundice will occur. d. Transmission of the virus is possible with oral-anal contact during sex. c. Typically there is a spontaneous recovery.

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? a. Angiography b. Electroencephalography c. Radioisotope liver scan d. Magnetic resonance imaging

c. Radioisotope liver scan A radioisotope liver scan assesses liver size and hepatic blood flow and obstuction. Magnetic resonance imaging is used to identify normal structures and abnormalities of the liver and biliary tree. Angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. Electroencephalography is used to detect abnormalities that occur with hepatic coma.

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

d. Pad the side rails on the bed Padding the side rails can reduce injury if the client becomes agitated or restless. Restraints would not be an initial measure to implement. Four side rails are considered a restraint, and this would not be an initial measure to implement. Family and friends generally assist in calming a client.

Which term describes the passage of a hollow instrument into a cavity to withdraw fluid? a. Paracentesis b. Dialysis c. Ascites d. Asterixis

a. Paracentesis Paracentesis may be used to withdraw fluid (ascites) if the accumulated fluid is causing cardiorespiratory compromise. Asterixis refers to involuntary flapping movements of the hands associated with metabolic liver dysfunction. Ascites refers to accumulation of serous fluid within the peritoneal cavity. Dialysis refers to a form of filtration to separate crystalloid from colloid substances.

Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension? a. Spironolactone (Aldactone) b. Cyclosporine (Sandimmune) c. Kanamycin (Kantrex) d. Lactulose (Cephulac)

a. Spironolactone (Aldactone) For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.

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: a. Ibuprofen b. Acetaminophen c. Benadryl d. Dextromethorphan

b. Acetaminophen Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

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? a. Serum potassium level of 3.5 mEq/L b. Loss of 2.2 lb (1 kg) in 24 hours c. Serum sodium level of 135 mEq/L d. Blood pH of 7.25

b. Loss of 2.2 lb (1 kg) in 24 hours Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.

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? a. Riboflavin b. Vitamin A c. Thiamine d. Vitamin K

b. Vitamin A Problems common to clients with severe chronic liver dysfunction result from inadequate intake of sufficient vitamins. Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? a. "I'll wash my hands often." b. "I'll be very careful when preparing food for my family." c. "I'll take all my medications as ordered." d. "How did this happen? I've been faithful my entire marriage."

d. "How did this happen? I've been faithful my entire marriage." The client requires further teaching if he suggests that he acquired the virus through sexual contact. Hepatitis A is transmitted by the oral-fecal route or through ingested food or liquid that's contaminated with the virus. Hepatitis A is rarely transmitted through sexual contact. Clients with hepatitis A need to take every effort to avoid spreading the virus to other members of their family with precautions such as preparing food carefully, washing hands often, and taking medications as ordered.

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

c. Hemolytic Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders. Obstructive and hepatocellular jaundice are the result of liver disease. Nonobstructive jaundice occurs with hepatitis.

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? a. need for more frequently divided doses b. medications becoming ineffective in clients with liver disease c. need for increased drug dosages d. metabolism of medications

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

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. a. Ascites b. Accelerated behaviors and mental processes c. Excess storage of vitamin C d. Enlarged liver size e. Hemorrhoids

a. Ascites c. Excess storage of vitamin C e. Hemorrhoids Early in the course of cirrhosis, the liver tends to be large, and the cells are loaded with fat. The liver is firm and has a sharp edge that is noticeable on palpation. Portal obstruction and ascites, late manifestations of cirrhosis, are caused partly by chronic failure of liver function and partly by obstruction of the portal circulation. The obstruction to blood flow through the liver caused by fibrotic changes also results in the formation of collateral blood vessels in the GI system and shunting of blood from the portal vessels into blood vessels with lower pressures. These distended blood vessels form varices or hemorrhoids, depending on their location. Because of inadequate formation, use, and storage of certain vitamins (notably vitamins A, C, and K), signs of deficiency are common, particularly hemorrhagic phenomena associated with vitamin K deficiency. Additional clinical manifestations include deterioration of mental and cognitive function with impending hepatic encephalopathy and hepatic coma, as previously described.

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? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention c. Peripheral vascular assessment related to immobility d. Skin assessment related to increase in bile salts

a. Respiratory assessment related to increased thoracic pressure If a patient with ascites from liver dysfunction is hospitalized, nursing measures include assessment and documentation of intake and output (I&O;), abdominal girth, and daily weight to assess fluid status. The nurse also closely monitors the respiratory status because large volumes of ascites can compress the thoracic cavity and inhibit adequate lung expansion. The nurse monitors serum ammonia, creatinine, and electrolyte levels to assess electrolyte balance, response to therapy, and indications of encephalopathy.

