Liver

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. a. Jaundice b. Petechiae c. Ecchymoses d. Cyanosis of the lips e. Aphthous stomatitis

a. Jaundice b. Petechiae c. Ecchymoses

The single modality of pharmacologic therapy for chronic type B viral hepatitis is: a. Alpha-interferon b. Hepsera c. Epivir d. Baraclude

a. Alpha-interferon

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? a. Octreotide b. Spironolactone c. Propranolol d. Lactulose

In an actively bleeding client, medications are administered initially because they can be obtained and administered quicker than other therapies. Octreotide (Sandostatin) causes selective splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage. 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.

Which of the following the are early manifestations of liver cancer? Select all that apply. a. Pain b. Continuous aching in the back c. Increased appetite d. Fever e. Jaundice f. Vomiting

a. Pain b. Continuous aching in the back Early manifestations of liver cancer include pain and continuous dull aching in the right upper quadrant epigastrium or back. Weight loss, anorexia, and anemia may occur. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever and vomiting are not associated manifestations.

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

a. Vaccine

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a. Vitamin A b. Thiamine c. Riboflavin d. Vitamin K

a. Vitamin A Vitamin A deficiency results in night blindness and eye and skin changes. Thiamine deficiency can lead to beriberi, polyneuritis, and Wernicke-Korsakoff psychosis. Riboflavin deficiency results in characteristic skin and mucous membrane lesions. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

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

a. tachycardia and tachypnea The compensatory stage is the first stage of shock. During this stage, the sympathetic nervous system (SNS) is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia, and the respiratory system, causing tachypnea. Thus, tachycardia (not bradycardia) and tachypnea (not bradypnea) occur with the compensatory stage of shock.

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

b. Vasopressin

A client comes to the clinic to see the health care provider for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with? a. Hepatitis b. Biliary colic c. Cholelithiasis d. Cholecystitis

c. Cholelithiasis

A client has developed drug-induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction? a. Paracentesis b. Liver transplantation c. High-dose corticosteroids d. Azathioprine

c. High-dose corticosteroids Drug-induced hepatitis occurs when a drug reaction damages the liver. This form of hepatitis can be severe and fatal. High-dose corticosteroids usually administered first to treat the reaction. Liver transplantation may be necessary. Paracentesis would be used to withdraw fluid for the treatment of ascites. Azathioprine (Imuran) may be used for autoimmune hepatitis.

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

c. Reduce fluid accumulation and venous pressure.

A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? a. Furosemide b. Acetazolamide c. Spironolactone d. Ammonium chloride

c. Spironolactone The use of diuretic agents along with sodium restriction is successful in 90% of clients with ascites. Spironolactone, an aldosterone-blocking agent, is most often the first-line therapy in clients with ascites from cirrhosis. When used with other diuretic agents, spironolactone helps prevent potassium loss.

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? a. Creatinine b. Urobilinogen c. Chloride d. Albumin

d. Albumin Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.

What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention? a. Diuretic therapy b. Therapeutic paracentesis c. Platelet infusions d. Albumin infusion

d. Albumin infusion Albumin infusions help to correct decreases in effective arterial blood volume that lead to sodium retention. The use of this colloid reduces the incidence of postparacentesis circulatory dysfunction with renal dysfunction, hyponatremia, and rapid reaccumulation of ascites associated with decreased effective arterial volume.

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

d. Asterixis