Liver and Cirrohosis

A nurse is teaching a community education course about the physical complications related to substance use disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis? a. Alcohol b. Caffeine c. Cocaine d. Inhalants

a. Alcohol rationale: Primary cause of liver cirrhosis

A nurse is assessing a client immediately following a paracentesis for the treatment of ascites. which of the following findings indicates the procedure was effective? a. presence of a fluid wave b. increased heart rate c. equal pre & post procedure weights d. decreased SOB

decreased shortness of breath increased abdominal fluid can limit the expansion of the diaphragm and prevent the client from taking a deep breath. once excess peritoneal fluid is removed, the diaphragm will expand more freely. the nurse should identify this finding as an indicator of the effectiveness of the paracentesis.

A Nurse is reviewing the laboratory findings for client who has liver failure and acites, The client is taking aldactone. Which of the following findings is an adverse effects of medication? a. Serum sodium 140 mEq/l b. Serum chloride 99 mEq/l c. Serum potassium 5.2 d. Serum calcium 1.5

c. Serum potassium 5.2

A nurse is administering an IM injection to a client who has hepatitis C. Before placing the syringe and needle in a puncture-resistant container, which of the following actions should the nurse take? a. Recap the needle b. Place the cap on the bedside table and slide the needle into the cap c. Wrap the needle with gauze d. Dispose of the needle uncapped

d. Dispose of the needle uncapped rationale: The nurse should immediately place the uncapped needle in a puncture-resistant container to prevent a needle stick with the contaminated needle

A client with cirrhosis begins to develop ascites. Spironolactone (Aldactone) is prescribed to treat the ascites. The nurse should monitor the client closely for which of the following drug-related adverse effects? 1. Constipation. 2. Hyperkalemia. 3. Irregular pulse. 4. Dysuria.

2. Hyperkalemia. Spironolactone (Aldactone) is a potassium-sparing diuretic; therefore, clients should be monitored closely or hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common adverse effects of spironolactone. An irregular pulse is not an adverse effect of spironolactone but could develop i serum potassium levels are not closely monitored

The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? 1. Peripheral edema. 2. Ascites. 3. Anorexia. 4. Jaundice

3. Anorexia. Early clinical manifestations of cirrhosis are subtle and usually include gastrointestinal symptoms, such as anorexia, nausea, vomiting, and changes in bowel patterns. These changes are caused by the liver's altered ability to metabolize carbohydrates, proteins, and fats. Peripheral edema, ascites, and jaundice are later signs of liver failure and portal hypertension

The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the physician of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? 1. Aldosterone. 2. Creatinine. 3. Potassium. 4. Protein.

3. Potassium. Hypokalemia is a precipitating actorin hepatic encephalopathy. A decrease in creati-nine results rom muscle atrophy; an increase in creatinine would indicate renal insufciency. With liver dysfunction, increased aldosterone levels are seen. A decrease in serum protein will decrease colloid osmotic pressure and promote edema.

A community health nurse is planning an educational program about Hep A. When preparing the materials, the nurse should identify that which of the following groups is most at risk for developing Hep A. Children and young adults Older adults Women who are pregnant Middle-aged men

Children and young adults Rationale: The usual mode of transmission for Hep A is oral-fecal route. Children and young adults are the two groups most often affected by the Hep A virus. They usually acquire it at school through poor hand hygiene, hand to mouth contact, or another from of close contact

A nurse is reviewing the laboratory report for a client who has cirrhosis which of the following results should the nurse expect for this client? a. elevated albumin level b. decreased liver enzymes c. prolonged prothrombin time & increased INR d. elevated sodium levels

Prolonged Prothrombin time & Increased INR

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? * Requesting vaccination for hepatitis A * Using a needleless system in daily work * Getting the three-part hepatitis B vaccine * Requesting an injection of immunoglobulin

Requesting an injection of immunoglobulin The administration of immunoglobulin, antibodies to hepatitis A, may prevent development of the disease. The vaccine for hepatitis A will take several weeks to stimulate the development of antibodies; passive immunity in the form of immunoglobulin is needed. Implementing a needleless system and getting the three-part vaccine may prevent the development of hepatitis B, not hepatitis A.

A nurse is caring for a client who has hepatic encephalopathy. the client asks the nurse if she can have a larger portion of beef for dinner. which of the following responses by the nurse is appropriate? A) "Beef is too high fat, but I can request chicken as a substitute." B) "You need to increase your fluid intake. Would you like beef and noodle soup?" C) "You should limit your animal protein intake. Can I get you a veggie burger instead?" D) "You need to limit calories. Would you like some sugar-free gelatin?"

you should limit your animal protein intake. can i get you a veggie burger instead? hepatic encephalopathy often requires a temporary reduction in animal protein intake due to the resulting increased production of ammonia. It is appropriate for the nurse to recommend replacing animal protein with vegetable protein

A nurse is providing discharge teaching for a client who has chronic hepatitis C. which of the following statements by the client indicates an understanding of the teaching? A. "I will avoid alcohol until I'm no longer contagious." B. "I will avoid medications that contain acetaminophen." C. "I will decrease my intake of calories." D. "I will need treatment for 3 months."

B. "I will avoid medications that contain acetaminophen." A client who has hepatitis C should avoid medications that contain acetaminophen, which can cause additional liver damage.

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following laboratory findings should the nurse expect? A. Presence of immunoglobulin G antibodies (IgG) B. Presence of enzyme immunoassay (EIA) C. Aspartate aminotransferase (AST) 35 units/L D.Alanine aminotransferase (ALT) 15 IU/L

B. CORRECT: The presence of EIA is an expected laboratory finding in a client who has a new diagnosis of hepatitis C.

A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client? a. Moist skin b. Spider angiomas c. Tarry stools d. Blood in urine

B. Spider angiomas rationale: Spider angiomas are lesions with a red center and numerous extensions that spread out like a spider web. This is an expected finding for a client who has cirrhosis

A nurse is caring for a client who has hepatitis A. The client asks the nurse how he might have contracted the virus. Which of the following is a question the nurse should ask the client? a. "Have you eaten any fresh water fish lately?" b. "Have you received a blood transfusion recently?" c. "Have you been to a third world country in the past?" d. "Do you take any recreational drugs?"

C. "Have you been to a third world country in the past?"

A nurse is reinforcing teaching with a commonly group about the prevention of viral hepatitis. Which of the following information should the nurse include in the teaching? A. Wear a mask when in crowded places B. Avoid washing fresh vegetables to prevent the removal of nutrients C. Thoroughly cook foods prepared with tap water D. Limit time spent around individuals who have a productive cough

C. Thoroughly cook foods prepared with tap water

A nurse is assessing a client who has acute hepatitis B. which of the following findings should the nurse expect? A. Joint pain B. Obstipation C. Abdominal distention D. Periumbilical discoloration

joint pain Joint pain is an expected finding in a client who has acute hepatitis B.

