Hepatic Questions
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 (p. 1407).
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: A. Excessive diuresis and dehydration. B. Excess potassium loss subsequent to prolonged use of diuretics. C. The digestion of dietary and blood proteins. D. Severe infections and high fevers.
C. The digestion of dietary and blood proteins. Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (ie, bleeding esophageal varices, chronic GI bleeding), a high-protein diet, bacterial infection, or uremia (p. 1394).
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? A. Radioisotope liver scan B. Angiography C. Magnetic resonance imaging D. Electroencephalography
A. 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 (p. 1382).
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply. A. Risk for injury related to altered clotting mechanisms B. Disturbed body image related to changes in appearance, sexual dysfunction, and role function C. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort D. Urinary incontinence related to general debility and muscle wasting E. Altered nutrition, more than body requirements, related to decreased activity and bed rest
A. Risk for injury related to altered clotting mechanisms B. Disturbed body image related to changes in appearance, sexual dysfunction, and role function C. Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risks for injury, activity intolerance, and disturbed body image are priority nursing diagnoses. The appropriate nursing diagnosis related to nutrition would be altered nutrition, less than body requirements, related to chronic gastritis, decreased gastrointestinal motility, and anorexia. Urinary incontinence is not generally a concern with hepatic cirrhosis (p. 1409).
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? A. Hemoglobin B. Albumin C. Bilirubin D. Temperature
B. Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema (p. 1385).
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? A. Colonoscopy B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Cholecystectomy D. Abdominal x-ray
B. 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 (p. 1433).
A client with suspected biliary obstruction due to gallstones reports changes to the color of his stools. Which stool color does the nurse recognize as common to biliary obstruction? A. Green B. Gray C. Red D. Black
B. Gray A gray-white stool color is common with a biliary obstruction because the stool is no longer colored with bile pigments (p. 1432).
What is the recommended dietary treatment for a client with chronic cholecystitis? A. high-fiber diet B. low-protein diet C. low-fat diet D. low-residue diet
C. low-fat diet The bile secreted from the gallbladder helps the body absorb and break down dietary fats. If the gallbladder is not functioning properly, then it will not secrete enough bile to help digest the dietary fat. This can lead to further complications; therefore, a diet low in fat can be used to prevent complications (p. 1434).
A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? A. 16 to 49 grams B. 50 to 75 grams C. 76 to 99 grams D. 100 to 126 grams
D. 100 to 126 grams Daily protein intake should be maintained at 1.2 to 1.5 g/kg per day. To calculate protein intake, multiply the 84 kg by the low and high ranges: (84 kg × 1.2 = 100 g; 84 kg × 1.5 = 126 g). This client would require a daily protein range from 100 to 126 grams (p. 1396).
Which of the following diagnostic studies definitely confirms the presence of ascites? A. Computed tomography of abdomen B. Abdominal x-ray C. Colonoscopy D. Ultrasound of liver and abdomen
D. Ultrasound of liver and abdomen Ultrasonography of the liver and abdomen will definitively confirm the presence of ascites. An abdominal x-ray, colonoscopy, and computed tomography of the abdomen would not confirm the presence of ascites (p. 1382).
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. Lactulose (Cephulac) B. Vasopressin (Pitressin) C. Propranolol (Inderal) D. Spironolactone (Aldactone)
B. 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 (p. 1390).