Exam 4
Match the liver malfunction with its assessment finding: 1. Hormonal dysregulation 2. Clotting dysfunction 3. Lack of vitamin storage 4. Lack of processing and excreting of ammonia 5. Inability to conjugate/excrete bilirubin 6. Inability to reduce drug levels Central obesity and round face Medication toxicity Hepatic encephalopathy PT 6, INR 15 Folic acid deficiency Jaundice
1. Central obesity and round face - Hormonal dysregulation 2. PT 6, INR 15 - Clotting dysfunction 3. Folic acid deficiency - Lack of vitamin storage 4. Lack of processing and excreting of ammonia - Hepatic encephalopathy 5. Jaundice - Inability to conjugate/excrete bilirubin 6. Medication toxicity - Inability to reduce drug levels
Match these medications used in cirrhosis and alcoholism treatment with their drug classes. 1. Lactulose 2. Disulfiram 3. Gabapentin 4. Lorazepam 5. Naltrexone 6. Buprenorphine Alcoholism treatment medication that provides an unpleasant reaction when alcohol is ingested (Antabuse). Laxative and ammonia reducer. Suboxone: used in both opioid and alcoholism treatment. High risk for dependence; taper off slowly. Do not combine with alcohol. Benzodiazepine used during alcoholism detoxification. Anticonvulsant: off label use to treat symptoms of alcohol craving. Opioid receptor blocker to reduce alcohol craving and use.
1. Laxative and ammonia reducer. - Lactulose 2. Alcoholism treatment medication that provides an unpleasant reaction when alcohol is ingested (Antabuse). - Disulfiram 3. Anticonvulsant: off label use to treat symptoms of alcohol craving. - Gabapentin 4. Benzodiazepine used during alcoholism detoxification. - Lorazepam 5. Opioid receptor blocker to reduce alcohol craving and use. - Naltrexone 6. Suboxone: used in both opioid and alcoholism treatment. High risk for dependence; taper off slowly. Do not combine with alcohol. - Buprenorphine
Match the oncologic emergency with its most likely preventative assessment and/or intervention: 1. Thrombocytopenia 2. Hypercalcemia 3. Spinal cord compression 4. Acute renal failure 5. Tumor lysis syndrome 6. Superior vena cava syndrome Monitor for muscle innervation, fracture, and parathesias. Administer calcitonin, hydrate and monitor for near changes and muscle weakness. Assess for signs of chest pain, difficulty breathing, lightheadedness and cough. Assess for signs of electrolyte imbalance including high potassium, high phosphate, low calcium and also hyperuricemia, muscle weakness, and renal failure. Assess GFR, BUN, creatinine, and medications that the patient is receiving. Monitor CBC including platelets and for signs/symptoms of bleeding.
1. Monitor CBC including platelets and for signs/symptoms of bleeding. - Thrombocytopenia 2. Administer calcitonin, hydrate and monitor for near changes and muscle weakness. - Hypercalcemia 3. Monitor for muscle innervation, fracture, and parathesias. - Spinal cord compression 4. Assess GFR, BUN, creatinine, and medications that the patient is receiving. - Acute renal failure 5. Assess for signs of electrolyte imbalance including high potassium, high phosphate, low calcium and also hyperuricemia, muscle weakness, and renal failure. - Tumor lysis syndrome 6. Assess for signs of chest pain, difficulty breathing, lightheadedness and cough. - Superior vena cava syndrome
The nurse is teaching the patient with opioid misuse about the risk for liver cancer. Which of the following is the best definition of the connection between opioid misuse and liver cancer? A. "Injecting opioids especially with unclean or shared needles can increase your risk and exposure to Hepatitis B & especially Hepatitis C, both which can lead to liver cancer." B. "Injecting opioids can introduce substances to your liver, which initiates it and can eventually cause liver cancer." C. "Smoking heroin can lead to lung cancer and a secondary or metastasis site for lung cancer is liver cancer." D. "Smoking heroin is irritating to your liver as it tries to process the foreign chemical and that can cause cancer."
A. "Injecting opioids especially with unclean or shared needles can increase your risk and exposure to Hepatitis B & especially Hepatitis C, both which can lead to liver cancer."
A male client with extreme weakness, pallor, weak peripheral pulses, and disorientation is admitted to the emergency department. His wife reports that he has been "spitting up blood." A Mallory-Weiss tear is suspected, and the nurse begins taking the client's history from the client's wife. The question by the nurse that demonstrates her understanding of Mallory-Weiss tearing is: A. "Tell me about your husband's alcohol usage." B. "Is your husband being treated for tuberculosis?" C. "Has your husband recently fallen or injured his chest?" D. "Describe spices and condiments your husband uses on food."
A. "Tell me about your husband's alcohol usage."
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."
The nurse knows that which of the following statements is the best descriptor of alcohol use disorder recovery goals? A. "You should find treatment and support with others that works for you." B. "You should never relapse." C. "You should cut down on alcohol use." D. "You should never use alcohol again." E. "If your family is screwed up, you should not include them in your treatment plan and focus on you."
A. "You should find treatment and support with others that works for you."
The nurse knows that which of the following are signs of healthcare worker substance use disorder? Select all that apply. A. A change in appearance or affect B. Volunteering to deliver pain meds for other patients C. Charting or medication entries that do not match medication dispensation information D. Offering to waste narcotics for other nurses E. Hiding, avoiding or not talking to other staff members
A. A change in appearance or affect B. Volunteering to deliver pain meds for other patients C. Charting or medication entries that do not match medication dispensation information D. Offering to waste narcotics for other nurses E. Hiding, avoiding or not talking to other staff members
You are developing a care plan for 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.
Hepatic encephalopathy develops when the blood level of which substance increases? A. Ammonia B. Amylase C. Calcium D. Potassium
A. Ammonia
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
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 reflux
A. Asterixis
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 sound 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 sound over the right lung.
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.
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.
Which diagnostic test would be used first to evaluate a client with upper GI bleeding? A. Endoscopy B. Upper GI series C. Hemoglobin (Hb) levels and hematocrit (HCT) D. Arteriography
A. Endoscopy
The nurse knows that which of the following are signs that a liver transplant is being rejected? Select all that apply. A. Flank pain B. Tachycardia C. Oliguria D. Abdominal pain E. HTN F. Parathesias
A. Flank pain B. Tachycardia C. Oliguria D. Abdominal pain E. HTN
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.
The nurse knows that which of the following are included on CAGE survey for alcohol use? Select all that apply. A. Have you ever felt you needed to cut down on your drinking? B. Have people annoyed you by criticizing your drinking? C. Have you ever felt guilty about drinking? D. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover? E. Have you ever been injured as a result of your drinking? F. Have you ever not been able to stop drinking once you started?
A. Have you ever felt you needed to cut down on your drinking? B. Have people annoyed you by criticizing your drinking? C. Have you ever felt guilty about drinking? D. Have you ever felt you needed a drink first thing in the morning (eye-opener) to steady your nerves or to get rid of a hangover?
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
The nurse knows that which of the following is the most likely cause of liver cancer (hepatocellular carcinoma)? A. Hepatitis B B. Hepatitis D C. Hepatitis E D. Hepatitis A
A. Hepatitis B
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 liver failure? A. Hypoalbuminemia B. Increased capillary permeability C. Abnormal peripheral vasodilation D. Excess renin release from the kidneys
A. Hypoalbuminemia
The nurse knows that which of the following are appropriate treatment interventions for opioid misuse? Select all that apply. A. Inpatient therapy, possibly long term B. Buprenorphine/Suboxone C. Naltrexone/Vivitrol D. Disulfiram E. 12 step program/monthly meetings F. Behavioral therapy
A. Inpatient therapy, possibly long term B. Buprenorphine/Suboxone C. Naltrexone/Vivitrol D. Disulfram F. Behavioral therapy
You observe 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
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? A. Malaise B. Dark stools C. Weight gain D. Left upper quadrant discomfort
A. Malaise
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 pasta D. Cakes and pastries
A. Meats and beans
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 lb per week
A. Oliguria and azotemia
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
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 nurse knows that which of the following are likely treatments for liver cancer? Select all that apply. A. Possible radiation, especially targeted radiation B. Possible surgery/resection C. Possible chemotherapy D. Liver chelation; removing toxins through chemical binding E. Artificial liver implantation F. Liver transplantation
A. Possible radiation, especially targeted radiation B. Possible surgery/resection C. Possible chemotherapy D. Liver chelation; removing toxins through chemical binding F. Liver transplantation
Which of the following measures should the nurse focus on for the client with esophageal varices? A. Recognizing hemorrhage. B. Controlling blood pressure. C. Encouraging nutritional intake. D. Teaching the client about varices.
A. Recognizing hemorrhage.
Your patient's ABG reveals an acidic pH, an acidic CO2, and a normal bicarbonate level. Which of the following indicates this acid-base disturbance? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis
A. Respiratory acidosis
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.
The nurse is monitoring a client for the early signs and symptoms of dumping syndrome. Which findings indicate this occurrence? A. Sweating and pallor B. Bradycardia and indigestion C. Double vision and chest pain D. Abdominal cramping and pain
A. Sweating and pallor
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.
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 the level of consciousness. B. The patient exhibits improved skin integrity. C. The patient experiences no evident signs of bleeding. D. The patient verbalizes decreased episodes of pain.
A. The patient demonstrates an increase in the level of consciousness.
The nurse knows that which criteria are measured on the Clinical Institute Withdrawal Assessment (CIWA)? Select all that apply. A. Tremor B. Sweats C. Mood changes D. Change in family relationships E. Auditory/visual disturbances F. Anxiety/agitation G. Nausea/vomiting
A. Tremor B. Sweats C. Mood changes D. Change in family relationships E. Auditory/visual disturbances F. Anxiety/agitation G. Nausea/vomiting
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
Which blood lab values are expected to be elevated in a client with worsening liver cirrhosis? Select all that apply.
Ammonia Bilirubin Prothrombin time (PT)
Which hematologic symptoms might be noted in a patient with cirrhosis of the liver? Select all that apply.
Anemia Leukopenia Thrombocytopenia
Which assessments would indicate if a client with cirrhosis has progressed to hepatic encephalopathy? Select all that apply.
Ask the client for their date of birth, name, date, and location Tell the client to extend their arms Compare ammonia blood levels with that of previous shifts
Client with cirrhosis... portal HTN, ascites, and esophageal varices. Which of the following is correct patient teaching?
Avoid straining when having a BM
The primary health care provider has determined that a client has contracted hepatitis A based on flulike symptoms and jaundice. Which statement made by the client supports this medical diagnosis? A. "I have had unprotected sex with multiple partners." B. " I ate shellfish about 2 weeks ago at a local restaurant." C. "I was an IV drug abuse in the past and shared needles." D. "I had a blood transfusion 30 years ago after major abdominal surgery."
B. " I ate shellfish about 2 weeks ago at a local restaurant."
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."
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
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.
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
Digoxin preparations and absorbents should not be given simultaneously. As a nurse, you are aware that if these agents are given simultaneously, which of the following will occur? A. Increased absorption of digoxin. B. Decreased absorption of digoxin. C. Increased absorption of the absorbent. D. Decreased absorption of the absorbent.
B. Decreased absorption of digoxin.
You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicates that the paracentesis was effective? A. Pruritus B. Dyspnea C. Jaundice D. Peripheral Neuropathy
B. Dyspnea
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
Ralph has a history of alcohol abuse and has acute pancreatitis. Which lab value is most likely to be elevated? A. Calcium B. Glucose C. Magnesium D. Potassium
B. Glucose
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
A client diagnosed with viral hepatitis is complaining of "no appetite" and "losing my taste for food". What instruction would the nurse give the client to provide adequate nutrition? A. Select foods high in fat B. Increase intake of fluids, including juices C. Eat a good supper, when anorexia is less severe D. Eat less often, preferably only three large meals daily
B. Increase intake of fluids, including juices
Patients with esophageal varices would reveal the following assessment: A. Increased blood pressure B. Increased heart rate C. Decreased respiratory rate D. Increased urinary output
B. Increased heart rate
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
While palpating a female client's right upper quadrant (RUQ), the nurse would expect to find which of the following structures? A. Sigmoid colon B. Appendix C. Spleen D. Liver
D. Liver
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
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
Which complication is a patient with cirrhosis at risk for?
Bleeding
Nurse Farrah is providing care for Kristoff who has jaundice. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client? A. "Jaundice is associated with pressure ulcer formation." B. "Jaundice impairs urea production, which produces pruritus." C. "Jaundice produces pruritus due to impaired bile acid excretion." D. "Jaundice leads to decreased tissue perfusion and subsequent breakdown."
C. "Jaundice produces pruritus due to impaired bile acid excretion."
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.
The nurse is reviewing the record of a client with a diagnosis of cirrhosis and notes that there is documentation of the presence of asterixis. How would the nurse assess for its presence? A. Dorsiflex the client's foot B. Measure the abdominal girth C. Ask the client to extend the arms D. Instruct the client to lean forward
C. Ask the client to extend the arms
The nurse knows that which of the following are the most Cushing-like symptoms in the liver failure patient? A. Central obesity, spider angiomas, increased risk of fractures B. Systemic obesity, bronze skin, low blood pressure C. Central obesity, abdominal striae, irritability D. Systemic obesity, abdominal striae, bruises
C. Central obesity, abdominal striae, irritability
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.
Which of the following tests can be useful as a diagnostic and therapeutic tool in the biliary system? A. Ultrasonography B. MRI C. Endoscopic retrograde cholangiopancreatography (ERCP) D. Computed tomography scan (CT scan)
C. Endoscopic retrograde cholangiopancreatography (ERCP)
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
The nurse is reviewing the laboratory results for a client with cirrhosis and notes that the ammonia level is 85 mcg/dL (51 mcmol/L). Which dietary selection does the nurse suggest to the client? A. Roast pork B. Cheese omelet C. Pasta with sauce D. Tuna fish sandwich
C. Pasta with sauce
Following a liver biopsy, the nurse would assist the client into which position? A. Right side lying with left arm elevated B. Left side lying with pillow or towel under puncture site C. Right side lying with pillow or towel under puncture site D. Left side lying with right arm elevated
C. Right side lying with pillow or towel under puncture site
In a client with diarrhea, which outcome indicates that fluid resuscitation is successful? A. The client passes formed stools at regular intervals. B. The client reports a decrease in stool frequency and liquidity. C. The client exhibits firm skin turgor. D. The client no longer experiences perianal burning.
C. The client exhibits firm skin turgor.
Dark, tarry stools indicate bleeding in which location of the GI tract? A. Upper colon B. Lower colon C. Upper GI tract D. Small intestine
C. Upper GI tract
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.
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."
The spouse of a client who abuses alcohol states, "I wish I could just get out of this situation and far away from my spouse." Which response by the nurse is most therapeutic? A. "In order to ensure your safety, it's probably best that you leave." B. "Maybe you could make this decision when your spouse is stable." C. "I don't think that's what is best for you or your spouse now." D. "What aspects of this situation are most difficult for you?"
D. "What aspects of this situation are most difficult for you?"
A nurse is preparing to care for a female client with esophageal varices who just had a Sengstaken-Blakemore tube inserted. The nurse gathers supplies, knowing that which of the following items must be kept at the bedside at all times? A. An obturator B. Kelly clamp C. An irrigation set D. A pair of scissors
D. A pair of scissors
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.