A nurse is reinforcing dietary instruction with a client who has episodes of biliary colic from chronic cholecystitis, which of the following diet should the nurse reinforce in the patients teaching plan? a. low sodium diet b. high protein diet c. high fiber diet d. low fat diet

low fat diet

a nurse is providing teaching for a client who has cirrhosis and a new prescription for lactulose. the nurse should include which of the following instructions in the teaching? A. Notify provider if bloating occurs B. Expect to have 2-3 soft stools per day C. Restrict carbohydrates in the diet D. Limit oral fluid intake to 1000 mL per day of clear fluids

B. expect 2-3 soft stools per day. The purpose of administering lactulose is to promote excretion of ammonia in stool. the nurse should instruct the client to take he medication every day and inform the client that 2-3 bowel movements everyday is the treatment goal.

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client's ammonia level? a. Administer diuretics b. Restrict the client's intake of fluids c. Reduce the client's intake of protein d. Administer vitamin K

C. Reduce the client's intake of protein rationale: Ammonia is formed in the GI tract by the action of bacteria on protein. Limiting dietary intake can assist with decreasing the client's ammonia level. Protein is necessary for healing, so strict limitation of dietary protein is not recommended

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which client should be assigned to the RN? * Client who is taking lactulose and has diarrhea * Client with hepatitis C who requires a dressing change * Client with end-stage cirrhosis who needs teaching about a low-sodium diet * Obtunded client with alcoholic encephalopathy who needs a blood draw

Client with end-stage cirrhosis who needs teaching about a low-sodium diet The RN is responsible for client teaching; therefore, the client with end-stage cirrhosis should be assigned to the RN. Assisting a client with toileting and recording stool number and amount can be accomplished by nonprofessional staff. The LPN/LVN can provide dressing changes. Ancillary staff can perform venipuncture.

A nurse is caring for a client who is schedule to undergo a liver biopsy for a suspected malignancy. Which of the following laboratory findings should the nurse monitor to the procedure? Prothrombin time Serum lipase Bilirubin Calcium

Prothrombin time

A nurse is preparing to administer the hepatitis B vaccine to a client. Which of the following techniques should the nurse use to locate the deltoid muscle? a. Locate the center of the arm between the elbow and the shoulder b. Find the center of the anterior aspect of the thigh c. Locate the middle third of the anterior thigh between the greater trochanter fo the femur and the lateral femoral condyle d. Place one finger across the acromion process and measure 3 finger breadths below to the midpoint and center of the lateral aspect of the upper arm

d. Place one finger across the acromion process and measure 3 finger breadths below to the midpoint and center of the lateral aspect of the upper arm

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? * The client must not consume alcohol. * Avoid sharing the bathroom with the client. * Members of the household must not share toothbrushes. * Drink only bottled water and avoid ice.

* Members of the household must not share toothbrushes Toothbrushes, razors, towels, and items that may spread blood and body fluids should not be shared. The client should not consume alcohol, but abstention will not prevent spread of the virus. The client may share a bathroom if he or she is continent. To prevent hepatitis A when traveling to foreign countries, bottled water should be consumed and ice made from tap water should be avoided.

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.)

-Diuretic -Beta-blocking agent -Lactulose (Cephulac)Diuretics facilitate excretion of excess fluid from the body in a client who has cirrhosis.Beta-blocking agents are prescribed for a client who has cirrhosis to prevent bleedingfrom varicies.Lactulose (Cephulac) is prescribed for a client who has cirrhosis to aid in theelimination of ammonia in the stool.

A nurse is planning care for a client who has cirrhosis of the liver. Which of the following actions should the nurse include in the plan? (Select all that apply) a. Administer furosemide b. Administer Warfarin c. Implement a low-sodium diet d. Measure the client's abdominal girth e. Encourage weight lifting during physical therapy

A,C,D rationale: A: The nurse should administer furosemide to the client to reduce fluid accumulation in the abdomen, C: To control fluid accumulation in the abdomen, D: Daily weights are even more reliable indicator of fluid accumulation

The health care provider orders lactulose for a patient with hepatic encephalopathy. The nurse will monitor for effectiveness of this medication for this pt by assessing what? a. relief of constipation b. relief of ab pain c. decreased liver enzymes d. decreased ammonia levels

D hepatic encephalopathy is associated with elevated ammonia levels. Lactulose traps ammonia in the intestinal tract. It's laxative effect then expels ammonia from the colon, resulting in decreased ammonia levels, correcting hepatic encephalopathy.

When assessing a client for hepatic cancer, the nurse anticipates finding an elevation in which laboratory test result? * Hemoglobin and hematocrit * Leukocytes * Alpha-fetoprotein * Serum albumin

* Alpha-fetoprotein Fetal hemoglobin (alpha-fetoprotein) is abnormal in adults; it is a tumor marker indicative of cancers. Although anemia may be present, elevated hemoglobin and hematocrit are not diagnostic of hepatic cancer. White blood cells (leukocytes) are not used to specifically diagnose cancers. Serum albumin levels may be low in liver cancer and in malnutrition.

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

ANS: A Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.

A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites? a. Monitor intake and output. b. Provide a low-sodium diet. c. Increase oral fluid intake. d. Weigh the client daily.

ANS: B A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. I should drink bottled water during my travels. b. I will not eat off anothers plate or share utensils. c. I should eat plenty of fresh fruits and vegetables. d. I will wash my hands frequently and thoroughly.

ANS: C The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.

A nurse is caring for a client who has cirrhosis and a prescription for lactulose. Following administration, the nurse should monitor the client for which of the following adverse effects? A. Dry mouth B. Diarrhea C. Headache D. Peripheral edema

B. Diarrhea

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? * Having a larger meal early in the morning * Consuming increased carbohydrates and moderate protein * Restricting fluids to 1500 mL/day * Limiting alcoholic beverages to once weekly

* Consuming increased carbohydrates and moderate protein To repair the liver, the client should have a high-carbohydrate and moderate-protein diet; fats may cause dyspepsia. The client with hepatitis feels full easily and should have four to six small meals daily. Fluids are restricted with ascites caused by cirrhosis; not all clients with hepatitis progress to cirrhosis. Complete abstention from alcohol is necessary until the liver enzymes return to normal.

A nurse is planning care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse include int he plan of care? a. Decrease the client's fluid intake b. Increase the client's saturated fat intake c. Increase the client's sodium intake d. Decrease the client's carbohydrate intake

A. Decrease the client's fluid intake rationale: The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client's risk for increased fluid retention

An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

ANS: A, C, D, E Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.

A nurse assesses a client who has liver disease. Which laboratory findings should the nurse recognize as potentially causing complications of this disorder? (Select all that apply.) a. Elevated aspartate transaminase b. Elevated international normalized ratio (INR) c. Decreased serum globulin levels d. Decreased serum alkaline phosphatase e. Elevated serum ammonia f. Elevated prothrombin time (PT)

ANS: B, E, F Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the clients confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

The nurse is providing discharge instructions for a client with cirrhosis. Which of the following statements best indicates that the client has under-stood the teaching? 1. "I should eat a high-protein, high-carbohydrate diet to provide energy." 2. "It is safer for me to take acetaminophen(Tylenol) for pain instead of aspirin." 3. "I should avoid constipation to decrease chances of bleeding." 4. "If I get enough rest and follow my diet, it is possible for my cirrhosis to be cured."

