Care of Patients with Liver Problems Chapter 58

B. Endoscopic retrograde cholangiopancreatography (ERCP)

A patient is scheduled for a procedure to place a stent in the biliary tract. For which procedure does the nurse provide patient teaching? A. Esophagogastroduodenoscopy (EGD) B. Endoscopic retrograde cholangiopancreatography (ERCP) C. Upper gastrointestinal (GI) series D. Cholangiogram

A. Jaundice B. Esophageal varices C. Coagulation defects E. Spontaneous bacterial peritonitis F. Ascites

A patient with decompensated cirrhosis is at risk for which complications? Select all that apply. A. Jaundice B. Esophageal varices C. Coagulation defects D. Hepatitis A virus (HAV) E. Spontaneous bacterial peritonitis F. Ascites

D. It decreases the rate of ammonia production.

How is neomycin sulfate used to treat patients with cirrhosis? A. It treats the current infection the patient has. B. It prevents future infections of the liver. C. It restores normal function to the liver cells. D. It decreases the rate of ammonia production.

A. Right upper quadrant pain C. Guarding of the abdomen E. Kehr's sign F. Abdominal rigidity

In performing an assessment on a patient with liver trauma, what does the nurse expect to find? Select all that apply. A. Right upper quadrant pain B. Increased blood pressure C. Guarding of the abdomen D. Bradypnea E. Kehr's sign F. Abdominal rigidity

B. Elevated ammonia level

The nurse identifies which laboratory value as the usual indication of hepatic encephalopathy? A. Elevated sodium level B. Elevated ammonia level C. Increased blood urea nitrogen (BUN) D. Increased clotting time

B. Liver hemorrhage

The nurse is assessing a patient with liver trauma and finds that the patient is confused, with a blood pressure of 86/50 mm Hg, heart rate of 128/minute, and cool, clammy skin. What does the nurse suspect? A. Septic shock B. Liver hemorrhage C. Liver cancer D. GI bleeding

C. Increased ascites due to sodium and water retention

The nurse is assessing a patient with massive ascites. What related complication must the nurse monitor for with this patient? A. Bleeding due to fragile, thin-walled veins B. Hematemesis due to absence of clotting factors C. Increased ascites due to sodium and water retention D. Bruising due to low platelet count

B. Alternating periods of activity with periods of rest

The nurse is caring for a patient with acute viral hepatitis. What is the major care concern at this time? A. Providing three small meals a day B. Alternating periods of activity with periods of rest C. Monitoring for the development of jaundiced skin D. Teaching the patient the importance of avoiding alcohol intake

A. Do not use table salt. C. Eat small frequent meals. D. Drink supplemental liquids such as Ensure. E. Be sure to take a multivitamin every day.

The nurse is teaching a patient with cirrhosis about nutrition therapy. Which key points must the nurse include? Select all that apply. A. Do not use table salt. B. Adding salt when cooking is acceptable. C. Eat small frequent meals. D. Drink supplemental liquids such as Ensure. E. Be sure to take a multivitamin every day. F. Avoid foods that are rich in vitamin K.

A. "As few as two or three drinks per day over 10 years can lead to cirrhosis."

The nurse is teaching a young woman about cirrhosis prevention by limiting alcohol intake. What is the nurse's best advice? A. "As few as two or three drinks per day over 10 years can lead to cirrhosis." B. "You should be all right as long as you drink less than five drinks per day." C. "Binge drinking, rather than drinking every day, reduces your risk for hepatitis or fatty liver." D. "The amount of alcohol that causes cirrhosis does not vary by gender."

D. Stage IV comatose

The nurse who is assessing a patient with portal-systemic encephalopathy finds that the patient has fetor hepaticus, a positive Babinski's sign, and seizures, but no asterixis. The nurse identifies the patient as being in which stage of portal-systemic encephalopathy? A. Stage I prodromal B. Stage II impending C. Stage III stuporous D. Stage IV comatose

D. Notify the surgeon immediately.

The patient who just had a liver transplant develops oozing around two IV sites as well as some new bruising. What is the nurse's best first action? A. Apply pressure to the IV sites. B. Measure the size of the bruises. C. Document these findings as the only action. D. Notify the surgeon immediately.

B. "I will not remove more than 2000 mL of fluid at a time." C. "The drain will make breathing more comfortable for me after some fluid is removed." E. "This drain will be useful to remove fluid from my belly when there is too much."

The patient with liver cancer will be discharged with a tunneled ascites drain. What statements by the patient indicate an understanding of the purpose of this device? Select all that apply. A. "I will have this drain until I am able to get the tumor removed." B. "I will not remove more than 2000 mL of fluid at a time." C. "The drain will make breathing more comfortable for me after some fluid is removed." D. "After I drain off the extra fluid, I can remove the drain." E. "This drain will be useful to remove fluid from my belly when there is too much." F. "I will flush the tunneled ascites drain twice a day with normal saline."

A. Uses a straight-edge razor to shave the patient.

The student nurse is caring for a patient with cirrhosis. Which action by the student nurse causes the supervising nurse to intervene? A. Uses a straight-edge razor to shave the patient. B. Monitors for orthostatic changes of blood pressure. C. Avoids intramuscular injections. D. Uses a toothette for oral care.

A. Thrombocytopenia

When admitting the patient with cirrhosis, the nurse assesses for which conditions related to splenomegaly as possible complications of the disease? A. Thrombocytopenia B. Bleeding esophageal varices C. Hepatorenal syndrome D. Portal hypertensive gastropathy

A. Perform proper hand washing, especially after handling shellfish. B. Receive immune globulin within 14 days if exposed to the virus. C. Receive the HAV vaccine before traveling to Mexico or the Caribbean. E. Receive the vaccine if working in a long-term care facility.

When teaching a group of adult patients about measures for preventing hepatitis A (HAV), which information does the nurse include? Select all that apply. A. Perform proper hand washing, especially after handling shellfish. B. Receive immune globulin within 14 days if exposed to the virus. C. Receive the HAV vaccine before traveling to Mexico or the Caribbean. D. After exposure, HAV symptoms always let the patient know something is wrong. E. Receive the vaccine if working in a long-term care facility. F. Avoid unprotected sex with a person who has HAV.

A. Lamivudine B. Entecavir C. Enofovir E. Adefovir

Which antiviral drugs are given to patients with chronic hepatitis B virus? Select all that apply. A. Lamivudine B. Entecavir C. Enofovir D. Oral ribavirin E. Adefovir F. Telaprevir

B. Diabetes mellitus C. Obesity D. Elevated lipid profile E. Alcohol abuse

Which conditions place a patient at high risk for the development of fatty liver (steatosis)? Select all that apply. A. Hypertension B. Diabetes mellitus C. Obesity D. Elevated lipid profile E. Alcohol abuse F. Hepatitis A

A. Elevated serum aspartate aminotransferase (AST) B. Elevated serum alanine aminotransferase (ALT) C. Elevated lactate dehydrogenase (LDH) F. Increased International Normalized Ration (INR)

Which elevated laboratory test results indicate hepatic cell destruction? Select all that apply. A. Elevated serum aspartate aminotransferase (AST) B. Elevated serum alanine aminotransferase (ALT) C. Elevated lactate dehydrogenase (LDH) D. Decreased serum total bilirubin E. Increased fecal urobilinogen F. Increased International Normalized Ration (INR)

A. High-protein diet C. Infection D. Constipation F. Use of illicit drugs

Which factors may lead to hepatic encephalopathy in patients with cirrhosis? Select all that apply. A. High-protein diet B. Hypervolemia C. Infection D. Constipation E. Hyperkalemia F. Use of illicit drugs

A. "Do not take over-the-counter medications unless approved by your health care provider." C. "The lactulose syrup should cause you to have two to three bowel movements every day." D. "Take your furosemide early in the day so that it does not keep you up at night." E. "Report any muscle weakness or lightheadedness to your health care provider right away." F. "Your health care provider may prescribe a potassium supplement to replace losses."

Which key points does the nurse include when teaching the patient with cirrhosis and his family about drug therapy before discharge? Select all that apply. A. "Do not take over-the-counter medications unless approved by your health care provider." B. "The beta-blocker called propanolol will cause your heart rate to increase." C. "The lactulose syrup should cause you to have two to three bowel movements every day." D. "Take your furosemide early in the day so that it does not keep you up at night." E. "Report any muscle weakness or lightheadedness to your health care provider right away." F. "Your health care provider may prescribe a potassium supplement to replace losses."

A. Patient with metastatic tumors C. Patient with severe respiratory disease E. Patient with advanced cardiac disease F. Patient who is unable to follow instructions

Which patients would not be considered candidates for a liver transplant? Select all that apply. A. Patient with metastatic tumors B. Patient with type 2 diabetes C. Patient with severe respiratory disease D. Patient with chronic liver disease E. Patient with advanced cardiac disease F. Patient who is unable to follow instructions

A. People who have unprotected sex with more than one partner B. Men who have sex with men D. Firefighters E. Health care providers F. Patients prescribed immunosuppressant drugs

Which people need immunization against hepatitis B (HBV)? Select all that apply. A. People who have unprotected sex with more than one partner B. Men who have sex with men C. Any patient scheduled for a surgical procedure D. Firefighters E. Health care providers F. Patients prescribed immunosuppressant drugs

D. Radiofrequency ablation (RFA)

Which procedure uses energy waves to heat cancer cells and kill them? A. Cryotherapy B. Selective internal radiation therapy (SIRT) C. Hepatic artery embolization D. Radiofrequency ablation (RFA)

A. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. B. Bleeding esophageal varices are a medical emergency. D. A nonselective beta blocker such as propanolol is prescribed to prevent varices from bleeding. E. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation.

Which statements about a patient with cirrhosis and esophageal varices are accurate? Select all that apply. A. All patients with cirrhosis should be screened for esophageal varices to detect them before they bleed. B. Bleeding esophageal varices are a medical emergency. C. Esophageal balloon tamponade is often used to control bleeding esophageal varices. D. A nonselective beta blocker such as propanolol is prescribed to prevent varices from bleeding. E. Bleeding esophageal varices can be managed by use of endoscopic variceal ligation. F. The bleeding appears as dark coffee grounds in emesis or stool.

C. Liver transplantation

Which treatment offers the patient with liver cancer the possibility of long-term survival? A. Chemotherapy B. Selective internal radiation therapy C. Liver transplantation D. Hepatic arterial embolization