Med Surg - Chapter 58 - Care of Patients with Liver Problems

The registered nurse teaches a student nurse about radiofrequency ablation (RFA). Which statement made by the student nurse indicates the need for further teaching? 1 "RFA inhibits the division of cancer cells." 2 "RFA uses energy waves to heat cancer cells." 3 "RFA is performed as an ambulatory procedure." 4 "Percutaneous laparoscopic procedure is involved in RFA."

1 "RFA inhibits the division of cancer cells." RFA is a routinely used ablation procedure that kills, not inhibits the division of, cancer cells. It produces energy-induced heat waves. It is an ambulatory procedure done using a percutaneous laparoscopic approach.

A patient diagnosed with hepatitis A asks the nurse how this disease may have been contracted. Which answer by the nurse is correct? 1 "You may have consumed foods contaminated with the virus." 2 "If you received a blood transfusion, you may have been exposed." 3 "You may have been exposed if you had unprotected sexual intercourse." 4 "The virus is airborne, so you may have contracted it from an infected person."

1 "You may have consumed foods contaminated with the virus." Hepatitis A is transmitted through the fecal-oral route and may be contracted by consuming contaminated foods; it is not a blood-borne or airborne virus. Hepatitis B, C, and D can be transmitted by blood transfusions received before 1992. Unprotected sex is a risk factor for hepatitis B and C (although the rate of sexual transmission with hepatitis C is very low in a monogamous relationship, but increases with multiple sex partners). There is no hepatitis virus that is airborne.

The nurse is instructing a patient with liver cancer about how to drain excess ascitic fluid using the PleurX drainage system. The nurse will know the teaching is successful if the patient identifies which number as the maximum amount to be drained in a session? 1 2000 mL 2 2500 mL 3 3000 mL 4 3500 mL

1 2000 mL In liver cancer, the maximum amount of fluid that can be drained in a session is 2000 mL. If more than 2000 mL is drained at one time, it may lead to hypovolemic shock.

A patient underwent a liver biopsy for suspected liver cancer. The nurse knows to be vigilant for which complication of this procedure? 1 Bleeding 2 Constipation 3 Hypertension 4 Loss of appetite

1 Bleeding Bleeding is a complication of liver biopsy. Constipation and loss of appetite are not associated with any complications following liver biopsy. Hypotension due to bleeding may occur after liver biopsy.

What is a risk factor for liver cancer? 1 Cirrhosis 2 Fatty liver 3 Hepatomegaly 4 Portal vein thrombosis

1 Cirrhosis Cirrhosis is a severe scarring of the liver, and this chronic condition may lead to liver cancer. Fatty liver is caused by the accumulation of fats and etiological factors, which include diabetes mellitus and obesity; this condition may not lead to liver cancer. Hepatomegaly is a sign of underlying problems, which may or may not include liver cancer. Portal vein thrombosis is blockage or narrowing of the portal vein by a blood clot; this condition may not be a risk factor for liver cancer.

What treatment utilizes liquid nitrogen to destroy liver tumors? 1 Cryotherapy 2 Radiation therapy 3 Radiofrequency ablation 4 Percutaneous ethanol injection

1 Cryotherapy Cryotherapy uses liquid nitrogen to freeze and destroy the tumor cells in the liver. Radiation therapy uses ionizing radiation to kill or control the tumor cells. Radiofrequency ablation uses energy waves to heat and kill cancer cells. In percutaneous ethanol injection, ethanol is directly injected into the tumor to kill the cancerous cells.

In caring for a patient who has undergone paracentesis, which changes in the patient's status should be promptly reported to the provider? 1 Decreased blood pressure, increased heart rate 2 Tachypnea, diaphoresis, increased blood pressure 3 Increased blood pressure, increased respiratory rate 4 Increased respiratory rate, increased apical pulse, pallor

1 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 patient's part.

What laboratory finding signifies an immune response to liver disease? 1 Elevated serum globulin 2 Elevated serum ammonia 3 Decreased serum albumin 4 Decreased serum total protein

1 Elevated serum globulin An increase in the serum globulin level indicates an immune response to liver disease. A decrease in serum total protein signifies chronic liver disease, and a decrease in serum albumin signifies severe liver disease. The serum ammonia level is elevated in advanced liver disease or portal-systemic encephalopathy because the liver is unable to detoxify protein byproducts.