"I should avoid constipation to decrease chances of bleeding." Clients with cirrhosis should be instructed to avoid constipation and straining at stool to prevent hemorrhage. The client with cirrhosis has bleeding tendencies because o the liver's inability to produce clotting actors. A low-protein and high-carbohydrate diet is recommended. Clients with cirrhosis should not take acetaminophen (Tylenol),which is potentially hepatotoxic. Aspirin also should be avoided i esophageal varices are present.Cirrhosis is a chronic disease.

When caring for a client with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? (Select all that apply.) * Prolonged partial thromboplastin time * Icterus of skin * Swollen abdomen * Elevated magnesium * Currant jelly stool * Elevated amylase level

* Prolonged partial thromboplastin time * Icterus of skin * Swollen abdomen The liver produces clotting factors; when it is damaged, prolonged coagulation times and bleeding may result. Icterus, or jaundice, results from cirrhosis. The client with cirrhosis may develop ascites, or fluid in the abdominal cavity. Elevated magnesium is not related to cirrhosis. The client with cirrhosis may develop hypocalcemia and/or hypokalemia. Currant jelly stool is consistent with intussusception, a type of bowel obstruction. Cirrhosis is consistent with elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; amylase is typically elevated in pancreatitis.

The nurse provides discharge instructions for a 64 y.o. women with ascites and peripheral edema related to cirrhosis. Which statement, if made by the pt, indicates teaching WAS effective? a. it is safe to take acetaminophen up to four times a day for pain b. lactulose (cephulac) should be taken everyday to prevent constipation c. herbs and other spices should be used to season my foods instead of salt d. i will eat foods high in potassium while taking spironolactone (aldactone)

. herbs and other spices should be used to season my foods instead of salt

A nurse is caring for a client who cirrhosis. When delivering the clients lunch tray which of the fooling food selection requires intervention by the nurse? 1) 1 medium baked potato 2) 1 cup of sliced cucumbers in vinegar 3) 1 slice of ham on whole wheat bread 4) 1 240 ml (8 oz) milkshake

1 slice of ham on whole wheat bread ham is high in sodium and can increase fluid retention, leading to edema. Clients who have cirrhosis are prone to edema as the osmotic pressures change

The client with cirrhosis receives 100 mL of 25% serum albumin IV. Which finding would best indicate that the albumin is having its desired effect? 1. Increased urine output. 2. Increased serum albumin level. 3. Decreased anorexia. 4. Increased ease of breathing.

1. Increased urine output.Normal serum albumin is administered to reduce ascites. Hypoalbuminemia, a mechanism underlying ascites formation, results in decreased colloid osmotic pressure. Administering serum albumin increases the plasma colloid osmotic pressure, which causes fluid to ow rom the tissue space into the plasma. Increased urine output is the best indication that the albumin is having the desired effect.An increased serum albumin level and increased ease of breathing may indirectly imply that the administration o albumin is effective in relieving the ascites. However, it is not as direct an indicator as increased urine output. Anorexia is not affected by the administration fo albumin.

A client is to be discharged with a prescription for lactulose. The nurse teaches the client and the client's spouse how to administer this medication. Which of the following statements would indicate that the client has understood the information? 1. "I'll take it with Maalox." 2. "I'll mix it with apple juice." 3. "I'll take it with a laxative." 4. "I'll mix the crushed tablets in some gelatin."

2. "I'll mix it with apple juice." The taste o lactulose is a problem for some clients. Mixing it with fruit juice, water, or milk can make it more palatable. Lactulose should not be given with antacids, which may inhibit its action. Lactulose should not be taken with a laxative because diarrhea is an adverse effect o the drug.Lactulose comes in the form of syrup or oral or rectal administration.

A nurse is contributing to a teaching plan about the prevention of hepatitis A. The nurse should include that which of the following activities can spread hepatitis A? A. Sharing personal hygiene items like razors B. Eating uncooked foods C. Getting a tattoo D. Having vaginal intercourse

B. Eating uncooked foods

A nurse is contributing to the plan of care for a client who has cirrhosis of the liver. Which of the following interventions should the nurse include in the plan? (Select all) A. Implement fall precautions B. Obtain a weekly weight C. Initiate a low sodium diet D. Measure abdominal girth daily E. Administer enemas to manage constipation

implement fall precautions initiate low sodium diet measure abdominal firth daily

A nurse is caring for a client who has hepatitis A. The client asks the nurse how he might have contracted the virus. Before responding, which of the following questions should the nurse first ask the client? A. "Have you eaten any shellfish lately?" B. "Did you have a blood transfusion recently?" C. "Have you traveled to a third world country in the past two months?" D. "Do you take any recreational drugs?"

A. "Have you eaten any shellfish lately?"

An emergency room nurse assesses a client with potential liver trauma. Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.) a. Hypertension b. Tachycardia c. Flushed skin d. Confusion e. Shallow respirations

ANS: B, D Symptoms of hemorrhage and hypovolemic shock include hypotension, tachycardia, tachypnea, pallor, diaphoresis, cool and clammy skin, and confusion.

A nurse is collecting data from a client who is in the early stages of Hep A. Which of the following manifestations should that nurse expect? Jaundice Anorexia Dark Urine Pale feces

Anorexia Rationale: Jaundice, dark urine, and pale feces are all late manifestations of Hep A

A nurse is preparing to dispose of a needle after administering an intramuscular injection to a client who has hepatitis C. Which of the following actions should the nurse take? A. Recap the needle B. Place the cap on the table and slide the needle into the cap C. Ask another nurse to recap the needle D. Dispose of the needle uncapped

D. Dispose of the needle uncapped

A nurse is preparing a client who has advanced cirrhosis for an abdominal paracentesis which of the action should the nurse take? A. Instruct the client to empty his bladder B. Place the client on his back C. Assure the client that the procedure is painless D. Have the client increase fluid intake after the procedure

Instruct the client to empty his bladder

When caring for a client with hepatic encephalopathy, in which situation does the nurse question the use of neomycin (Mycifradin)? A Kidney failure B Refractory ascites C Fetor hepaticus D Paracentesis scheduled for today

Kidney failure The aminoglycoside drugs, which include neomycin, are nephrotoxic and ototoxic, and should not be taken by the client with hepatic encephalopathy. Cirrhosis and hepatic failure cause both ascites and encephalopathy; no contraindication for neomycin is known. Fetor hepaticus causes an ammonia smell to the breath when serum ammonia levels are elevated; neomycin is used to decrease serum ammonia levels. The client may be NPO for a few hours before paracentesis, but may take neomycin when the procedure is complete, or with less than 30 mL of water, depending on hospital policy.

