Med/Surg PrepU - Hepatic Disorders

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a) Vitamin K b) Potassium c) Vitamin B d) Oral bile acids

a) Vitamin K

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in this client? Select all that apply. a) Ketoconazole b) Insulin c) Acetaminophen d) Diazepam e) Valproic acid

a) Ketoconazole c) Acetaminophen e) Valproic acid

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) Vitamin K c) Thiamine d) Riboflavin

a) Vitamin A

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver? a) Convert urea into ammonia b) Excrete bile c) Breakdown amino acids d) Break down coagulation factors

b) Excrete bile

A homeless client at the neighborhood clinic has a lengthy history of alcohol addiction and is being seen for jaundice. Which of the following would the appearance of jaundice most likely indicate? a) Liver disorder b) Bile overproduction c) Glucose underproduction d) Gallbladder disease

a) Liver disorder

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide? a) Normal activities may be resumed in 1 week. b) Normal activities may be resumed the day after surgery. c) Normal activities may be resumed in 2 weeks. d) Normal activities may be resumed in 1 month.

a) Normal activities may be resumed in 1 week.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition has recently deteriorated. The nurse reviews the client's recent laboratory findings and recognizes that which of the following findings will place the client at risk for complications? a) Low platelet count b) Low sodium level c) Low hemoglobin d) Decreased prothrombin time

a) Low platelet count

A client has worked for a company that produces paint and varnishing compounds for 24 years. She is visiting the clinic with complaints of chronic fatigue, dyspepsia, diarrhea, and a recently developing yellowing of her skin and sclera. She reports clay-colored stools and frequent nosebleeds. Which type of cirrhosis would the nurse suspect is the cause of the client's symptoms? a) Postnecrotic cirrhosis b) Biliary cirrhosis c) Respiratory cirrhosis d) Alcoholic cirrhosis

a) Postnecrotic cirrhosis

A client has ascites. Which of the following interventions would the nurse prepare to assist with implementing to help the client control this condition? Select all that apply. a) Administering prescribed spironolactone (Aldactone) b) Instructing the client to remove salty and salted foods from the diet c) Assisting with placement of a transjugular intrahepatic portosystemic shunt d) Mobilizing the client every 2 hours e) Taking the client's weight every 3 to 4 days

a) Administering prescribed spironolactone (Aldactone) b) Instructing the client to remove salty and salted foods from the diet c) Assisting with placement of a transjugular intrahepatic portosystemic shunt

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a) Clay-colored stools b) Elevated urobilinogen in the urine c) Straw-colored urine d) Reduced hematocrit

a) Clay-colored stools

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? a) Tacrolimus (Prograf, FK506) b) Chenodiol (Chenix) c) Interferon alfa-2b, recombinant (Intron A, Roferon-A) d) Ursodiol (Actigall)

a) Tacrolimus (Prograf, FK506)

When caring for a client with cirrhosis, which of the following symptoms should a nurse report immediately? Select all that apply. a) Diarrhea or constipation b) Signs of GI bleeding c) Change in mental status d) Anorexia and dyspepsia

b) Signs of GI bleeding c) Change in mental status

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. The nurse understands that a likely cause of her symptoms is ________. a) hepatitis B b) acute cholecystitis c) hepatitis A d) pancreatitis

b) acute cholecystitis

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis? a) Sharp, stabbing pain in the left lower quadrant of the abdomen b) Dull pain, points to epigastric area c) Severe abdominal pain that radiates to the right shoulder d) Severe midabdominal to upper abdominal pain radiating to both sides and to the back

d) Severe midabdominal to upper abdominal pain radiating to both sides and to the back

A client with advanced cirrhosis has a prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer:

phytonadione (Mephyton).

A client with cirrhosis has been referred to hospice care. Assessment data reveal a need to discuss nutrition with the client. What is the nurse's priority intervention? a) Discuss the importance of eliminating caffeine in the diet. b) Discuss meals that have a high-fiber, high-protein content. c) Discuss meals that include low-fat high-carbohydrate content. d) Discuss the importance of drinking at least 64 oz (1,893 ml) of water daily.

c) Discuss meals that include low-fat high-carbohydrate content.

Which of the following terms is used to describe a chronic liver disease in which scar tissue surrounds the portal areas? a) Biliary cirrhosis b) Postnecrotic cirrhosis c) Compensated cirrhosis d) Alcoholic cirrhosis

d) Alcoholic cirrhosis

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

d) cryoprecipitate and fresh frozen plasma.

A young patient with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The patient asks the nurse how long she needs to stay in the hospital. In planning care for the patient, the nurse identifies impaired psychosocial issues and assigns the highest priority to which of the following patient outcomes? a) Identifying the source of exposure to hepatitis b) Minimizing social isolation c) Reducing the spread of the disease d) Establishing a stable home environment

b) Minimizing social isolation

A 67-year-old client is returning for a follow-up appointment to the primary care group where you practice nursing. At his last appointment, he received the diagnosis of portal hypertension. What is the primary aim of portal hypertension treatment? Select all that apply. a) Reduce blood coagulation. b) Reduce venous pressure. c) Reduce fluid output. d) Reduce fluid accumulation.

b) Reduce venous pressure. d) Reduce fluid accumulation.