A patient who contracted hepatitis C several years ago via intravenous drug use appears angry and withdrawn and refuses to participate in self-care activities and exercise. Which initial action should the nurse take? 1 Encourage the patient to discuss feelings of guilt or remorse. 2 Reassure the patient that feelings of malaise will improve over time. 3 Request a psychological consultation and involvement of a social worker. 4 Enlist the assistance of a family member to encourage increased activity.

1 Encourage the patient to discuss feelings of guilt or remorse. Patients with hepatitis B and C often experience guilt and remorse about their actions and behaviors that caused the disease. The initial response by the nurse should be to encourage the patient to discuss this. Because family members are often angry with these patients, asking them to intervene may not be the best first step. Reassurance only belittles the patient's feelings in this case. A psychological consultation or social worker involvement may be necessary, but are not the first action.

A patient who underwent a liver transplant for the treatment of liver cancer is prescribed cyclosporin. The patient reports a sore throat and fever. The nurse suspects which complication? 1 Infection 2 Dehydration 3 Kidney injury 4 Transplant rejection

1 Infection An increase in temperature and a sore throat are symptoms of infection due to the use of an immunosuppressant drug such as cyclosporin. In dehydration, patients report a dry mouth and dizziness. In a kidney injury, patients may report reduced urine output. In a transplant rejection, patients will report bleeding and yellow skin color.

What condition may occur if a patient who underwent liver transplantation for the treatment of liver cancer is prescribed cyclosporin A? 1 Infection 2 Hypotension 3 Hypothermia 4 Hepatic thrombosis

1 Infection Cyclosporin A is an immunosuppressant prescribed to prevent a liver transplant rejection; this medication significantly increases the patient's risk of infection. Hypertension may occur with the use of cyclosporin. Hypothermia and hepatic thrombosis are not associated with the use of cyclosporin.

Which statement about hepatitis A is accurate? 1 It is transmitted by the fecal-oral route. 2 It is more common in affluent countries. 3 It is resistant to the action of chlorine (bleach). 4 It is more severe in children and young adults.

1 It is transmitted by the fecal-oral route. Hepatitis A virus is spread via the fecal-oral route either by consumption of contaminated water and food, or by person-to-person contact in those who engage in oral-anal sexual activity. The virus is destroyed by chlorine (bleach). It is more common in nonaffluent countries where sanitation is inadequate or lacking. The course of the infection is more severe in those who are older than 40 years.

The nurse is caring for a patient who has primary liver cancer. The patient is asking the nurse about treatments. What treatment offers the best chance at long-term survival? 1 Liver transplant 2 Chemoembolization 3 Internal radiation therapy 4 Palliative and hospice treatment

1 Liver transplant Liver transplantation offers the best chance of long-term survival for patients with liver cancer. Chemoembolization involves injecting chemotherapeutic drugs into the hepatic artery. Internal radiation therapy is a surgical procedure where radiation seeds are implanted into the liver. Palliative and hospice services are reserved for patients who are near the end of life. Chemoembolization, internal radiation therapy, and palliative and hospice treatments do not offer the best chance at long-term survival.

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? 1 Men who prefer sex with men 2 Patients who work with shellfish 3 Patients traveling to a third-world country 4 Patients with elevations of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

1 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 patient is exposed to blood and body fluids during travel. Patients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B.

What would be the complication of biliary anastomosis breakdown in post liver transplantation? 1 Peritonitis 2 Heart failure 3 Acute renal failure 4 Acute graft rejection

1 Peritonitis The breakdown of biliary anastomosis may lead to leakage or the site becoming necrotic or obstructed. These complications can result in abscess formation and peritonitis. Heart failure may occur if the patient had a history of hypertension and obesity. Acute renal failure and acute graft rejection are the complications of liver transplantation.