A nurse is contributing to a plan of care for a client who has Hepatitis B. Which of the following should the nurse include in the plan? A. Administer antibiotics B. Provide a high-fat diet C. Use disposable plates and utensils D. Limit activity

Limit activity

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestation should the nurse expect to find? A. Spider angioma B. Dark colored stools C. Weak pulse D. Increased body hair

Spider angioma

A nurse is teaching self-management to a client who has hepatitis B. Which of the following instructions should the nurse include in the teaching? a. You may donate blood 6 months after completing the medication regimen b. Consume a high-protein diet c. Rest frequently throughout the day d. Take acetaminophen every 4 hr, as needed, for discomfort

c. Rest frequently throughout the day rationale: Rest frequently throughout the day to reduce the metabolic demands upon the liver and decrease energy demands; not B bc liver's ability yo metabolize protein by-products is impaired so diet high in carbs and moderate in fat & protein

The condition of the pt who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the pt has developed liver cancer? a. serum a-fetoprotein level b. ventilation/perfusion scan c. hepatic structure ultrasound d. abdominal girth measurement

c. hepatic structure ultrasound

During assessment of a pt with obstructive jaundice, the nurse would expect to find: clay colored stools dark urine and stool pyrexia and pruritis elevated urinary urobilinogen

clay colored stool

A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan? a. Administer antibiotics b. Provide a diet high in fat c. Restrict fluids d. Encourage short periods of ambulation

d. Encourage short periods of ambulation rationale: The nurse should encourage a client who has hepatitis B to alternate between activity and rest

A nurse is contributing to the plan of care for a client who has cirrhosis and ascites. Which of the following interventions should the nurse recommend for the incision in the plan of care?

decrease the clients fluid intake or increase daily calorie intake

A nurse is reinforcing teaching with a group of community residents about hepatitis B.Which of the following statements should the nurse include in the teaching? "Hep B immunization is recommended for those who travel, especially military personnel" "Hep B immunization is given to infants and children" "Hep B is acquired by eating foods that are contaminated during handling" "Hep B can be prevented by using good personal hygiene habits and proper sanitation"

"Hep B immunization is given to infants and children"

The pt with cirrhosis is being taught self care. which statement indicates the pt needs MORE teaching? a. if i notice a fast heart rate and irregular beats, this is normal for cirrhosis b. i need to take good care of my belly and ankle skin where it is swollen. c. a scrotal support may be more comfortable when i have scrotal edema d. i can use pillows to support my head to help me breathe when i am in bed.

A This may indicative of hypokalemia and should be reported to healthcare provider, this is not normal for cirrhosis.

When planning care for a pt with cirrhosis, the nurse will give highest priority to which nursing diagnosis? a. impaired skin integrity related to edema, ascites, and pruritis b. imbalanced nutrition: less than body requirements related to anorexia c. excess fluid volume related to portal hypertension and hyperaldosteronism d. ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

D airway and breathing are always highest priority.

A nurse is assisting with the admission of a client who has fulminant hepatic failure. Which of the following procedures should the nurse expect for this client? Endoscopic sclerotherapy Liver Lobectomy Liver transplant Transjugular intrahepatic portal-systemic shunt placement

Liver transplant Rationale: Fulminant hepatic failure, most often caused by viral hepatitis, is caused by the development of hepatic encephalopathy within weeks of the onset of disease in a client without prior evidence of hepatic dysfunction. Mortality remains high, even with treatment modalities such as blood or plasma exchanges, charcoal hemoperfusion, and corticosteroids. Consequently, liver transplantation has become the treatment of choice for these clients

The nurse is reviewing the lab results for a pt with cirrhosis and notes that the ammonia level is elevated. Which diet does the nurse anticipate to be prescribed for this pt? Low-protein High-protein Moderate-fat High-carb

Low-protein diet Protein provided by the diet is transported to the liver via the portal vein. The liver breaks down protein, which results in the formation of ammonia.

The nurse asks a client with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? * Positive Babinski's sign * Hyperreflexia * Kehr's sign * Asterixis

* Asterixis Liver flap or asterixis is related to increased serum ammonia levels—the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments. Babinski's sign is positive when, as the sole of the foot is stroked, the great toe points up and the toes fan out. Hyperreflexia refers to deep tendon reflexes that are overactive. Kehr's sign is reflected by increased abdominal pain, exaggerated by deep breathing, and referred to the right shoulder.

A client who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered? * Colon cancer with metastasis to the liver * Hypertension * Hepatic encephalopathy * Ascites and shortness of breath

* Colon cancer with metastasis to the liver Transplantation is performed for hepatitis and primary (not secondary) liver cancers. Hypertension is a controllable factor and would not preclude the client from a liver transplant. Encephalopathy is a consequence of advanced liver disease, consistent with the condition of a client awaiting transplantation; it can be treated with lactulose and nonabsorbable antibiotics. Ascites and resulting shortness of breath are also consequences of advanced liver disease, consistent with the client awaiting transplantation; they can be managed with diuretics and paracentesis.

In caring for a client who has undergone paracentesis, which changes in the client's status should be promptly reported to the provider? * Increased blood pressure, increased respiratory rate * Decreased blood pressure, increased heart rate * Increased respiratory rate, increased apical pulse, pallor * Tachypnea, diaphoresis, increased blood pressure

* Decreased blood pressure, increased heart rate Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the client's part.

A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Limit physical activity B. Avoid alcohol. C. Take acetaminophen for comfort. D. Wear a mask when in public places. E. Eat small frequent meals

A. CORRECT Limiting physical activity and taking frequent rest breaks conserves energy and assists in the recovery process for a client who has hepatitis B. B. CORRECT Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B. C. Acetaminophen is metabolized in the liver and should be avoided by the client who has hepatitis B. D. Hepatitis B is a blood‑borne disease. Wearing a mask is not necessary to prevent transmission to others. E. CORRECT The client who has hepatitis B should eat small frequent meals to promote improved nutrition due to the presence of anorexia.

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? * Provides enzymes necessary to digest dairy products * Reduces portal pressure * Promotes gastrointestinal (GI) excretion of ammonia * Decreases GI bleeding

Promotes gastrointestinal (GI) excretion of ammonia Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy products. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding.

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education? a. Use a pill organizer to ensure you take this medication as prescribed. b. Transient muscle aching is a common side effect of this medication. c. Follow up with your provider in 1 week to test your blood for toxicity. d. Take your radial pulse for 1 minute prior to taking this medication.

ANS: A Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.

A nurse plans care for a client who has hepatopulmonary syndrome. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Oxygen therapy b. Prone position c. Feet elevated on pillows d. Daily weights e. Physical therapy

ANS: A, C, D Care for a client who has hepatopulmonary syndrome should include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the client in a prone position, on the clients stomach. Although physical therapy may be helpful to a client who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome.

A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver? a. A 22-year-old with a history of blunt liver trauma b. A 48-year-old with a history of diabetes mellitus c. A 66-year-old who has a history of cirrhosis d. An 82-year-old who has chronic malnutrition

ANS: C The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer.

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first? a. Sedate the client to prevent tube dislodgement. b. Maintain balloon pressure at 15 and 20 mm Hg. c. Irrigate the gastric lumen with normal saline. d. Assess the client for airway patency.

ANS: D Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect? a. Nausea and vomiting b. Frontal headache c. Vertigo and syncope d. Mid-sternal chest pain

ANS: D Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.

