liver/obesity prepU
A nurse cares for an obese client taking phentermine for weight loss. What client teaching will the nurse include when discussing precautions about the medication?
"Do not drink alcohol while taking this medication."
A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching?
"How did this happen? I've been faithful my entire marriage."
The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include?
"How often do you drink alcohol?"
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:
"I need to make sure I don't eat too many high potassium foods."
A client is to be discharged with a prescription for lactulose. The nurse teaches the client how to administer this medication. Which statement would indicate that the client has understood the information?
"I will mix it with apple juice" (tastes bad) don't take with antacids or laxatives
A client with long-standing obesity has been prescribed phentermine/topiramate-ER. What statement by the client suggests that further health education is necessary?
"I'm so relieved to start this medication. I really don't like having to exercise or change what I eat."
What intervention does the nurse anticipate providing for the patient with ascites that will help correct the decrease in effective arterial blood volume that leads to sodium retention?
albumin infusion
Lactulose (Cephulac) is administered to a patient diagnosed with hepatic encephalopathy to reduce which of the following?
ammonia
A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply.
fluid accumulation venous pressure
A nurse is caring for a client with a BMI of 35 kg/m2 who is wanting to lose weight. What is the initial recommendation the nurse will expect from the client's health care provider?
lifestyle modification
The nurse understands that the action of most diuretics typically results in which effects? (Select all that apply.)
loss of chloride loss of water
A nurse cares for a client who is post op bariatric surgery. Which position will the nurse place the client in order to best promote comfort?
low fowler's
Understanding the definition of eating disorders is important in communicating facts while managing these conditions. Which is not an eating disorder?
obesity
A client who is postoperative from bariatric surgery reports foul-smelling, fatty stools. What is the nurse's understanding of the primary reason for this finding?
rapid gastric dumping
A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?
until the gag reflex returns
Which of the following is the most effective strategy to prevent hepatitis B infection?
vaccine
A nurse cares for a client who is obese. The health care provider prescribes orlistat in an effort to help client lose weight, along with diet and exercise. When teaching the client about this medication, what will the nurse include?
"It binds with enzymes to help prevent digestion of fat."
The nurse is working with a sedentary adult client who has expressed a determination to lose weight over the next several months, despite the presence of other major health problems. What is the nurse's best advice for this client?
"It might be challenging to start an exercise program, but we'll start with a few minutes per day."
A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response?
"You may have eaten contaminated restaurant food."
A nurse prepares nutrition education for a client who will undergo bariatric surgery. What nutrition suggestion best indicates a beneficial effect on the number and quality of bowel movements the client may have after surgery?
avoid high fat foods
A nurse researcher is reviewing data obtained from a developing nation on nutrition and metabolism issues facing that country. What is the nurse's understanding of the "double-burden" many developing nations now face?
both undernutrition and obesity
The nurse is caring for a hospitalized client who has class II obesity and who has limited mobility. The nurse should address the client's risk for skin breakdown by:
cleaning and drying regularly within the client's skin folds.
A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity?
cushing's disease
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?
hypotension
Diagnostic testing has revealed that a client's hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this client's plan of care will focus on what intervention?
lobectomy
A client with liver disease has developed ascites; the nurse is collaborating with the client to develop a nutritional plan. The nurse should prioritize which of the following in the client's plan?
reduction in sodium intake
A nurse is caring for a client who is post operative bariatric surgery. The client's pain has not been well controlled. Which nursing diagnosis is the nurse's priority?
risk for impaired gas exchange
A client with obesity has been taking lorcaserin for several months and presents to the health care provider's office reporting fever and diarrhea. Which life-threatening condition does the nurse suspect?
serotonin syndrome
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?
vasopressin
What client is most likely to have impaired drug metabolism?
client with diagnosis of hep C
Which type of jaundice seen in adults is the result of increased destruction of red blood cells?
hemolytic
A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications?
metabolism of medications
A client with obesity taking lorcaserin reports feeling agitated lately and has had diarrhea for several days. What is the nurse's priority response?
notify healthcare provider
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?
purpura and petechiae
A client is scheduled for a Roux-en-Y bariatric surgery. When teaching the client about the surgical procedure, which statement will the nurse use?
"The stomach is stapled to create a very small pouch and part of the small intestine is rerouted."
A client with obesity is prescribed orlistat for weight loss. The client asks the nurse, "I understand the medication prevents digestion of fat, but what happens if I eat fat?" What is the nurse's best response?
"the fat is passed in your stools"
A nurse who provides care in a campus medical clinic is performing an assessment of a 21-year-old student who has presented for care. After assessment, the nurse determines that the client has a BMI of 45. What does this indicate?
client is extremely obese
A client with hepatitis C develops liver failure and GI hemorrhage. The blood products that most likely bring about hemostasis in the client are:
cryoprecipitate and fresh frozen plasma.