A patient underwent a liver transplantation surgery and receives cyclosporine. The nurse monitors the patient for which primary indicator of an acute graft rejection? 1 Tachycardia 2 Hyperventilation 3 Clay-colored stools 4 Foul-smelling urine

1 Tachycardia Acute graft rejection may occur from the 4th to 10th day after a liver transplantation. The symptoms include tachycardia, pain in the right upper quadrant, and change in bile color. Hyperventilation occurs in acute renal failure. Hepatic complications may result in clay-colored stools. Keeping the T-tube in the dependent position will help reduce the hepatic complications. Foul-smelling urine results from infection and can be treated with antibiotics.

A patient who has liver disease with ascites refuses the evening dinner tray and reports moderate abdominal pain. The nurse notifies the provider after assessing a low-grade fever and abdominal rigidity. The provider prepares to perform a paracentesis and orders an antibiotic to be given. When does the nurse administer the antibiotic? 1 After a short-term ascites drain has been placed 2 After a sample of fluid is sent to the lab for culture 3 Before the paracentesis to prevent sepsis from the procedure 4 After the culture and sensitivity results are returned from the lab

2 After a sample of fluid is sent to the lab for culture This patient has symptoms characteristic of spontaneous bacterial peritonitis. The nurse should give the ordered antibiotic after a sample of ascitic fluid has been sent for culture. Since the patient is symptomatic, the antibiotic should be given before the culture results are known.

The nurse is administering medications to a patient with liver cancer who just underwent a liver transplant. The nurse will closely monitor the patient's blood pressure after which medication? 1 Acyclovir 2 Cyclosporin 3 Ciprofloxacin 4 Metronidazole

2 Cyclosporin Cyclosporin is an immunosuppressant that may cause hypertension because it increases prostaglandin synthesis and decreases water, sodium, and potassium excretion. Acyclovir, ciprofloxacin, and metronidazole do not interfere with prostaglandin synthesis.

A patient is suspected of having liver cancer and the nurse is reviewing the laboratory results. Which laboratory result, if present in the patient's chart, would the nurse recognize as a confirmation of this diagnosis? 1 Increased bilirubin levels 2 Increased alpha-fetoprotein 3 Decreased alkaline phosphatase 4 Increased alanine aminotransferase

2 Increased alpha-fetoprotein Alpha-fetoprotein (AFP) is a tumor marker of liver cancer; increased alpha-fetoprotein levels confirm liver cancer. The levels of bilirubin and alanine aminotransferase may increase if there is a liver dysfunction due to any reason. In liver cancer, the levels of alkaline phosphatase usually increase.

A liver is retrieved from a donor for liver transplantation for a patient with liver cancer. What would be the maximum duration within which the liver has to be transplanted to the cancer patient? 1 2 hours 2 5 hours 3 8 hours 4 18 hours

3 8 hours A donor liver is preserved in a solution and must be transplanted within 8 hours. Two hours is the duration of preserving a donor heart. For lung transplantation, the duration of preserving is 5 hours. Kidneys can be preserved for 18 hours.

A patient with cirrhosis reports having difficulty getting to sleep and staying asleep. Which action by the nurse is correct? 1 Tell the patient that this indicates irreversible encephalopathy. 2 Reassure the patient that this is a transient disease side effect. 3 Contact the provider to discuss ordering a sedating medication. 4 Discuss this early sign of serious complications with the provider.

2 Reassure the patient that this is a transient disease side effect. A change in sleep patterns in patients with cirrhosis is an early indicator of hepatic encephalopathy and may be reversible with early intervention. The nurse should notify the provider so that intervention may begin. Sedatives may or may not be ordered, but evaluation of the cause is necessary. Difficulty getting to sleep and staying asleep is not transient, and at this stage is reversible.

Which drug is used to treat liver cancer and acts by kinase inhibition? 1 Cisplatin 2 Sorafenib 3 Doxorubicin 4 5-Fluorouracil

2 Sorafenib Sorafenib is a targeted therapy used to treat liver cancer by inhibiting the kinase enzyme. Cisplatin is an alkylating agent. Doxorubicin is an anthracycline antitumor antibiotic. 5-fluorouracil acts by inhibiting thymidylate synthase.