Which of the following would be the most important nursing assessment in a patient diagnosed with ascites? a) Auscultation of abdomen b) Palpation of abdomen for a fluid shift c) Daily weight and measurement of abdominal girth d) Assessment of oral cavity for foul-smelling breath

c) Daily weight and measurement of abdominal girth

A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. a) Carbohydrate metabolism b) Zinc storage c) Glucose metabolism d) Ammonia conversion e) Protein metabolism

c) Glucose metabolism d) Ammonia conversion e) Protein metabolism

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which of the following nursing diagnoses should the nurse consider when caring for this acutely ill client? Select all that apply. a) Alterations in respiratory function b) Potential for infection c) Fluid volume excess d) Acute pain and discomfort

a) Alterations in respiratory function b) Potential for infection d) Acute pain and discomfort

A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones? a) Chenodiol (Chenix) b) Pancreatin (Creon) c) Cyclosporine (Sandimmune) d) Tacrolimus (Prograf)

a) Chenodiol (Chenix)

A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? a) Elevated alpha-fetoprotein b) Decreased alkaline phosphatase levels c) Decreased AST levels d) Elevated white blood cell count

a) Elevated alpha-fetoprotein

A client is given a diagnosis of hepatic cirrhosis. The client asks the nurse what findings led to this determination. Which of the following clinical manifestations would the nurse correctly identify? Select all that apply. a) Enlarged liver size b) Accelerated behaviors and mental processes c) Ascites d) Excess storage of vitamin C e) Hemorrhoids

a) Enlarged liver size c) Ascites e) Hemorrhoids

Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a) Hemolytic b) Hepatocellular c) Obstructive d) Nonobstructive

a) Hemolytic

The nurse is assessing a patient with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply. a) Insomnia b) Complaints of headache c) Decreased deep tendon reflexes d) Agitation e) Alterations in mood

a) Insomnia d) Agitation e) Alterations in mood

A nurse is caring for a client with acute pancreatitis. His physical examination reveals that he has jaundice with diminished bowel sounds and a tender distended abdomen. Additionally, his lab results indicate that he is hypovolemic. Which of the following will his healthcare provider consider ordering to treat the large amount of protein-rich fluid that has been released into his tissues and peritoneal cavity? a) Sodium b) Albumin c) Diuretics d) Dextrose solution

b) Albumin c) Diuretics

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? a) Irritability b) Asterixis c) Negative Babinski reflex d) Increased motor activity

b) Asterixis

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. a) Ingestion of undercooked beef b) Infection at school c) Sexual activity d) Consumption of sewage-contaminated water or shellfish e) Suboptimal sanitary habits

b) Infection at school c) Sexual activity d) Consumption of sewage-contaminated water or shellfish e) Suboptimal sanitary habits

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a) Fatigue during ambulation b) Irritability and drowsiness c) Jaundice d) Pruritus of the arms and legs

b) Irritability and drowsiness

Louisa Collins, a 52-year-old high school science teacher, is your client on the medical-surgical floor at the hospital where you practice nursing. She is undergoing diagnostics to determine what is causing her liver disorder. As you discuss her condition, Louisa asks questions pertaining to liver physiology and cellular function. Which liver cells perform most of the liver's metabolic functions? a) Canaliculi cells b) Kupffer cells c) Parenchymal cells d) Islets of Langerhans

c) Parenchymal cells

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) Bradycardia and tachypnea b) Bradycardia and bradypnea c) Tachycardia and tachypnea d) Tachycardia and bradypnea

c) Tachycardia and tachypnea

The nurse is administering medications to a patient that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? a) abdominal ascites. b) severe abdominal pain radiating to the shoulder. c) anorexia, nausea, and vomiting. d) eructation and constipation.

c) anorexia, nausea, and vomiting.

A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: a) elevated liver enzymes and low serum protein level. b) elevated blood urea nitrogen and creatinine levels and hyperglycemia. c) subnormal serum glucose and elevated serum ammonia levels. d) subnormal clotting factors and platelet count.

c) subnormal serum glucose and elevated serum ammonia levels

After undergoing a liver biopsy, a client should be placed in which position? a) Semi-Fowler's position b) Supine position c) Prone position d) Right lateral decubitus position

d) Right lateral decubitus position

The nurse is preparing a care plan for a patient with hepatic cirrhosis. Which of the following nursing diagnoses are appropriate? Select all that apply. a) Risk for injury related to altered clotting mechanisms b) Altered nutrition, more than body requirements, related to decreased activity and bed rest c) Urinary incontinence related to general debility and muscle wasting d) Disturbed body image related to changes in appearance, sexual dysfunction, and role function e) Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort

a) Risk for injury related to altered clotting mechanisms d) Disturbed body image related to changes in appearance, sexual dysfunction, and role function e) Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort

Timothy is a client being treated for hepatitis in the infectious disease office where you practice nursing. He has a history of IV drug use. He presents today with jaundice and arthralgias. Timothy most likely has which type of hepatitis? a) Hepatitis C b) Hepatitis B c) Hepatitis A d) Hepatitis E

b) Hepatitis B

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) Liver transplantation b) High-dose corticosteroids c) Azathioprine (Imuran) d) Paracentesis

b) High-dose corticosteroids

A patient with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which of the following would be the most appropriate response from the nurse? a) You can use milk thistle instead of the medications you have been prescribed. b) You should not use herbal supplements in conjunction with medical treatment. c) Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated. d) Herbal supplements are approved by the FDA, so there should be no problem with their usage if you check with your primary care provider.

c) Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis.However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated.