Med. surg. practice questions (LIVER)

You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include? A) Administering a lactulose enema as ordered B) Encouraging a protein-rich diet C) Administering sedatives, as necessary D) Encouraging ambulation at least four times a day

A) Administering a lactulose enema as ordered You may administer the laxative lactulose to reduce ammonia levels in the colon.

You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her? A) Asterixis B) Chvostek's sign C) Trousseau's sign D) Hepatojugular reflex

A) Asterixis Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.

Stephen is a 62 y.o. patient that has had a liver biopsy. Which of the following groups of signs alert you to a possible pneumothorax? A) Dyspnea and reduced or absent breath sounds over the right lung B) Tachycardia, hypotension, and cool, clammy skin C) Fever, rebound tenderness, and abdominal rigidity D) Redness, warmth, and drainage at the biopsy site

A) Dyspnea and reduced or absent breath sounds over the right lung Signs and Symptoms of pneumothorax include dyspnea and decreased or absent breath sounds over the affected lung (right lung).

You're caring for a 28 y.o. woman with hepatitis B. She's concerned about the duration of her recovery. Which response isn't appropriate? A) Encourage her to not worry about the future. B) Encourage her to express her feelings about the illness. C) Discuss the effects of hepatitis B on future health problems. D) Provide avenues for financial counseling if she expresses the need.

A) Encourage her to not worry about the future. Telling her not to worry minimizes her feelings.

Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? A) Restrict fluids B) Encourage ambulation C) Increase sodium in the diet D) Give antacids as prescribed

A) Restrict fluids Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space

For a client in hepatic coma, which outcome would be the most appropriate? A) The client is oriented to time, place, and person. B) The client exhibits no ecchymotic areas. C) The client increases oral intake to 2,000 calories/day. D) The client exhibits increased serum albumin level.

A) The client is oriented to time, place, and person. Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves, improvement in the client's level of consciousness occurs. The client should be able to express orientation to time, place, and person

A nursing intervention for a patient with hepatitis B would include which of the following types of isolation. A) Universal precautions B) Blood transfusions C) Enteric isolation D) Strict isolation

A) Universal precautions Universal precautions are indicated for the patient with hepatitis B. Hepatitis B is contracted via blood and blood products, body secretions, and punctures from contaminated needles.

Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following medication-related side effects? A) Jaundice B) Hyperkalemia C) Tachycardia D) Constipation

B) Hyperkalemia This is a potassium-sparing diuretic so clients should be monitored closely for hyperkalemia. Diarrhea, dizziness, and headaches are other more common side effects.

A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should: A) place the client in a private room B) wear a mask when handling the client's bedpan C) wash the hands after touching the client D) wear a gown when providing personal care for the client

C) wash the hands after touching the client To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client.

You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate? A) The patient demonstrates an increase in level of consciousness. B) The patient exhibits improved skin integrity. C) The patient experiences no evident signs of bleeding. D) The patient verbalize decreased episodes of pain.

A) The patient demonstrates an increase in level of consciousness. Increased level of consciousness indicates resolving of a comatose state.

Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy? A. Passage of two or three soft stools daily B. Evidence of watery diarrhea C. Daily deterioration in the client's handwriting D. Appearance of frothy, foul-smelling stools

A. Passage of two or three soft stools daily

Develop a teaching care plan for Angie who is about to undergo a liver biopsy. Which of the following points do you include? A) "You'll need to lie on your stomach during the test." B) "You'll need to lie on your right side after the test." C) "During the biopsy you'll be asked to exhale deeply and hold it." D) "The biopsy is performed under general anesthesia."

B) "You'll need to lie on your right side after the test." After a liver biopsy, the patient is placed on the right side to compress the liver and to reduce the risk of bleeding or bile leakage.

You're caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct her to: A) Empty her bladder B) Lie supine in bed C) Remain NPO for 4 hours D) Clean her bowels with an enema

A) Empty her bladder A full bladder can interfere with paracentesis and be punctured inadvertently.

A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A) "You may have eaten contaminated restaurant food." B) "You could have gotten it by using I.V. drugs." C) "You must have received an infected blood transfusion." D) "You probably got it by engaging in unprotected sex."