A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client? a. Vasopressin (Pitressin) b. Lactulose (Cephulac) c. Propranolol (Inderal) d. Spironolactone (Aldactone)

a. Vasopressin (Pitressin) In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Vasopressin (Pitressin) may be the initial mode of therapy in urgent situations, because it produces constriction of the splanchnic arterial bed and decreases portal pressure. Propranolol (Inderal) and nadolol (Corgard), beta-blocking agents that decrease portal pressure, are the most common medications used both to prevent a first bleeding episode in clients with known varices and to prevent rebleeding. Beta-blockers should not be used in acute variceal hemorrhage, but they are effective prophylaxis against such an episode. Spironolactone (Aldactone), an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. Lactulose (Cephulac) is administered to reduce serum ammonia levels in clients with hepatic encephalopathy.

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? a. Anorexia for more than 3 days b. Change in the client's handwriting and/or cognitive performance c. Weight loss of 2 pounds in 3 days d. Constipation for more than 2 days

b. Change in the client's handwriting and/or cognitive performance The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental status immediately. Chronic fatigue, anorexia, dyspepsia, nausea, vomiting, and diarrhea or constipation with accompanying weight loss are regular symptoms of cirrhosis.

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. Hepatitis C b. Hepatic encephalopathy c. Esophageal varices d. Portal hypertension

b. Hepatic encephalopathy 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.

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? a. Dull pain, points to epigastric area b. Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back c. Sharp, stabbing pain in the left lower quadrant of the abdomen d. Severe abdominal pain that radiates to the right shoulder

b. Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back The most common complaint of clients with pancreatitis is severe mid-abdominal to upper abdominal pain, radiating to both sides and straight to the back. The other answers are not pain that is usually associated with acute pancreatitis.

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

b. 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.

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? a. Riboflavin deficiency b. Vitamin K deficiency c. Vitamin A deficiency d. Folic acid deficiency

b. Vitamin K deficiency Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency leads to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Pyridoxine deficiency results in skin and mucous membrane lesions and neurologic changes. Vitamin C deficiency results in the hemorrhagic lesions of scurvy. Vitamin K deficiency results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses. Folic acid deficiency results in macrocytic anemia.

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? a. "Does your work expose you to chemicals?" b. "Have you had an infection recently?" c. "How often do you drink alcohol?" d. "What type of over-the-counter pain reliever do you use?"

c. "How often do you drink alcohol?" The most common type of cirrhosis results from chronic alcohol intake and is frequently associated with poor nutrition. Although it can follow chronic poisoning with chemicals or ingestion of hepatotoxic drugs such as acetaminophen, asking about alcohol intake would be most important. Asking about an infection or exposure to hepatotoxins or industrial chemicals would be important if the client had postnecrotic cirrhosis.

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? a. Peanut butter b. Sliced ham c. A pear d. Hot dog

c. A pear 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.

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? a. Coagulation studies b. Magnetic resonance imaging c. Liver biopsy d. Radioisotope liver scan

c. 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 has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? a. Hepatocellular jaundice b. Cirrhosis of the liver c. Obstructive jaundice d. Hemolytic jaundice

c. Obstructive jaundice Obstructive jaundice is caused by a block in the passage of bile between the liver and intestinal tract. Hemolytic jaundice is caused by excess destruction of red blood cells. Hepatocellular jaundice is caused by liver disease. Cirrhosis of the liver would be an example of hepatocellular jaundice.

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? a. Ascites and orthopnea b. Gynecomastia and testicular atrophy c. Purpura and petechiae d. Dyspnea and fatigue

c. Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: a. can digest high-fat foods. b. are at risk for hepatic encephalopathy. c. cannot tolerate high-glucose concentration. d. are at risk for gallbladder contraction.

c. cannot tolerate high-glucose concentration. Total parental nutrition (TPN) is used carefully in clients with pancreatitis because some clients cannot tolerate a high-glucose concentration even with insulin coverage. Intake of coffee increases the risk for gallbladder contraction, whereas intake of high protein increases risk for hepatic encephalopathy in clients with cirrhosis. Patients with pancreatitis should not be given high-fat foods because they are difficult to digest.

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: a. peptic ulcer disease. b. appendicitis. c. cirrhosis. d. cholelithiasis.

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

d. Hepatic encephalopathy Hepatic encephalopathy is a central nervous system dysfunction resulting from liver disease. It is frequently associated with an elevated ammonia concentration that produces changes in mental status, altered level of consciousness, and coma. Portal hypertension is an elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.

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? a. Maintaining fluid volume b. Relieving the client's anxiety c. Controlling bleeding d. Maintaining the airway

d. Maintaining the airway 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.

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? a. Sclerotherapy b. Vasopressin (Pitressin) c. Balloon tamponade d. Transjugular intrahepatic portosystemic shunting (TIPS)

d. Transjugular intrahepatic portosystemic shunting (TIPS) A TIPS procedure (see Fig. 49-8) is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. In 10% to 20% of patients for whom urgent band ligation or sclerotherapy and medications are not successful in eradicating bleeding, a TIPS procedure can effectively control acute variceal hemorrhage by rapidly lowering portal pressure.