Med Surg Week 8 Part 2

The RN has just received the change-of-shift report for the medical unit. Which patient should the RN see first?

Patient with portal-systemic encephalopathy (PSE) who has become increasingly difficult to arouse

The nurse is discussing with a nursing student the care of a patient with cirrhosis. Which statement by the student indicates a correct understanding of how to observe for esophageal bleeding in the patient?

"Any melena should be reported immediately."

The nurse is teaching a spouse and patient with hepatitis C about preventing the spread of infection. Which instruction does the nurse include in the teaching plan?

"Do not share toothbrushes."

A patient diagnosed with hepatitis A asks the nurse how this disease may have been contracted. Which answer by the nurse is correct?

"You may have consumed foods contaminated with the virus."

A liver is retrieved from a donor for liver transplantation for a patient with liver cancer. What would be the maximum duration within which the liver has to be transplanted to the cancer patient?

5

A patient admitted for treatment of liver disease has a decreased serum total protein. Based on this finding, how may the nurse classify this patient's disease?

Chronic

The nurse is caring for a patient with cirrhosis. What factors may lead to hepatic encephalopathy in the patient? Select all that apply.

Constipation Decreased fluid volume Gastrointestinal bleeding

A patient who has undergone liver transplantation due to primary liver cancer reports clay-colored stools and vomiting. What post-surgical complication does the nurse anticipate?

Hepatic complication

A patient who is being treated for hepatic encephalopathy reports intestinal bloating and cramping. On assessment, the nurse finds that the patient is experiencing alcohol withdrawal. The nurse reviews the patient's medication profile and identifies that which medication will likely be discontinued?

Lactulose

What would be the complication of biliary anastomosis breakdown in post liver transplantation?

Peritonitis

Which individual has the greatest risk for developing hepatitis A?

Person who consumes raw oysters

The nurse is educating a patient with liver cancer about liver transplantation. What statement made by the patient indicates a need for further teaching?

"Donor liver implantation precedes surgical removal of diseased liver."

Which diet instruction does the nurse give to a patient with active hepatitis?

"Eat small meals at frequent intervals."

Which patient statement causes the nurse to suspect that the patient has stage I hepatic encephalopathy?

"I am unable to sleep during the night."

Which statement by a patient with cirrhosis indicates that further instruction is needed about the disease?

"My liver is scarred, but the cells can regenerate themselves and repair the damage."

The nurse is educating a patient who recently underwent liver transplantation for primary liver cancer about possible complications. What should the nurse instruct the patient to do if he or she develops a fever of 101.0° F?

"Notify the primary healthcare provider."

The registered nurse is teaching a student nurse about liver cancer. What statement made by the student nurse needs correcting?

"Patients with liver cancer will have a decrease in serum alpha fetoprotein."

The registered nurse is teaching a student nurse about liver transplantation as a treatment option for patients with primary liver cancer. Which statement made by the student nurse indicates the need for further teaching?

"The diseased liver is removed through an incision made in the lower abdomen."

The registered nurse is teaching a student nurse about the complications of liver transplantation for patients with liver cancer. Which statement made by the student nurse requires further teaching?

"The use of immunosuppressants should be discontinued if there is an infection."

A patient with long-standing alcoholic liver disease has a decrease in serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) from previously assessed levels. What does the nurse tell the patient about these results?

"These decreases may indicate liver deterioration."

The nurse is counseling an asymptomatic patient who is worried about possible hepatitis C exposure several years ago. What does the nurse tell this patient about the risk of this disease?

"You may have serious long-term damage even without symptoms."

Arrange the steps for chemoembolization of a tumor for liver cancer in the correct order.

1.Sedating the patient moderately 2.Threading a catheter through the femoral artery 3.Injecting small beads into the hepatic 4.Infusing a chemotherapeutic agent into the hepatic artery

The nurse is instructing a patient with liver cancer about how to drain excess ascitic fluid using the PleurX drainage system. The nurse will know the teaching is successful if the patient identifies which number as the maximum amount to be drained in a session?