During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?
following proper hand washing techniques
A client who is postoperative bariatric surgery is diagnosed with bile reflux. Which conditions are associated with bile reflux? Select all that apply.
gastritis esophagitis
The nurse is obtaining a nursing history of a client suspected of having hepatitis C. What information should the nurse obtain from the client? Has the client:
had a tattoo?
The nurse is preparing a client for paracentesis. What should the nurse do?
have client void before procedure (to collapse the bladder)
A health care provider prescribes spironolactone, a potassium-sparing diuretic, for a client with cirrhosis. For which category of clients is the use of potassium-sparing diuretics contraindicated?
hyperkalemia
A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.
immunization use of standard precautions
The school nurse is working with a female high school junior whose BMI is 31. When planning this girl's care, the nurse should identify what goal?
increase in exercise and reduction in calories
The nurse in the ICU is caring for a 47-year-old, obese male client who is in shock following a motor vehicle accident. What would be the main challenge in meeting this client's elevated energy requirements during prolonged rehabilitation?
loss of skeletal bone
A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal?
maintaining the airway
The nurse is reviewing the chart information for a client with increased ascites. The data include the following: temperature 98.9°F (37.2°C), heart rate 118 bpm, shallow respirations 26 breaths/min, blood pressure 128/76 mm Hg, and SpO2 89% on room air. What should the nurse do first?
raise the head of the bed
A client with obesity is early in the process of preparing for a Roux-en-Y gastric bypass (RYGB). The client states, "After the surgery, the amount of food that I consume will be limited and I'll absorb fewer calories from what I do eat." When responding to the client, the nurse should:
validate what the client understands about the surgical procedure.
The nurse is presenting health education to a 48-year-old man who was just diagnosed with type 2 diabetes. The client has a BMI of 35 and leads a sedentary lifestyle. The nurse gives the client information on the risk factors for his diagnosis and begins talking with him about changing behaviors around diet and exercise. The nurse knows that further client teaching is necessary when the client tells you what?
"There is nothing that can be done anyway, because chronic diseases like diabetes cannot be prevented."
A nurse cares for a female client of childbearing age who will undergo bariatric surgery. When teaching the client about precautions after surgery, which teaching will the nurse include that is specific to this population?
"You should avoid pregnancy for at least 18 months after surgery."
A client with end-stage liver disease is scheduled to undergo a liver transplant. The client tells the nurse, "I am worried that my body will reject the liver." Which statement is the nurse's best response to the client?
"You will need to take daily medication to prevent rejection of the transplanted liver. The new liver has a good chance of survival with the use of these drugs."
A school nurse is teaching a group of high school students about risk factors for diabetes. What action has the greatest potential to reduce an individual's risk for developing diabetes?
lose weight, if obese
A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of what health problem?
obstructive sleep apnea
A nurse is caring for a client with cirrhosis secondary to heavy alcohol use. The nurse's most recent assessment reveals subtle changes in the client's cognition and behavior. What is the nurse's most appropriate response?
Report this finding to the primary provider due to the possibility of hepatic encephalopathy.
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?
The client's hepatic function is decreasing.
Which of the following diagnostic studies definitely confirms the presence of ascites?
Ultrasound of liver and abdomen
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?
Change in the client's handwriting and/or cognitive performance
Place the pathophysiological steps in order of how a client with obesity is at greater risk for venous thromboembolism in comparison to the general population.
Increased adipose tissue Impairment of peripheral blood flow Blood stasis Formation of a thrombus
The nurse is completing a health history and physical assessment on a client admitted with esophageal varices and cirrhosis. What signs and symptoms alert the nurse to a potential internal hemorrhage?
Pulse 108 bpm, temperature 97.7°F (36.5°C), distended abdomen, and nausea
In what location would the nurse palpate for the liver?
RUQ
When caring for a client with cirrhosis, which symptom(s) should the nurse report immediately?
change in mental status
A nurse is providing discharge instruction for a client who is postoperative bariatric surgery. What statement will the nurse include when providing teaching aimed at decreasing the risk of gastric ulcers?
"Avoid taking non-steroidal anti-inflammatory drugs."
A client with bleeding esophageal varices and cirrhosis of the liver due to alcoholism asks the nurse, "Will I survive and make it out of the hospital? One of my friends died from the same problem." What is the best nursing response?
"That's a difficult question to answer, and this must be very frightening for you."
A client with obesity has recently begun treatment with phentermine/topiramate-ER. The client tells the nurse, "I'm eating a lot of spinach and other leafy green vegetables, both cooked and in salads." What is the nurse's best response?
"That's great. Spinach has a lot of vitamins and nutrients and very few calories."
A client with obesity is prescribed lorcaserin for weight loss. The client reports dry mouth. What is the nurse's best response?
"This is an expected finding with this medication."
When discussing lifestyle modifications with a client who has obesity, what caloric deficit should the nurse recommend in order for the client to safely lose weight?
500-1000 calories
A nurse epidemiologist examines the overall decrease in life expectancy related to obesity. What finding is true?
6-20 year decrease in life expectancy
The nurse is providing care for a client who had a biliopancreatic diversion with duodenal switch 2 days ago. How should the nurse best address the client's risk for postoperative venous thromboembolism?
Assist the client with ambulating as early and often as possible
A client with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this client's treatment, the nurse should anticipate what intervention?
A regimen of antiviral medications
A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?
Abstain from drinking alcohol.
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.
Acetaminophen Ketoconazole Valproic acid
The postoperative nurse is attending beginning-of-shift report and learns that a client who is recovering from bariatric surgery has been experiencing bile reflux. What is the nurse's most appropriate action?
Administer proton pump inhibitors as prescribed
A client's physician has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.
Alanine aminotransferase (ALT) Gamma-glutamyl transferase (GGT) Aspartate aminotransferase (AST)
The nurse is providing care for a client who has recently been diagnosed with chronic gastritis. What health practice should the nurse address when teaching the client to limit exacerbations of the disease?
Avoid taking aspirin to treat pain or fever
The nurse cares for clients with obesity and understands that causes are multifactorial. What factors contribute to the development of obesity? Select all that apply.
Behavior Environment Physiology Genetics
A patient is brought to the emergency department by ambulance. He has hematemesis and alteration in mental status. The patient has tachycardia, cool clammy skin, and hypotension. The patient has a history of alcohol abuse. What would the nurse suspect the patient has?
Bleeding esophageal varices
A 69 year-old client has maintained a consistent diet and activity level throughout adulthood. Over the past few years, however, the client has reported a gradual increase in adipose tissue. When providing health education, the nurse should address what topic?
Changes in metabolism that accompany the aging process
The nurse is providing an educational workshop about coronary artery disease (CAD) and its risk factors. The nurse explains to participants that CAD has many risk factors, some that can be controlled and some that cannot. What risk factors should the nurse list that can be controlled or modified?
Cholesterol levels, hypertension, and smoking
When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?
Clay-colored or whitish
The nurse plans care for a client with obesity. What does the nurse recognize is the primary pathophysiological reason clients with obesity are at greater risk for developing thromboembolism?
Compromised peripheral blood flow
Which nursing assessment is most important in a client diagnosed with ascites?
Daily measurement of weight and abdominal girth
The nurse is caring for a client who has developed dumping syndrome while recovering from a gastrectomy. What recommendation should the nurse make to the client?
Eat several small meals daily spaced at equal intervals.
A client has recovered well from bariatric surgery 3 weeks ago, but during the nurse's most recent assessment, the client states, "I'm having some trouble swallowing my food, and that was never an issue before." What is the nurse's best initial action?
Encourage the client to eat slowly and chew food thoroughly
A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client's husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client's clinical manifestations?
Hepatic encephalopathy
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?
Hepatitis C increases a person's risk for liver cancer.
A nurse working in a cardiac health care office notes increased risk of certain cardiac conditions as a result of obesity. Which conditions can be associated with obesity? Select all that apply.
Hypertension Coronary artery disease Heart failure Myocardial infarction
A nurse who is conducting sessions on preventing the spread of sexually transmitted infections (STIs) discovers that there is a very high incidence of hepatitis B in the community. Which measure should the nurse take to ensure the prevention of the disease?
Instruct people to get vaccinated for hepatitis B.
A client with class II obesity has been unable to lose weight despite trying to increase activity level and limit food intake. The health care provider has prescribed orlistat. What health education should the nurse provide to the client?
It is important to maintain a nutrient-rich diet and take multivitamins.
A nurse is planning care for a client who will be arriving to the unit postoperatively from bariatric surgery. In an effort to decrease the risk of venous thromboembolism (VTE), which health care provider orders does the nurse anticipate?
Mechanical compression and prophylactic anticoagulation
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?
Loss of 2.2 lb (1 kg) in 24 hours
A client has massive bleeding from esophageal varices. In what order from first to last should the interprofessional team provide care for this client?
Maintain a patent airway. Control hemorrhaging. Replace fluids. Relieve the client's anxiety.
What pathophysiological concept is related to the increase in the hormone leptin, as it relates to satiety and hunger?
increased adipose stores
A nurse is teaching an adult female client about the risk factors for hypertension. What should the nurse explain as risk factors for primary hypertension?
Obesity and high intake of sodium and saturated fat
A nurse researcher studies the pathophysiology and etiology of obesity. What does the nurse discover is true regarding the "thrifty gene" theory of obesity?
Over time, we have become efficient in food storage and deposition of fat stores.