A patient with hepatic encephalopathy may require which dietary or pharmacologic therapy to help decrease serum ammonia levels? 1 Nonabsorbable antibiotics given for long-term therapy 2 Trial of lactulose to increase the excretion of ammonia 3 Diet high in carbohydrates and protein with moderate fats 4 Diet low in protein and moderate in fats and carbohydrates

2 Trial of lactulose to increase the excretion of ammonia Lactulose can be used with hepatic encephalopathy to increase the excretion of ammonia through the stools. To help minimize serum ammonia, patients may be started on a moderate protein, fat, and carbohydrate diet. High protein increases ammonia and low protein does not provide enough protein for healing. Nonabsorbable antibiotics may be used, but are given short-term only.

Which laboratory parameter will be elevated in a patient diagnosed with primary liver cancer? 1 Leukocyte count 2 Serum albumin 3 Alpha-fetoprotein (AFP) 4 Hemoglobin and hematocrit

3 Alpha-fetoprotein (AFP) Elevation of fetal hemoglobin (alpha-fetoprotein) in adults is a tumor marker indicative of cancers. Leukocytosis may be seen, but is not used to specifically diagnose liver cancer. Serum albumin levels may be low in liver cancer as a result of damaged hepatocytes. Anemia is a typical finding in many cancers, but is not diagnostic. Anemia would present as a decrease in Hbg/Hct, not an elevation.

A patient admitted for treatment of liver disease has a decreased serum total protein. Based on this finding, how may the nurse classify this patient's disease? 1 Acute 2 Severe 3 Chronic 4 Advanced

3 Chronic Decreased serum total protein indicates chronic liver disease. Increased serum total protein indicates acute liver disease. Elevated serum ammonia indicates advanced liver disease. Decreased serum albumin indicates severe liver disease.

Following liver transplantation, which medication will the nurse administer to reduce the risk of organ rejection? 1 Cisplatin 2 Rifaximin 3 Cyclosporin 4 Metronidazole

3 Cyclosporin Cyclosporin is an immunosuppressant drug used to reduce the risk of organ rejection. Cisplatin is an antineoplastic drug used to treat liver cancer. Rifaximin is an intestinal antiseptic used to manage hepatic encephalopathy. Metronidazole is an antibiotic used for infection prophylaxis following transplantation and the initiation of immunosuppressant therapy.

The nurse is completing an abdominal assessment of a patient who has suspected liver cancer. What should the nurse expect to feel when palpating the right upper quadrant of the abdomen? 1 Tenderness 2 Soft and smooth liver 3 Enlarged and nodular liver 4 Firm with irregular surface liver

3 Enlarged and nodular liver An enlarged and nodular liver would be found on palpation because of tumor growth. Tenderness is associated with hepatitis. A palpation that is soft in consistency and having a smooth surface is found in a fatty liver. A palpation that is firm with an irregular surface is associated with cirrhosis.

Which intervention is important for the nurse to include in the plan of care for a patient who is to undergo paracentesis later today? 1 Measure and record drainage. 2 Obtain informed consent for the procedure. 3 Have the patient void before the procedure is performed. 4 Monitor aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase.

3 Have the patient 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 healthcare provider performing the procedure should discuss the intervention and potential complications with the patient and obtain informed consent.

Which type of intervention gives a patient who is diagnosed with liver cancer a chance for long-term survival? 1 Chemotherapy 2 Radiation therapy 3 Liver transplantation 4 Hepatic artery embolization

3 Liver transplantation Liver transplantation may ensure long-term survival in a patient with liver cancer. Chemotherapy, radiation therapy, and hepatic artery embolization individually do not assure long-term survival.

A patient with a history of cardiac arrhythmias is diagnosed with liver cancer. Which treatment would be contraindicated in the patient? 1 Chemotherapy 2 Radiation therapy 3 Liver transplantation 4 Radiofrequency ablation

3 Liver transplantation Liver transplants are contraindicated for patients with liver cancer and underlying cardiovascular disease because the procedure may result in a life-threatening condition. Chemotherapy, radiation therapy, and radiofrequency ablation are the suggested treatments in this case.