2000 mL

What teaching does the home health nurse give the family of a patient with hepatitis C to prevent the spread of the infection?

Members of the household must not share toothbrushes.

The nurse asks a patient with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record?

Asterixis

A patient who has liver disease with ascites refuses the evening dinner tray and reports moderate abdominal pain. The nurse notifies the provider after assessing a low-grade fever and abdominal rigidity. The provider prepares to perform a paracentesis and orders an antibiotic to be given. When does the nurse administer the antibiotic?

After a sample of fluid is sent to the lab for culture

The nurse is providing care to a patient recently diagnosed with cirrhosis of the liver. To prevent further fibrosis of the liver and allow the liver to heal and regenerate, which substances should the nurse tell the patient to avoid? Select all that apply.

Alcohol Cigarettes Illicit drugs Acetaminophen

The serum level of what enzyme is elevated in patients with obstructive jaundice?

Alkaline phosphatase

Which laboratory parameter will be elevated in a patient diagnosed with primary liver cancer?

Alpha-fetoprotein (AFP)

The nurse knows that which patient concern is most common with liver cancer?

Alterations in abdominal comfort

A patient with Laennec's cirrhosis has an increased abdominal girth of 12 cm over the measured abdominal girth from a previous admission. Which condition does the nurse suspect in this patient?

Ascites

When caring for a patient with portal hypertension, the nurse assesses for which potential complications? Select all that apply.

Ascites Hemorrhoids Esophageal varices

A patient who has liver disease with ascites asks about any necessary dietary changes. What instruction does the nurse include when teaching this patient?

Avoid using table salt.

A nurse is assessing a patient who underwent a liver transplantation for the treatment of liver cancer. What finding would be associated with the rejection of the transplanted liver?

Clay-colored stools and increased serum bilirubin

The nurse is teaching a patient with hepatitis about proper diet. Which meal selection demonstrates that the patient has a correct understanding of the teaching?

Baked chicken breast with spinach and lemon

The nurse is reviewing the diagnostic test results for a patient with hepatitis. Which elevated test result does the nurse correlate to the presence of jaundice?

Bilirubin

A patient underwent a liver biopsy for suspected liver cancer. The nurse knows to be vigilant for which complication of this procedure?

Bleeding

What complications should the nurse review with the patient prior to undergoing an ultrasound-guided liver biopsy to confirm a diagnosis of liver cancer? Select all that apply.

Bleeding Infection Spread of tumor cells

A patient is scheduled to undergo placement of a transjugular intrahepatic portal-systemic shunt (TIPS). The nurse explains that this is placed to prevent which complication?

Bleeding esophageal varices

What is a risk factor for liver cancer?

Cirrhosis

A patient who was awaiting liver transplantation is excluded from the procedure after the presence of which condition is discovered?

Colon cancer with metastasis to the liver

What is the most accurate test to confirm the diagnosis of liver cancer?

Computed tomography (CT) guided liver biopsy

When providing dietary teaching to a patient with hepatitis, what practice does the nurse recommend?

Consuming increased carbohydrates and moderate protein

What treatment utilizes liquid nitrogen to destroy liver tumors?

Cryotherapy

After a liver transplant for the treatment of liver cancer, the nurse observes decreased urine output and increased serum creatinine. What drug may be the cause of this condition?

Cyclosporin

Following liver transplantation, which medication will the nurse administer to reduce the risk of organ rejection?

Cyclosporin

The nurse is administering medications to a patient with liver cancer who just underwent a liver transplant. The nurse will closely monitor the patient's blood pressure after which medication?

Cyclosporin

The nurse is assessing a patient who underwent a liver transplantation for the treatment of liver cancer. Which finding indicates normal liver function?