A) "You may have eaten contaminated restaurant food." Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers.

Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis? A) Increase fluid intake to 3000 ml per day B) Adequate bed rest C) Bland diet D) Administer antibiotics as ordered

B) Adequate bed rest Treatment of hepatitis consists of bed rest during the acute phase to reduce metabolic demands on the liver, thus increasing blood supply and cell regeneration.

Which of the following factors can cause hepatitis A? A) Contact with infected blood B) Blood transfusions with infected blood C) Eating contaminated shellfish D) Sexual contact with an infected person

C) Eating contaminated shellfish Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water.

A 52-year-old man was admitted with diagnosed with ascites. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care? A. Measuring serum potassium for hyperkalemia B. Assessing the client for hypervolemia C. Measuring the client's weight weekly D. Documenting precise intake and output

D. Documenting precise intake and output

Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? (Select all that apply.) A) Assessing the client's neurologic status every 2 hours B) Monitoring the client's hemoglobin and hematocrit levels C) Evaluating the client's serum ammonia level D) Monitoring the client's handwriting daily E) Preparing to insert an esophageal tamponade tube F) Making sure the client's fingernails are short

A) Assessing the client's neurologic status every 2 hours C) Evaluating the client's serum ammonia level D) Monitoring the client's handwriting daily Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client's neurologic status, serum ammonia level, and handwriting.

Nathaniel has severe pruritus due to having hepatitis B. What is the best intervention for his comfort? A) Give tepid baths B) Avoid lotions and creams C) Use hot water to increase vasodilation D) Use cold water to decrease the itching

A) Give tepid baths For pruritus, care should include tepid sponge baths and use of emollient creams and lotions

Dr. Smith has determined that the client with hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D

A) Hepatitis A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers.

A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure? A) Hypoalbuminemia B) Increased capillary permeability C) Abnormal peripheral vasodilation D) Excess rennin release from the kidneys

A) Hypoalbuminemia Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring.

The student nurse is teaching the family of a patient with liver failure. You instruct them to limit which foods in the patient's diet? A) Meats and beans B) Butter and gravies C) Potatoes and pastas D) Cakes and pastries

A) Meats and beans Meats and beans are high-protein foods. In liver failure, the liver is unable to metabolize protein adequately, causing protein by-products to build up in the body rather than be excreted

Nurse Juvy is caring for a client with cirrhosis of the liver. To minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of: A) Pork B) Milk C) Chicken D) Broccoli

A) Pork The client with cirrhosis needs to consume foods high in thiamine. Thiamine is present in a variety of foods of plant and animal origin. Pork products are especially rich in this vitamin. Other good food sources include nuts, whole grain cereals, and legumes.

You obser changes in mentation, irritability, restlessness, and decreased concentration in a patient with cancer of the liver. Hepatic encephalopathy is suspected and the patient is ordered neomycin enemas. Which of the following information in the patient's history would be a contraindication of this order? A) left nephrectomy B) glaucoma in both eyes C) myocardial infarction D) peripheral neuropathy

A) left nephrectomy Neomycin prevents the release of ammonia from the intestinal bacteria flora and from the breakdown of red blood cells. Common side-effects of this drug are nephrotoxicity and ototoxicity. Patients with renal disease or renal impairment should not take this drug.

Hepatic encephalopathy develops when the blood level of which substance increases? A) Ammonia B) Amylase C) Calcium D) Potassium

B) Amylase Ammonia levels increase d/t improper shunting of blood, causing ammonia to enter systemic circulation, which carries it to the brain.

For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important? A) Allowing complete independence of mobility B) Applying pressure to injection sites C) Administering antibiotics as prescribed D) Increasing nutritional intake

B) Applying pressure to injection sites The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important.

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective? A) Pruritus B) Dyspnea C) Jaundice D) Peripheral Neuropathy

B) Dyspnea Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing.

A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? A) Elevated hemoglobin level B) Elevated serum bilirubin level C) Elevated blood urea nitrogen level D) Decreased erythrocyte sedimentation rate

B) Elevated serum bilirubin level Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia.