A patient is diagnosed with liver cancer, and the tumor is found to be unresectable. Which targeted therapy would be prescribed by the primary health care provider? 1 Cisplatin 2 Entecavir 3 Sorafenib 4 Lamivudine

3 Sorafenib Sorafenib is a kinase inhibitor and is the drug of choice for inoperable or unresectable liver tumors. Cisplatin is a chemotherapy agent and is the second drug of choice for inoperable liver cancer. Entecavir and lamivudine are used to treat chronic hepatitis B.

The nurse is educating a patient with liver cancer about liver transplantation. What statement made by the patient indicates a need for further teaching? 1 "One lobe of the donor liver is usually resected." 2 "The donor liver cannot be preserved for longer than 8 hours." 3 "The donor liver is regenerated to meet the demands of the body." 4 "Donor liver implantation precedes surgical removal of diseased liver."

4 "Donor liver implantation precedes surgical removal of diseased liver." The donor liver should be placed after the surgical removal of the diseased liver. Usually one lobe is resected from the donor (note that the donor lobe cannot be stored for more than 8 hours) before placing it in the patient. Both the donor and the recipient will be able to regenerate the remaining liver based on the needs of the body.

The registered nurse is teaching a student nurse about liver cancer. What statement made by the student nurse needs correcting? 1 "Risk factors include hepatitis B and hepatitis C." 2 "Alcoholic liver disease increases the risk of liver cancer." 3 "Treatment involves surgical resection and liver transplantation." 4 "Patients with liver cancer will have a decrease in serum alpha fetoprotein."

4 "Patients with liver cancer will have a decrease in serum alpha fetoprotein." Alpha fetoprotein is a tumor marker. Increased levels of this enzyme indicate liver cancer. Infection with hepatitis B and hepatitis C and alcoholic liver disease may lead to cirrhosis, which increases the risk of liver cancer. Surgical resection and liver transplantation offer the only treatments for long-term survival from liver cancer.

The registered nurse is teaching a student nurse about the complications of liver transplantation for patients with liver cancer. Which statement made by the student nurse requires further teaching? 1 "Remove invasive lines to prevent infection." 2 "Conduct a frequent cultures of tubes, lines, and drainage." 3 "Use vaccines and prophylactic antibiotics to prevent infection." 4 "The use of immunosuppressants should be discontinued if there is an infection."

4 "The use of immunosuppressants should be discontinued if there is an infection." Immunosuppressant drugs must be used for the rest of a patient's life after a liver transplantation is performed. The complications of using immunosuppressant should be treated specifically. The removal of invasive lines; the conducting of frequent cultures of tubes, lines, and drainage; and the use of vaccines and prophylactic antibiotics help to prevent infection when an immunosuppressant is used.

The nurse knows that which patient concern is most common with liver cancer? 1 Recent weight loss 2 Presence of anorexia 3 Increasing weakness 4 Alterations in abdominal comfort

4 Alterations in abdominal comfort The most commonly reported concern with liver cancer is an alteration in abdominal comfort. Anorexia, weight loss, and weakness may also be reported, but they are less frequently reported.

When providing dietary teaching to a patient with hepatitis, what practice does the nurse recommend? 1 Restricting fluids to 1500 mL per day 2 Having a larger meal early in the morning 3 Limiting alcoholic beverages to once weekly 4 Consuming increased carbohydrates and moderate protein

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

The nurse is caring for a patient with cirrhosis and profound ascites. Which assessment finding causes the nurse to notify the provider? 1 Anasarca 2 Marked jaundice 3 Multiple ecchymoses 4 Inaudible breath sounds

4 Inaudible breath sounds Orthopnea and dyspnea can result from ascites, which limit thoracic expansion and diaphragmatic excursion; this is manifested by decreased or absent breath sounds. Anasarca is an expected finding in cirrhosis as the liver is unable to produce plasma proteins which exert colloid osmotic pressure to pull fluid from interstitial tissues. Jaundice, another expected finding, results when the failing liver cannot excrete bilirubin. Ecchymosis is typical when the patient with cirrhosis cannot produce prothrombin, which promotes blood clotting.

