Chapter 49: Assessment and Management of Patients With Hepatic Disorders

Octreotide

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?

Liver biopsy

A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder?

A liver biopsy

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis?

Change in the client's handwriting and/or cognitive performance

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?

Folic acid

Which type of deficiency results in macrocytic anemia?

Hemolytic

Which type of jaundice seen in adults is the result of increased destruction of red blood cells?

radical pancreatoduodenectomy

A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas into the middle section of the small intestine. What procedure is this client having performed?

Tacrolimus

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?

subnormal serum glucose and elevated serum ammonia levels.

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:

Asterixis

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?

Ultrasound of liver and abdomen

Which of the following diagnostic studies definitely confirms the presence of ascites?

Ecchymoses Jaundice Petechiae

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.

Reduce fluid accumulation and venous pressure.

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

Asterixis

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as?

Fecal-oral

The mode of transmission of hepatitis A virus (HAV) includes which of the following?

"You must have the second one in 1 month and the third in 6 months."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

Cholelithiasis

A client comes to the clinic and informs the nurse that he is there to see the physician for right upper abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?

Obstructive jaundice

A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has?

Hepatic encephalopathy

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

anorexia, nausea, and vomiting.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

acute cholecystitis

A middle-aged obese female presents to the ED with severe radiating right-sided flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is:

"How did this happen? I've been faithful my entire marriage."

A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?

Clay-colored stools

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

Hepatitis C increases a person's risk for liver cancer.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Minimizing social isolation

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome?

Hypotension

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?

Hemolytic

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?

Purpura and petechiae

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Measure abdominal girth daily. Perform daily weights.

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is increasing? (Select all that apply.)

cannot tolerate high-glucose concentration.

Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients:

low-fat diet

What is the recommended dietary treatment for a client with chronic cholecystitis?

Endoscopic retrograde cholangiopancreatography (ERCP)

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Clay-colored or whitish

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?

Vasopressin

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

fluid accumulation venous pressure

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply.

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

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.

phytonadione (Mephyton)

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:

Albumin

A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?