NURS 2211: Impaired Liver and Biliary function

The family of a client newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which response by the nurse is best?

"An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure."

When teaching the client with acute hepatitis C (HCV), the client demonstrates understanding when the client makes which statement?

"I will need to be checked for chronic HCV and other liver problems."

The client with cirrhosis is being taught self-care. Which statement indicates the client needs more teaching?

"If I notice a fast heart rate or irregular beats, it is normal for cirrhosis."

When providing discharge teaching for the client after a laparoscopic cholecystectomy, which information should the nurse include?

A lower-fat diet may be tolerated better for several weeks.

A client with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, which assessment should the nurse preform?

Abdominal girth

The nurse evaluates the effectiveness of a paracentesis in a client who has ascites. Which measurement is most important for the nurse to note?

Abdominal girth

A client presents with acute upper quadrant pain radiating to the back that the client rates as a 10 on a 1-to-10 pain scale. The client says, "I'm nauseated, and I've vomited several times." The diagnosis is cholecystitis with cholelithiasis. Which collaborative nursing diagnosis does the nurse recognize as the highest priority?

Acute pain related to inflammation and blockage of the biliary tract.

The nurse is admitting a client with cirrhosis. The nurse checks the client's history for which most frequent risk factor associated with cirrhosis?

Alcohol misuse

The nurse is interviewing a client with acute pancreatitis. Which finding should the nurse anticipate in the client's history?

Alcohol use disorder

The nurse recalls that hepatic encephalopathy results primarily from accumulation of which substance in the blood?

Ammonia

The nurse suspects that a client has hepatitis A. Which symptom will the client most likely report developed first?

Anorexia

A client with acute hepatitis B will be discharged tomorrow. The nurse should include which measures in the discharge teaching plan? Select all that apply.

Avoid foods that are very hot or very cold. Be sure to allow for periods of rest during the day. Eat small meals frequently rather than three times a day.

A client with a 3-year history of liver cirrhosis is hospitalized for treatment of recently diagnosed esophageal varices. Which information is most important for the nurse to include in the discharge teaching plan for this client?

Avoid straining during defecation to keep venous pressure low.

The nurse caring for a client who has undergone cholecystectomy should monitor the client for which major immediate postoperative complication?

Bleeding

The nurse assessing a client with pancreatitis suspects the presence of Grey Turner's sign when the client exhibits which symptom?

Bluish discoloration of the flank area

A client who underwent a cholecystectomy is now having pain that is referred to the right shoulder. Which causes are probable reasons for this pain? Select all that apply.

Carbon dioxide that was used in surgery. Irritation of the phrenic nerve.

The parent of a pediatric client suffering from hepatitis A approaches the nurse and is worried about the spread of infection to other family members through use of the same bathroom. Which information should the nurse provide to the client's parent? Select all that apply.

Clean the bathroom and commode thoroughly. Ask your child to wash hands thoroughly after using the bathroom. Ask all other family members to wash their hands thoroughly before eating and after using the bathroom.

When assessing the mental status of a client in acute renal failure, a nurse recognizes that abnormal findings are most likely caused by what?

Confusion related to an increased urea level.

A nurse reviews lab test results for a client in acute renal failure. Which is the best indicator of renal function?

Creatinine

The nurse reviews a client's laboratory values and recognizes which finding as an indication of resolution of acute pancreatitis?

Decreasing serum amylase level.

Which precautions should nurses and hospital staff follow while handling clients diagnosed with hepatitis infections? Select all that apply.

Dispose of the needles and syringes used on the client carefully. Wear gloves while handling articles contaminated by urine or feces. Follow infection control precautions while injecting the client, and avoid getting pricked by the used needle.

A client with cirrhosis of the liver is admitted to the hospital. Which complications of cirrhosis is the nurse likely to find in the client? Select all that apply.

Edema of the feet Blood in the stools or black stools Disorientation and lethargy

A young adult donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The client is experiencing a lot of pain and refuses to get up to walk. How should a nurse handle this situation?

Encourage even a short walk to avoid complications of surgery.

To prevent complications, which turning schedule should the nurse implement for a client with ascites who spends most of the day in bed?

Every 1 to 2 hours

The nurse, assessing a client with hepatitis A, expects which common clinical manifestations? Select all that apply.

Fatigue Jaundice Anorexia Constipation

A client suffering from cholelithiasis underwent a cholecystectomy. Which dietary information should the nurse provide to the client? Select all that apply.

Have a high- fibre diet. Have small but frequent meals. Limit saturated fats.

The condition of a client who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the client has developed liver cancer?

Hepatic structure ultrasound

A client suffering from ascites is admitted to the hospital. Which factors can lead to ascites development? Select all that apply.

Hyperaldosteronism Portal hypertension Decreased serum colloidal oncotic pressure

The nurse is planning discharge teaching for a client after a laser laparoscopic cholecystectomy. The nurse explains to the client about self-care at home. Which client statements indicate that the discharge teaching has been effective? Select all that apply.

I can have normal food that is low in fat. I may have mild shoulder pain for a week. I should not lift heavy weights for a few days.

A client is scheduled for laparoscopic cholecystectomy. When explaining the advantages of minimally invasive surgery over conventional surgery to the client, which information should the nurse include? Select all that apply.

Incisions are smaller. Blood loss is reduced. Postoperative pain is decreased.

The client who is vomiting and has sudden pain in the left upper quadrant radiating to the back was diagnosed with acute pancreatitis. Which intervention should the nurse expect to include in the client's plan of care?

Insert a nasogastric (NG) tube and maintain nothing by mouth (NPO) status to allow the pancreas to rest.

A client has been diagnosed with cholelithiasis. Which parameters should the nurse assess for manifestations of obstructed bile flow? Select all that apply.

Jaundice Steatorrhea Dark, amber urine Bleeding tendencies

The client with advanced cirrhosis asks why the skin is so yellow. Which information is the basis for the nurse's response?

Jaundice results from the body's inability to conjugate and excrete bilirubin.

The nurse is collecting data from a client admitted with hepatitis A. Which information given by the client may indicate the client's susceptibility to contract hepatitis A? Select all that apply.

Living in a nursing home Working as local plumber Working as a sewage cleaner

A nurse is caring for a client with chronic kidney disease who is undergoing hemodialysis. What is an appropriate diet for the client?

Low protein and low potassium

A client with ascites is admitted to the hospital. Which primary nursing interventions are indicated for the client? Select all that apply.

Monitor fluid and electrolytes. Administer an albumin infusion. Anticipate paracentesis.

A nurse is caring for a client who had surgery for an arteriovenous fistula (AVF) in preparation for hemodialysis. What precautionary step should the nurse follow when caring for the client?

Never take blood pressure measurements in the extremity.

A client with a chronic hepatitis C virus (HCV) infection is admitted to the hospital. Which factors contribute to a high risk for development of cirrhosis of the liver? Select all that apply.

Nonalcoholic fatty liver disease Alcohol consumption Obesity

The nurse is providing postoperative care to a client who underwent an incisional cholecystectomy 3 days ago. Which finding during the nurse's assessment should prompt the nurse to notify the primary health care provider?

Oral temperature of 38.8° C

A client who has hepatitis B surface antigen (HBsAg) in the serum is being discharged with pain medication after knee surgery. Which medication prescription should the nurse question because it is most likely to cause hepatic complications?

Oxycodone with acetaminophen

The nurse is providing discharge instructions to a client and caregiver, following a laparoscopic cholecystectomy. Which measures should be included in the discharge counselling? Select all that apply.

Resume normal activities gradually. Eat a low-fat diet for several weeks after the surgery. Report any bile-colored drainage or pus from any incision.

Which clinical manifestation of pain does the nurse expect to identify in a client who has cholecystitis?

Right upper quadrant pain radiating to the client's scapula.

The nurse is caring for a client with a tentative diagnosis of acute pancreatitis. Which diagnostic tests should the nurse anticipate for the health care provider to prescribe to confirm the diagnosis? Select all that apply.

Serum amylase Serum lipase Computed tomography (CT) scan

A female client expresses her concern about becoming pregnant while her partner is on ribavirin therapy for chronic hepatitis C. Which information should the nurse tell the client?

She should avoid getting pregnant now.

A client admitted to the hospital with cirrhosis of the liver suddenly starts vomiting blood. Which action is priority for the nurse to implement?

Stabilize the client and manage airway.

A client with cirrhosis of the liver is on furosemide. The nurse should monitor the client for which findings to prevent complications of diuretic therapy? Select all that apply.

Tachycardia Hypotension Muscle weakness Cardiac dysrhythmias

Following a laparoscopic cholecystectomy, a client without pre- or postoperative complications is being discharged from the hospital. Which instructions should the nurse include in the discharge teaching? Select all that apply.

Take a shower. Wait 1 week after surgery to return to work. Notify the surgeon of any redness and swelling at the incision site.

A client is diagnosed with acute pancreatitis. When providing dietary teaching, which information should the nurse include in the teaching plan? Select all that apply.

Take fat-soluble vitamins. Avoid consuming alcohol. Consume a high-carbohydrate diet.

A client is being discharged after laparoscopic cholecystectomy. The nurse should instruct the client to notify the surgeon immediately if which condition develops?

Temperature of 39.4° C

The client with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. Which finding on the comprehensive evaluation may be a contraindication for liver transplantation?

The chest x-ray showed another lung cancer lesion.

A client with cirrhosis of the liver has ascites and is being prepared for a paracentesis. Which instruction should the nurse give the client?

The client should void urine immediately before the paracentesis.

The client with cirrhosis has an increased abdominal girth from ascites. The nurse knows that this fluid gathers in the abdomen for which reasons? Select all that apply.

There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin. Hyperaldosteronism related to damaged hepatocytes increases sodium and fluid retention. Portal hypertension pushes proteins from the blood vessels, causing leaking into the peritoneal cavity.

A client with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the knowledge that hepatitis A is transmitted primarily through which route?

Through fecal contamination of food or water.

Which information should the nurse emphasize while teaching a client ways to protect oneself from exposure to hepatitis B infection? Select all that apply.

Use disposable needles and syringes. Avoid sharing toothbrushes and razors. Avoid unsafe sex with multiple partners, and always use condoms.

When caring for a client with liver disease, the nurse recognizes the need to prevent bleeding resulting from altered clotting factors and rupture of varices. Which nursing interventions should the nurse implement to achieve this outcome? Select all that apply.

Use smallest gauge needle possible when giving injections or drawing blood. Teach client to avoid straining at stool, vigorous blowing of nose, and coughing. Advise client to use soft-bristle toothbrush and avoid ingestion of irritating food. Instruct client to avoid aspirin and nonsteroidal antiinflammatory drugs (NSAIDs) to prevent hemorrhage when varices are present.

When caring for a client with a biliary obstruction, the nurse will anticipate administering which vitamin supplements? Select all that apply.

Vitamin A Vitamin D Vitamin E Vitamin K

A client with hepatitis A infection is being discharged from the hospital. Which instruction is most important to include in the discharge teaching?

Wash hands carefully after bowel movements.