A patient with viral hepatitis has clay-colored stools and dark urine. These findings are typically characteristic of which complication of hepatitis? 1 Hepatic carcinoma 2 Cirrhosis of the liver 3 Obstructive jaundice 4 Intrahepatic obstruction

4 Intrahepatic obstruction Patients with hepatitis may develop intrahepatic obstruction, which will cause clay-colored stools and dark urine when the bile ducts are blocked. These findings may occur with hepatic obstruction in cirrhosis or carcinoma, but do not necessarily indicate that these have occurred. Obstructive jaundice is another sign of intrahepatic obstruction.

What teaching does the home health nurse give the family of a patient with hepatitis C to prevent the spread of the infection? 1 Drink only bottled water and avoid ice. 2 The patient must not consume alcohol. 3 Avoid sharing the bathroom with the patient. 4 Members of the household must not share toothbrushes.

4 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 patient should not consume alcohol, but abstention will not prevent spread of the virus. The patient 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.

When providing discharge teaching to a patient with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? 1 Nonabsorbable antibiotics 2 Potassium-sparing diuretics 3 Vitamin K-containing products 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

4 Nonsteroidal anti-inflammatory drugs (NSAIDs) Patients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The patient 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. Nonabsorbable antibiotics are used to decrease ammonia levels.

An unconscious patient brought to the emergency department has a history of Laennec's cirrhosis and esophageal varices. What is the priority assessment for this patient? 1 Assessing the size of the spleen 2 Evaluating the abdomen for ascites 3 Determining the presence of jaundice 4 Noting the presence of bloody emesis or stool

4 Noting the presence of bloody emesis or stool Patients with esophageal varices are at risk for hemorrhage, which is a life-threatening medical emergency. Unconsciousness may occur prior to observable bleeding, so the patient who is unconscious should be evaluated for this. Splenomegaly, jaundice, and ascites are all complications of cirrhosis, but are not life-threatening and not the priority assessment in this case.

The nurse is administering spironolactone to a patient with portal hypertension and portal systemic encephalopathy. Which additional medication order does the nurse question? 1 Lactulose 2 Neomycin 3 Propranolol 4 Potassium chloride

4 Potassium chloride Spironolactone is a potassium-sparing diuretic; additional potassium may result in potassium intoxication. Lactulose and neomycin are used to control hepatic encephalopathy, which is part of the expected treatment plan. Propranolol is used to prevent gastrointestinal hemorrhage secondary to portal hypertension and gastroesophageal varices, which is an expected treatment for portal hypertension.

A computed tomography (CT) scan of a patient shows a small tumor that is confined to one liver lobe. However, the patient is not a candidate for surgery. Which treatment does the nurse anticipate to be given by the primary health care provider? 1 Chemotherapy 2 Radiation therapy 3 Liver transplantation 4 Radiofrequency ablation

4 Radiofrequency ablation Radiofrequency ablation involves removing the tumor by using energy waves to heat and kill the cancer cells. This treatment is beneficial for patients who are not surgical candidates. Chemotherapy and radiation therapy are used to reduce the growth of the tumor after ablation or resection. Liver transplantation is preferred if the tumors are not cured by resection.

A patient is suspected of having liver cancer. What region of the abdomen would have pain on palpation? 1 Right iliac region 2 Hypogastric region 3 Right lumbar region 4 Right upper quadrant region

4 Right upper quadrant region The liver is in the right upper quadrant region of the abdomen. In liver cancer, the patient may report pain in the right upper quadrant region. The right iliac region, hypogastric region, and right lumbar region are not associated with the location of the liver.

Which precaution is most appropriate for the nurse to implement with a patient with hepatitis A? 1 Enteric precautions 2 Droplet precautions 3 Protective isolation 4 Standard Precautions

4 Standard Precautions Standard Precautions are used with all patients to prevent the spread of blood and body fluids, including the patient with hepatitis A. Standard Precautions prevent the spread of hepatitis A infection, which is spread by the fecal-oral route. Enteric precautions would be needed for patients with gastrointestinal infection if Standard Precautions were not used. Droplet precautions prevent the inhalation of respiratory droplets that spread infection, such as with meningitis. Protective isolation involves strict handwashing and limiting visitors and plants to protect the immunocompromised patient.