Which intervention will the nurse include in the plan of care for a client with severe liver disease? A. Encourage the client to eat a low-protein, high-carbohydrate diet. B. Administer Kayexalate enemas. C. Encourage the client to eat a high-protein, low-carbohydrate diet. D. Participate in frequent, vigorous physical activities.

Answer: A Rationale: The client with severe liver disease should eat a diet high in carbohydrates and calories with moderate amounts of fat and protein. Kayexalate enemas and frequent, vigorous physical activities should be avoided.

A nurse is reinforcing discharge instructions with a client who has hepatitis A. Which following statements by the client indicates an understanding of the teaching? A. "I will not eat fried foods." B. "I will abstain from sexual intercourse." C. "I will refrain from international travel." D. "I will not order a salad in a restaurant."

B. "I will abstain from sexual intercourse."

Which problem for a client with cirrhosis takes priority? A) Insufficient knowledge related to the prognosis of the disease process B) Discomfort related to the progression of the disease process C) Potential for injury related to hemorrhage D) Inadequate nutrition related to an inability to tolerate usual dietary intake

C) Potential for injury related to hemorrhage Potential for injury related to hemorrhage is the priority client problem because this complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate nutrition are not priorities because these issues are not immediately life-threatening.

The RN has just received the change-of-shift report for the medical unit. Which client should the RN see first? * Client with ascites who had a paracentesis 2 hours ago and is reporting a headache * Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse * Client with hepatic cirrhosis and jaundice who has hemoglobin of 10.9 g/dL and thrombocytopenia * Client with hepatitis A who has elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

Client with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse A change in the level of consciousness (LOC) of the client with PSE is the greatest concern; actions to improve the client's LOC should be rapidly implemented. Although uncomfortable, a headache in the client with ascites is not likely related to liver disease and does not pose an immediate threat or complication. A hemoglobin of 10.9 g/dL and thrombocytopenia are expected findings in a client with cirrhosis and do not pose an immediate threat. Elevated ALT and AST levels are expected for the client with hepatitis A and do not indicate a risk for severe complications.

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? A) "Cirrhosis is a chronic disease that has scarred my liver." B) "The scars on my liver create problems with blood circulation." C) "Because of the scars on my liver, blood clotting and blood pressure are affected." D) "My liver is scarred, but the cells can regenerate themselves and repair the damage."

D) "My liver is scarred, but the cells can regenerate themselves and repair the damage." Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent scars form in response to attempts by the cells to regenerate and create problems in blood circulation moving through the liver. Liver scarring will create problems with blood clotting, cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.

How does the home care nurse best modify the client's home environment to manage side effects of lactulose (Evalose)? * Provides small frequent meals for the client * Suggests taking daily potassium supplements * Elevates the head of the bed in high-Fowler's position * Requests a bedside commode for the client

Requests a bedside commode for the client Lactulose therapy increases the frequency of stools, so a bedside commode should be made available to the client, especially if he or she has difficulty reaching the toilet. Small frequent meals and elevating the head of the bed will not have any effect on the side effects of lactulose. Although lactulose produces excessive stools and could potentially result in loss of potassium, it is inappropriate for the nurse to suggest that the client take potassium supplements.

A nurse is assisting with the plan of care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan? 1) Provide a low calorie diet 2) Administer acetaminophen for pain 3) Encourage eating three large meals daily 4) Provide periods of rest

provide periods of rest client who has hepatitis should alternate periods of rest with activity to promote healing

A nurse is reinforcing teaching with a community group about the prevention of viral hepatitis. Which of the following information should the nurse include in the teaching? A. Wear a mask when in crowded places B. Avoid washing fresh vegetables to prevent the removal of nutrients C. Thoroughly cook foods prepared with tap water D. Limit time spent around individuals who have a productive cough

thoroughly cook foods prepared with tap water

A nurse is caring for a client who has cirrhosis of the liver with ascites. Which of the following interventions should the nurse take? A. Restrict foods high in protein B. Increase daily calorie intake C. Increase foods high in sodium D. Increase fluid intake

B. Increase daily calorie intake

A nurse is caring for a newborn whose mother is positive for the hepatitis B surface antigen. Which of the following treatments should the infant receive? A. Hepatitis B immune globulin at 1 week followed by the hepatitis B vaccine monthly for 6 months B. The hepatitis B vaccine monthly until the newborn tests negative for the hepatitis B surface antigen C. Hepatitis B immune goblin and the hepatitis B vaccine within 12 hr of birth D. The hepatitis B vaccine at 24 hr followed by hepatitis B immune globulin every 12 hr for 3 days

C. Hepatitis B immune goblin and the hepatitis B vaccine within 12 hr of birth

A nurse is assessing a client who has advanced cirrhosis which of the following manifestations should nurse expect to find? a. increased body hair b. weak pulse c. dark colored stools d. spider telangiectasis

spider telangiectasis

A nurse is reviewing the laboratory results of a client who has hepatic cirrhosis. which of the following laboratory findings should the nurse report to the provider? a. Albumin 4.0 g/dL b. INR 1.5 c. Bilirubin 0.2 mg/dL d. Ammonia 180 mcg/dL

ammonia 180 mcg/dl the nurse should report an increased serum ammonia level because it can indicate portal-systemic encephalopathy

A nurse is assessing client in a health clinic for risk factors for contracting hepatitis. Which of the following clients is at risk for developing hepatitis C? a. A client who eats raw shellfish b. A client who has multiple tattoos c. A client who works in a child care center d. A client who has recently traveled to a underdeveloped country

b. A client who has multiple tattoos

A nurse is assessing a client who has cirrhosis. which of the following findings is the priority for the nurse to report to the provider? a. spider angiomas b. peripheral edema c. bloody stools d. jaundice

bloody stools the greatest risk to the client is hemorrhaging. bloody stools are indication of bleeding in the gastrointestinal tract. this finding is the priority to the report to the provider.

It is essential that the nurse monitor the client returning from hepatic artery embolization for hepatic cancer for which potential complication? * Right shoulder pain * Polyuria * Bone marrow suppression * Bleeding

* Bleeding When monitoring a client post hepatic artery embolization, an arterial approach is taken; therefore, prompt detection of hemorrhage is the priority. Discomfort may be present, but the priority is to assess for hemorrhage. The nurse must assess for signs of shock, not polyuria. Embolization does not suppress the bone marrow; if chemotherapy or immune modulators are used, the nurse then assesses for bone marrow suppression.

Which intervention is important for the nurse to include in the plan of care for a client who is to undergo paracentesis later today? * Measure and record drainage. * Monitor aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. * Obtain informed consent for the procedure. * Have the client void before the procedure is performed.

* Have the client void before the procedure is performed. Voiding before the procedure prevents bladder injury. The drainage color and amount will be recorded after the procedure. Liver enzymes are expected to be elevated; this is the purpose of the procedure. The health care provider performing the procedure should discuss the intervention and potential complications with the client and obtain informed consent.

A nurse is assisting in the care of a client who is 24 hr postoperative liver lobectomy for hepatocellular carcinoma. The nurse should expect an alteration in which of the following laboratory tests?