What is the primary nursing diagnosis for a 4th to 10th day postoperative liver transplant patient? A) Excess Fluid Volume B) Risk for Rejection C) Impaired Skin Integrity D) Decreased Cardiac Output

B) Risk for Rejection Risk for rejection is always a possibility, especially during the 4th to 10th day postoperatively.

A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? (Select all that apply.) A) Range of motion every 4 hours B) Turn and reposition every 2 hours C) Abdominal and foot massages every 2 hours D) Alternating air pressure mattress E) Sit in chair for 30 minutes each shift

B) Turn and reposition every 2 hours D) Alternating air pressure mattress Edematous tissue must receive meticulous care to prevent tissue breakdown. Range of motion exercises preserve joint function but do not prevent skin breakdown.

When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client's family? A) Keeping the client in complete isolation B) Using good sanitation with dishes and shared bathrooms C) Avoiding contact with blood-soiled clothing or dressing D) Forbidding the sharing of needles or syringes

B) Using good sanitation with dishes and shared bathrooms Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing, personal hygiene and sanitation, and use of standard precautions.

A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: A) severe abdominal pain radiating to the shoulder B) anorexia, nausea, and vomiting C) eructation and constipation D) abdominal ascites

B) anorexia, nausea, and vomiting Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness.

A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would NOT be appropriate for this patient? A) Monitor for respiratory distress. B) Monitor for coagulation studies. C) Administer pain medications as ordered. D) Administer normal saline, crystalloids as ordered.

C) Administer pain medications as ordered. Pain medication may mask signs and symptoms of hemorrhage, further decrease blood pressure, and interfere with assessment of neurologic status and additional abdominal injury.

A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for: A) Malaise B) Stomatitis C) Hand tremors D) Weight loss

C) Hand tremors Hepatic encephalopathy results from the accumulation of neurotoxins in the blood, therefore the nurse wants to assess for signs of neurological involvement. Flapping of the hands (asterixis), changes in mentation, agitation, and confusion are common.

The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? A) Dyspnea and fatigue B) Ascites and orthopnea C) Purpura and petechiae D) Gynecomastia and testicular atrophy

C) Purpura and petechiae A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae.

You're discharging Nathaniel with hepatitis B. Which statement suggests understanding by the patient? A) "Now I can never get hepatitis again." B) "I can safely give blood after 3 months." C) "I'll never have a problem with my liver again, even if I drink alcohol." D) "My family knows that if I get tired and start vomiting, I may be getting sick again."

D) "My family knows that if I get tired and start vomiting, I may be getting sick again." Hepatitis B can recur. Patients who have had hepatitis are permanently barred from donating blood. Alcohol is metabolized by the liver and should be avoided by those who have or had hepatitis B

Rob is a 46 y.o. admitted to the hospital with a suspected diagnosis of Hepatitis B. He's jaundiced and reports weakness. Which intervention will you include in his care? A) Regular exercise B) A low-protein diet. C) Allow patient to select his meals. D) Rest period after small, frequent meals.

D) Rest period after small, frequent meals. Rest periods and small frequent meals is indicated during the acute phase of hepatitis B.

A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: A) whole blood and albumin B) platelets and packed red blood cells C) fresh frozen plasma and whole blood D) cryoprecipitate and fresh frozen plasma

D) cryoprecipitate and fresh frozen plasma The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors.

Which phase of hepatitis would the nurse incur strict precautionary measures at? A) icteric B) non-icteric C) post-icteric D) pre-icteric

D) pre-icteric Pre-icteric is the infective phase and precautionary measures should be strictly enforced. However, most patients are not always diagnosed during this phase.

A patient with severe cirrhosis of the liver develops hepatorenal syndrome. Which of the following nursing assessment data would support this? A) oliguria and azotemia B) metabolic alkalosis C) decreased urinary concentration D) weight gain of less than 1 pound per week

D) weight gain of less than 1 pound per week Hepatorenal syndrome is a functional disorder resulting from a redistribution of renal blood flow. Oliguria and azotemia occur abruptly as a result of this complication.