Katrina is diagnosed with lactose intolerance. To avoid complications with lack of calcium in the diet, which food should be included in the diet? A. Fruit B. Whole grains C. Milk and cheese products D. Dark green, leafy vegetables
D. Dark green, leafy vegetables
The nurse is caring for a client with cirrhosis who has hepatic encephalopathy. Which assessment finding should the nurse report to the primary health care provider? A. Difficulty sleeping B. Fatigue C. Seizure D. Disorientation
D. Disorientation
A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. 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
Jordin is a client with jaundice who is experiencing pruritus. Which nursing intervention would be included in the care plan for the client? A. Administering vitamin K subcutaneously B. Applying pressure when giving I.M. injections C. Decreasing the client's dietary protein intake D. Keeping the client's fingernails short and smooth
D. Keeping the client's fingernails short and smooth
A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A. Metabolic acidosis with hyperkalemia B. Metabolic acidosis with hypokalemia C. Metabolic alkalosis with hyperkalemia D. Metabolic alkalosis with hypokalemia
D. Metabolic alkalosis with hypokalemia
During the initial assessment of a patient post-endoscopy, the nurse notes absent bowel sounds, tachycardia, and abdominal distention. The nurse would anticipate: A. Ischemic bowel B. Peritonitis C. Hypovolemic shock D. Perforated bowel
D. Perforated bowel
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
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 the patient to select his meals. D. Rest period after small, frequent meals.
D. Rest period after small, frequent meals.
The nurse knows that which of the following shows that the nurse needs more education when speaking to a healthcare colleague when substance abuse is suspected? A. "You don't seem yourself and I'm concerned. Can we talk about why you're always late?" B. "Can I speak with you about your work? I've noticed some charting errors and I'm concerned." C. "I'm worried that I saw you pocketing a pill that looked like Vicodin earlier at the Pxyis. I've called the pharmacy, our manage, and security and I wanted to let you know that they will want to talk to you." D. "I'd like to help you with this med pass. Mr. Jones seems extra painful and maybe I can help make surer he feels better." E. "I saw you take that Vicodin. You're so weak that you have to turn to substances to cope. You'll never be a successful nurse."
E. "I saw you take that Vicodin. You're so weak that you have to turn to substances to cope. You'll never be a successful nurse."
A client with worsening liver failure presents to the med-surg floor... which assessment findings should the nurse expect? Select all that apply.
Enlarged abdomen from ascites Bruise marks on the skin Fatigue and possible confusion Sclera that appears yellow Reports of itchy skin
A nurse is assisting with a paracentesis for a patient with ascites caused by cirrhosis. Which action should the nurse take first?
Have the patient empty their bladder
During an assessment of a patient, the nurse finds asterixis, twitching of the extremities, and notices that the patient is displaying inappropriate behavior and disorientation. Which condition dose the nurse suspect?
Hepatic encephalopathy
Diet for cirrhosis?
Low protein = low ammonia; prevents Hepatic Encephalopathy Low sodium & fluid = low swelling; prevents ascites NO alcohol
The typical stool for a patient with cirrhosis may be described as:
Melena, black, tarry, sticky, hematochezia
What to monitor when the patient is taking Lactulose?
Monitor for Hypokalemia d/t excessive diarrhea
Client with a history of cirrhosis... with suspected gastroesophageal varices. Which order would the nurse question?
New NG tube insertion
First action when a client with cirrhosis begins vomiting blood after a meal?
Obtain vital signs (probable esophageal varices)
A patient with cirrhosis and esophageal varices is vomiting, and the nurse notes hematemesis. Which action should the nurse take first?
Place the patient in the side-lying position.
Which nursing intervention would be the highest priority in managing a patient with ruptured esophageal varices?
Protecting the airway
A client with cirrhosis... shows signs of hepatic encephalopathy. The nurse should plan a dietary consultation to limit... which ingredient?
Protein
The nurse is caring for a patient with severe liver cirrhosis and imbalanced nutrition. Which nursing intervention would prevent malnutrition in this patient?
Provide oral care before meals