-Blood glucose Blood glucose should be monitored during the first 24 to 48 hr following a liver lobectomy due to decreased gluconeogenesis and stress to the liver from surgery.

A nurse is reinforcing teaching with a client who has hepatitis B about home care. Which of the following should the nurse include in the teaching? (Select all that apply.)

-Limit physical activity -Avoid alcohol consumption -Eat small frequent meals Limiting physical activity and taking frequent rest breaks conserves energy and assistsin the recovery process for a client who has hepatitis B.Alcohol is metabolized in the liver and should be avoided by the client who has hepatitis B.A client who has hepatitis B should eat small frequent meals to promote improvednutrition due to the presence of anorexia.

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect to find? A. Spider angioma B. Dark colored stools C. Weak pulse D. Increased body hair

A. Spider angioma

A client previously diagnosed with liver cirrhosis visits the medical clinic. What assessment findings does the nurse expect in this client? Select all that apply. A. Ecchymosis B. Soft abdomen C. Moist, clammy skin D. Jaundice E. Ankle edema F. Fever

Answer: A, D, E Rationale: Clients with advanced cirrhosis often have symptoms such as gastrointestinal (GI) bleeding, jaundice, ascites, and spontaneous bruising. They may also have dry skin, rashes, purpuric lesions (e.g., petechiae), warm and bright red palms of the hands, vascular lesions (spider angiomas), and peripheral dependent edema of the extremities and sacrum.

A nurse is reviewing the laboratory reports for a client who has cirrhosis. Which of the following results should the nurse expect for this client? A. Elevated albumin level B. Decreased liver enzymes C. Elevated sodium levels D. Decreased platelets

D. Decreased platelets

A nurse is caring for a client who has liver cirrhosis with ascites and bleeding esophageal varies. Which of the following laboratory findings indicates that the clients gastrointestinal ( GI) tract is digesting and absorbing blood? A. Elevated BUN B. Elevated HbA1c C. Decreased chloride D. Decreased billirubin

Elevated BUN

Which activity by the nurse will best relieve symptoms associated with ascites? * Administering oxygen * Elevating the head of the bed * Monitoring serum albumin levels * Administering intravenous fluids

Elevating the head of the bed The enlarged abdomen of ascites limits respiratory excursion; Fowler's position will increase excursion and reduce shortness of breath. The client may need oxygen, but first the nurse should raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring will detect anticipated decreased serum albumin levels associated with cirrhosis and hepatic failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.

When caring for a client with portal hypertension, the nurse assesses for which potential complications? (Select all that apply.) *Esophageal varices * Hematuria * Fever * Ascites * Hemorrhoids

Esophageal varices Ascites Hemorrhoids Portal hypertension results from increased resistance to or obstruction (blockage) of the flow of blood through the portal vein and its branches. The blood meets resistance to flow and seeks collateral (alternative) venous channels around the high-pressure area. Veins become dilated in the esophagus (esophageal varices), rectum (hemorrhoids), and abdomen (ascites due to excessive abdominal [peritoneal] fluid). Hematuria may indicate insufficient production of clotting factors in the liver and decreased absorption of vitamin K. Fever indicates an inflammatory process.

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? (Select all that apply.) * Recent influenza infection * Brown stool * Tea-colored urine * Right upper quadrant tenderness * Itching

Tea-colored urine * Right upper quadrant tenderness * Itching The urine may be brown, tea-, or cola-colored in clients with hepatitis. Inflammation of the liver may cause right upper quadrant pain. Deposits of bilirubin on the skin, secondary to high bilirubin levels, and jaundice irritate the skin and cause itching. Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored.

A nurse is reinforcing teaching on prevention of transmission of hepatitis A with a recently infected client. Which of the following should the nurse include?

Wash your hands after toileting. "Hepatitis A is transmitted through infected stool, often due to improper hand-washing or preparation of fruits and vegetables.

A client with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? * Obtain the charts from the previous admission. * Listen for bowel sounds in all quadrants. * Obtain pulse and blood pressure. * Ask about abdominal pain.

* Obtain pulse and blood pressure. The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage. Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the client has stabilized. Assessment for adequate perfusion is the highest priority at this time.

A client is scheduled to undergo a liver transplantation. Which nursing intervention is most likely to prevent the complications of bile leakage and abscess formation? * Preventing hypotension * Keeping the T-tube in a dependent position * Administering antibiotic vaccinations * Administering immune-suppressant drugs

* Keeping the T-tube in a dependent position Keeping the T-tube in a dependent position and secured to the client is likely to prevent bile leakage, abscess formation, and hepatic thrombosis. Preventing hypotension will help to prevent the complication of acute kidney injury. Administering antibiotic vaccinations will help to prevent infection. Administering immune-suppressant drugs will help to prevent graft rejection.

A nurse is assisting with the care of a client who has a history of cirrhosis and is admitted with manifestation of hepatic encephalopathy. The nurse should anticipate a prescription for which of the following laboratory tests to determine the possibility or recent excessive alcohol use? Gamma-glutamyl tranferase (GGT) Alkaline phosphatase (ALP) Serum bilirubin Alanine aminotransferase (ALT)

Gamma-glutamyl tranferase (GGT)

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? * Clients who work with shellfish * Men who prefer sex with men * Clients traveling to a third-world country * Clients with elevations of aspartate aminotransferase and alanine aminotransferase

* Men who prefer sex with men Men who prefer sex with men are at increased risk for hepatitis B, which is spread by the exchange of blood and body fluids during sexual activity. Consuming raw or undercooked shellfish may cause hepatitis A, not hepatitis B. Travel to third-world countries exposes the traveler to contaminated water and risk for hepatitis A; hepatitis B is not of concern, unless the client is exposed to blood and body fluids during travel. Clients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B.

A client with cirrhosis is receiving lactulose.During the assessment, the nurse notes increasedconfusion and asterixis. The nurse should: 1. Assess for gastrointestinal (GI) bleeding. 2. Hold the lactulose. 3. Increase protein in the diet. 4. Monitor serum bilirubin levels

1. Assess for gastrointestinal (GI) bleeding. Clients with cirrhosis can develop hepaticencephalopathy caused by increased ammonialevels. Asterixis, a apping tremor, is a characteris-tic symptom o increased ammonia levels. Bacterialaction on increased protein in the bowel willincrease ammonia levels and cause the encephalop-athy to worsen. GI bleeding and protein consumedin the diet increase protein in the intestine and canelevate ammonia levels. Lactulose is given to reduceammonia ormation in the intestine and should notbe held since neurological symptoms are worsening.Bilirubin is associated with jaundice

A client has advanced cirrhosis of the liver.The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process? 1. "He must have been eating too many foods with salt in them. Salt pulls water with it." 2. "The swelling in his ankles must have moved up closer to his heart so the fluid circulates better." 3. "He must have forgotten to take his daily water pill." 4. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels.

4. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels.Portal hypertension and hypoalbumin-emia as a result o cirrhosis cause a fluid shit into the peritoneal space causing ascites. In a cardiac or kidney problem, not cirrhosis, sodium can promote edema formation and subsequent decreased urine output. Edema does not migrate upward toward the heart to enhance its circulation. Although diuretics promote the excretion of excess fluid, occasionally forgetting or omitting a dose will not yield the ascites ound in cirrhosis o the liver

A nurse is assessing a client who has advanced cirrhosis. The nurse should identify which of the following findings as indicators of hepatic encephalopathy? (Select all that apply.) A.Anorexia B.Change in orientation C.Asterixis D.Ascites E.Fetor hepaticus

A. Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. B. CORRECT A change in orientation indicates hepatic encephalopathy in a client who has advanced cirrhosis. C. CORRECT: Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy. D. Ascites can be present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. E. CORRECT: Fetor hepaticus, a fruity breath odor, is a finding of hepatic encephalopathy in the client who has advanced cirrhosis

A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, All of my family hates me. How should the nurse respond? a. You should make peace with your family. b. This is not unusual. My family hates me too. c. I will help you identify a support system. d. You must attend Alcoholics Anonymous.

ANS: C Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. The nurse should not minimize the clients concerns by brushing off the clients comment. Attending AA may be appropriate, but this response doesnt address the clients concern. Making peace with the clients family may not be possible. This statement is not client-centered.

The nurse is reviewing the record of a client with a dx of cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence? Dorsiflex the foot Measure abdominal girth Ask pt to extend the arms Instruct pt to lean forward

Ask the pt to extend the arms Asterixis is irregular flapping movements of the fingers and wrists when the hands and arms are outstretched, with the palms down, wrists bent up, and fingers spread. It is the most common and reliable sign that hepati encephalopathy is developing.

The pt with advanced cirrhosis asks why his abdomen is so swollen. The nurse's best response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity b. portal hypertension and hypoalbuminemia cause fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid.

B Ascites is accumulation of serious fluid in peritoneal cavity. With portal hypertension, protein shifts from the blood into the lymph. When the lymph system is unable to carry excess, it leaks thru the liver into the peritoneal cavity. osmotic pressure of the proteins pulls additional fluid into cavity. Second mechanism of ascites if hypoalbuminemia from the liver unable to synthesize albumin, resulting in decreased colloidal oncotic pressure.

A pt has been told she has NAFLD. The nursing teaching plan should include a. having genetic testing done b. recommend a heart healthy diet c. the necessity to reduce weight rapidly d. avoiding alcohol until liver enzymes return to normal

B NAFLD can progress to cirrhosis. NO definitive treatment; therapy directed at reducing risk like diabetes, body weight, and harmful medications.

A nurse is caring for a client who has esophageal varices and is hypotensive after vomiting 500mL of blood. Which of the following action is the nurse's priority? a. Elevate the client's feet b. Increase the client's IV fluid rate c. Initiate a dopamine IV infusion for the client d. Administer a unit of RBCs

B rationale: When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority is to increase the client's IV fluid rate. Providing fluid to the client will restore circulating volume and increase blood pressure

A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving spironolactone. Which of the following findings should the nurse expect? -Decreased sodium level -Decreased phosphate level -Decreased potassium level -Decreased chloride level

Decreased sodium level -The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.

The RN is caring for a client with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? * Assessing skin integrity and abdominal distention * Drawing blood from a central venous line for electrolyte studies * Evaluating laboratory study results for the presence of hypokalemia * Placing the client in a semi-Fowler's position .

Placing the client in a semi-Fowler's position Positioning the client in a semi-Fowler's position is included within UAP education and scope of practice, although the RN will need to supervise the UAP in providing care and will evaluate the effect of the semi-Fowler's position on client comfort and breathing. Assessment of skin integrity and abdominal distention, obtaining blood from a central line, and evaluation of laboratory results should be done by the RN.

A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond? a. A low-protein diet will help the liver rest and will restore liver function. b. Less protein in the diet will help prevent confusion associated with liver failure. c. Increasing dietary protein will help the client gain weight and muscle mass. d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.

ANS: B A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client? a. I drink two glasses of red wine each week. b. I take a lot of Tylenol for my arthritis pain. c. I have a cousin who died of liver cancer. d. I got a hepatitis vaccine before traveling.

ANS: B Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching? a. I cannot drink any alcohol at all anymore. b. I need to avoid protein in my diet. c. I should not take over-the-counter medications. d. I should eat small, frequent, balanced meals.

ANS: B Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.

An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take? a. Ask the client where in the car he or she was sitting during the crash. b. Assess the client by gently palpating the abdomen for tenderness. c. Notify the laboratory to draw blood for blood type and crossmatch. d. Place the client on the stretcher in reverse Trendelenburg position.

ANS: B The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. The client does not need to be in reverse Trendelenburg position.

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching? a. Some medications have been known to cause hepatitis A. b. I may have been exposed when we ate shrimp last weekend. c. I was infected with hepatitis A through a recent blood transfusion. d. My infection with Epstein-Barr virus can co-infect me with hepatitis

ANS: B The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis

A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%. The client states, I do not want to wear the oxygen because it causes my nose to bleed. Get out of my room and leave me alone! Which action should the nurse take? a. Instruct the client to sit in as upright a position as possible. b. Add humidity to the oxygen and encourage the client to wear it. c. Document the clients refusal, and call the health care provider. d. Contact the provider to request an extra dose of the clients diuretic.

ANS: A The client with hepatopulmonary syndrome is often dyspneic. Because the oxygen saturation is not significantly low, the nurse should first allow the client to sit upright to see if that helps. If the client remains dyspneic, or if the oxygen saturation drops further, the nurse should investigate adding humidity to the oxygen and seeing whether the client will tolerate that. The other two options may be beneficial, but they are not the best choices. If the client is comfortable, his or her agitation will decrease; this will improve respiratory status.

A nurse assesses a male client who has symptoms of cirrhosis. Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.) a. How frequently do you drink alcohol? b. Have you ever had sex with a man? c. Do you have a family history of cancer? d. Have you ever worked as a plumber? e. Were you previously incarcerated?

ANS: A, B, E When assessing a client with suspected cirrhosis, the nurse should ask about alcohol consumption, including amount and frequency; sexual history and orientation (specifically men having sex with men); illicit drug use; history of tattoos; and history of military service, incarceration, or work as a firefighter, police officer, or health care provider. A family history of cancer and work as a plumber do not put the client at risk for cirrhosis.

A nurse cares for a client with hepatitis C. The clients brother states, I do not want to contract this infection, so I will not go into his hospital room. How should the nurse respond? a. If you wear a gown and gloves, you will not get this virus. b. Viral hepatitis is not spread through casual contact. c. This virus is only transmitted through a fecal specimen. d. I can give you an update on your brothers status from here.

ANS: B Although family members may be afraid that they will contract hepatitis C, the nurse should educate the clients family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the clients status with the brother.

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond? a. The anti-rejection drugs you are taking make you susceptible to infection. b. You should go to the hospital immediately to have your new liver checked out. c. You should take an additional dose of cyclosporine today. d. Take acetaminophen (Tylenol) every 4 hours until you feel better.

ANS: B Fever, right quadrant or flank pain, and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

The nurse is providing teaching for a client scheduled for a paracentesis. Which statement by the client indicates the teaching has been successful? A. "I must not use the bathroom prior to the procedure." B. "I will lie on my stomach while the procedure is performed." C. "I will not be allowed to eat or drink anything the night before surgery." D. "The physician will likely remove 2 to 3 liters of fluid from my abdomen."

Answer: D Rationale: The client should void before the procedure to prevent injury to the bladder. The client will lie in bed with the head of the bed elevated during the procedure.

A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.) A.Diuretic B.Beta‑blocking agent C. Opioid analgesic D. Lactulose E.Sedative

A. CORRECT Diuretics facilitate excretion of excess fluid from the body in a client who has cirrhosis. B. CORRECT Beta‑blocking agents are prescribed for a client who has cirrhosis to prevent bleeding from varices. C. Opioid analgesics are metabolized in the liver. They should not be administered to a client who has cirrhosis. D. CORRECT Lactulose is prescribed for a client who has cirrhosis to aid in the elimination of ammonia in the stool. E. Sedatives are metabolized in the liver. They should not be administered to a client who has cirrhosis

A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse? a. Urine output via indwelling urinary catheter is 20 mL/hr b. Blood pressure increases from 110/58 to 120/62 mm Hg c. Respiratory rate decreases from 18 to 14 breaths/min d. A decrease in the clients weight by 6 kg

ANS: A Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this medication. I am not constipated." The nurse should explain that in client who have cirrhosis, lactulose is used to decreased levels of which of the following components in the bloodstream? a. Glucose b. Ammonia c. Potassium d. Bicarbonate

b. Ammonia rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the CNS, causing hepatic encephalopathy or coma

A nurse is assisting with the care of a client who has cirrhosis of the liver with ascites. Which of the following actions should the nurse take? 1) Position the client flat in bed 2) Medicate the client with acetaminophen for discomfort 3) Weight the client weekly 4) Measure the client's abdominal girth every 8 hours

measure the clients abdominal girth every 8 hr measure every 8 hours will determine whether the ascites is resolving or worsening

A nurse is caring for a client who has advanced cirrhosis with worsening hepatic encephalopathy. Which of the following is an expected assessment finding? (Select all that apply.)

-Change in orientation -Asterixis -Fetor hepaticus A change in orientation indicates worsening hepatic encephalopathy in a client whohas advanced cirrhosis.Asterixis, a coarse tremor of the wrists and fingers, is observed as a late complication in a client who has cirrhosis and hepatic encephalopathy.Fetor hepaticus, a fruity breath odor, is a clinical finding of worsening hepatic encephalopathy in the client who has advanced cirrhosis.

A pt with type 2 diabetes and cirrhosis asks if it would be okay to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? a. milk thistle may affect liver enzymes and thus alter drug metabolism b. milk thistle is generally safe in recommended doses for up to 10 yrs c. there is unclear scientific evidence for the use of milk thistle in treating cirrhosis d. milk thislte may elevate the serum glucose level and is thus contraindicated in diabetes.

A There is evidence that there is no real benefit from using milk thistle to protect liver enzyme from toxic damage. Milk thistle does affect liver enzyme and could alter drug metabolism. Pt will need to be monitored for drug interactions. It is dafe for up to 6 yrs not 10, and it may lower, not elevate, blood glucose levels.

The nurse is caring for clients in the outpatient clinic. Which of these phone calls should the nurse return first? A) Client with hepatitis A reporting severe and ongoing itching B) Client with severe ascites who has a temperature of 101.4° F (38° C) C) Client with cirrhosis who has had a 3-pound weight gain over 2 days D) Client with esophageal varices and mild right upper quadrant pain

B) Client with severe ascites who has a temperature of 101.4° F (38° C) The client with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should call this client first. Itching is anticipated with jaundice, this client may be called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis may cause mild right upper quadrant pain; this client should be called after the client with severe ascites.

A nurse is reinforcing teaching with a client who has a diagnosis of hepatitis A. Which of the following statements by the client indicates an understanding of the teaching? A. I am unable to donate blood B. I will need to get a booster shot of immune serum globulin every year C. I should stop eating raw clams D. I can get this disease by getting a tattoo

C. I should stop eating raw clams Rationale: Hepatitis A is transmitted via the fecal-oral route through consumption of contaminated fruits, vegetables, water, milk, or uncooked shellfish. Individuals who eat raw or steamed shellfish are at increased risk for acquiring Hepatitis A. Hepatitis B can be transmitted by shared needles or unclean tattoo equipment. Hepatitis A is transmitted through fecal contamination or contaminated food and water. Passive immunity to hepatitis A can be conferred for 6 to 7 weeks by the administration of immune serum globulin during the incubation period if the treatment is instituted within 2 weeks of exposure. A booster shot every year is not required. There is no danger of contracting any form of hepatitis or any other bloodborne pathogen from the sterile, single-donor blood collection process used at blood banks.

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching? a. Excessive alcohol consumption b. Hepatitis C c. Hepatotoxic medications d. Obstruction of the bile duct

D. Obstruction of the bile duct rationale: Prolonged obstruction of the common bile duct is the most common cause of biliary cirrhosis

A nurse on a medical‑surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? A.Initiate contact precautions. B.Weigh the client weekly. C.Measure abdominal girth 7.5 cm (3 in) above the umbilicus. D.Provide a high‑calorie, high‑carbohydrate diet.

D. The client who has hepatitis B should have a diet high in calories and carbohydrates.

A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond? a. Diarrhea is expected; thats how your body gets rid of ammonia. b. You may take Kaopectate liquid daily for loose stools. c. Do not take any more of the medication until your stools firm up. d. We will need to send a stool specimen to the laboratory.

ANS: A The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.

A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.) a. Apply lotion to the clients dry skin areas. b. Use a basin with warm water to bathe the client. c. For the clients oral care, use a soft toothbrush. d. Provide clippers so the client can trim the fingernails. e. Bathe with antibacterial and water-based soaps.

ANS: A, C, D Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the clients nails should be trimmed short to prevent the client from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap.

A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)? a. Have the client sign the informed consent form. b. Assist the client to void before the procedure. c. Help the client lie flat in bed on the right side. d. Get the client into a chair after the procedure.

ANS: B For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the side of the bed and leaning over the bedside table. The client will be on bedrest after the procedure.

A nurse is teaching a client who has hepatitis A about preventing transmission of the virus. Which of the following strategies should the nurse include in the teaching? a. Avoid eating at fast food restaurants b. Avoid serving raw foods c. Practice effective hand hygiene d. Wear barrier protection during vaginal intercourse

C. Practice effective hand hygiene rationale: Effective hand hygiene - along with immunization, sewer sanitation, and a safe water supply - are the most effective strategies for preventing the transmission of hepatitis A

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? A- Vitamin K-containing products B- Potassium-sparing diuretics C- Non-absorbable antibiotics D- Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Non-absorbable antibiotics are used to decrease ammonia levels.

A nurse is assisting with the admission of a client who has bleeding esophageal varices. The nurse should anticipate a prescription for which of the following medications? Famotidine Esomeprazole Vasopressin Omeprazole

Vasopressin