Which term describes the passage of a hollow instrument into a cavity to withdraw fluid?
Paracentesis
A nurse cares for an older adult client with obesity who also has glaucoma. Which obesity medication is contraindicated in this client?
Phentermine
The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler's position. What is the nurse's priority assessment of this patient?
Respiratory assessment related to increased thoracic pressure
The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? Select all that apply.
Risk for injury related to altered clotting mechanisms Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Disturbed body image related to changes in appearance, sexual dysfunction, and role function
Which of the following laboratory test results would the nurse associate with obstructive jaundice?
increased direct bilirubin
A nurse cares for a client who is post op from bariatric surgery. Once able, the nurse encourages oral intake for what primary purpose?
Stimulate GI peristalsis
The nurse is educating a patient with cirrhosis about the importance of maintaining a low-sodium diet. What food item would be permitted on a low-sodium diet?
a pear
The nurse is assisting the physician with a procedure to remove ascitic fluid from a client with cirrhosis. What procedure does the nurse ensure the client understands will be performed?
abdominal paracentesis
A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?
abstain from drinking alcohol
An important message for any nurse to communicate is that drug-induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is:
acetaminophen
causes of cirrhosis
alcohol (MC), HBV/HCV, hemochromatosis, Wilson's, AAT deficiency, 1° biliary
The nurse is caring for a client with esophageal varices. The nurse should discuss which laboratory report finding with the health care provider (HCP)?
elevated PT/INR (at higher risk for bleeding)
The nurse is preparing to assess a new client who has class III obesity. In order to provide empathic and holistic care for this client, the nurse should first:
examine his or her own preconceptions and beliefs about obesity.
The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?
hemolytic
The nurse is creating the care plan for a 70-year-old obese client who has been admitted to the postsurgical unit following a colon resection. This client's age and increased body mass index mean that she is at increased risk for what complication in the postoperative period?
infection
The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? Select all that apply.
insomnia agitation alterations in mood
The nurse is performing a health assessment of a client who has been taking antiobesity medications for several weeks. During the nurse's gastrointestinal assessment, the client reports bowel movements described as "greasy" and "oily." What medication is the client most likely taking?
orlistat
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).
Which is the most common cause of esophageal varices?
portal hypertension
Which position should be used for a client undergoing a paracentesis?
supine
During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in:
vitamin K
Which condition indicates an overdose of lactulose?
watery diarrhea
A nurse cares for clients with obesity. Which clinical measurements use quantified measurements to diagnose obesity? Select all that apply.
weight BMI waist circumference
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?
Obstructive jaundice
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?
Octreotide
A patient who had a recent myocardial infarction was brought to the emergency department with bleeding esophageal varices and is presently receiving fluid resuscitation. What first-line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?
Octreotide (Sandostatin)
The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia?
Spironolactone (Aldactone)
Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?
Spironolactone (Aldactone)
A client has been prescribed furosemide. What medication education should the nurse provide this client? (Select all that apply.)
The medication will cause you to urinate larger amounts of urine than you are accustomed to. You should try to avoid excessive intake of salt. Be aware that standing up quickly can cause you to be dizzy. Notify your health care provider if you have more than a 3-pound weight change in one day.
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?
A liver biopsy
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
An immune globulin injection
What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?
Endoscopic retrograde cholangiopancreatography (ERCP)
Which of the following terms describes the involuntary flapping movements of the hands associated with metabolic liver dysfunction?
asterixis
The nurse is administering medications to a client 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?
lactulose
A client was admitted for critical care due to esophageal varices and precarious physical condition. What could cause the client's varices to hemorrhage?
little protective tissue to protect fragile veins rough food chemical irritation (all options were correct)
Which term describes the passage of a hollow instrument into a cavity to withdraw fluid?
paracentisis
The nurse is providing medication administration teaching for a client with obesity who is prescribed liraglutide for weight loss. What will the nurse include in the teaching?
"You will be injecting the medication on a daily basis."
A client has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The client's current medication regimen includes lactulose four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?
2-3 soft bowel movements daily
A nurse is taking care of a 56-year-old man with end-stage liver disease. The nurse has a prescription to give 20 g of lactulose every 6 hours to treat the client's hepatic encephalopathy. On hand, the nurse has containers of lactulose that have 30 g in 45 ml. How many milliliters is the nurse going to administer every 6 hours to the client?
30 mL
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.
Enlarged liver size Ascites Hemorrhoids
A client with hepatitis B is visiting with a sibling when the client's I.V. catheter dislodges and bleeds onto the surface of the bedside table. Which action, if observed, would cause the nurse to intervene?
The nursing assistant uses tissue to blot up the blood.
While examining a 2-day old newborn, a nurse notices that the skin and sclera of the eyes appear yellow. The nurse recognizes this condition as:
jaundice