Dark green drainage in the T-tube

In caring for a patient who has undergone paracentesis, which changes in the patient's status should be promptly reported to the provider?

Decreased blood pressure, increased heart rate

Which is an important institutional measure that a hospital should take to prevent the transmission of hepatitis B (HBV) to health care workers?

Develop a hospital-wide needleless system for delivery of medications.

What laboratory finding signifies an immune response to liver disease?

Elevated serum globulin

Which activity by the nurse will best relieve symptoms associated with ascites?

Elevating the head of the bed

Which is a risk factor for the development of hepatitis C?

Employment in the health care field

A nurse is reviewing the medical records of patients diagnosed with liver disease. Which patient condition can be resolved with liver transplantation? Select all that apply.

End-stage liver disease Autoimmune liver disease

The nurse is completing an abdominal assessment of a patient who has suspected liver cancer. What should the nurse expect to feel when palpating the right upper quadrant of the abdomen?

Enlarged and nodular liver

A nurse is educating the spouse of a patient with cirrhosis about the patient's diet. Which nutritional recommendation for the patient will the nurse make?

Include a multivitamin

Which findings would the nurse see in a patient with primary liver cancer who is awaiting liver transplantation? Select all that apply.

Hepatic encephalopathy Total bilirubin of 5.5 mg/dL Increased alpha-fetoprotein

Which factors may lead to the development of hepatic encephalopathy in a patient with cirrhosis? Select all that apply.

Hypokalemia High-protein diet Gastrointestinal bleeding

What are the causes of acute renal failure in a patient after undergoing a liver transplant secondary to liver cancer? Select all that apply.

Hypotension Acute liver failure Use of cyclosporin

Which assessment finding is consistent with a diagnosis of viral hepatitis?

Icteric skin

When caring for a patient with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply.

Icterus of skin Swollen abdomen Prolonged partial thromboplastin time (PTT)

The nurse is caring for a patient with cirrhosis and profound ascites. Which assessment finding causes the nurse to notify the provider?

Inaudible breath sounds

A patient is suspected of having liver cancer and the nurse is reviewing the laboratory results. Which laboratory result, if present in the patient's chart, would the nurse recognize as a confirmation of this diagnosis?

Increased alpha-fetoprotein

A patient who underwent a liver transplant for the treatment of liver cancer is prescribed cyclosporin. The patient reports a sore throat and fever. The nurse suspects which complication?

Infection

The laboratory results for a patient who underwent a liver transplant due to liver cancer are shown in the following chart. What is a possible finding from the set of data?

Infection

What condition may occur if a patient who underwent liver transplantation for the treatment of liver cancer is prescribed cyclosporin A?

Infection

A patient with viral hepatitis has clay-colored stools and dark urine. These findings are typically characteristic of which complication of hepatitis?

Intrahepatic obstruction

When assessing a patient with hepatitis B, the nurse anticipates which assessment findings? Select all that apply.

Itching Tea-colored urine Right upper quadrant tenderness

Which symptoms would the nurse observe in a patient suspected of liver cancer? Select all that apply.

Jaundice Abdominal distension Nodular liver on palpation

The nurse is developing a care plan for a patient who underwent a liver transplantation secondary to primary liver cancer. What findings, if present in the patient, would indicate to the nurse that the patient is experiencing transplant rejection? Select all that apply.

Jaundice Low-grade fever Decreased bile drainage

When caring for a patient with hepatic encephalopathy, which patient condition would cause the nurse to question the use of neomycin?

Kidney failure

The nurse is caring for a patient who has primary liver cancer. The patient is asking the nurse about treatments. What treatment offers the best chance at long-term survival?

Liver transplant

Which type of intervention gives a patient who is diagnosed with liver cancer a chance for long-term survival?

Liver transplantation

Which nursing intervention will help prevent bile leakage and abscess formation following liver transplantation?

Maintaining the T-tube in a dependent position

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B?

Men who prefer sex with men

When providing discharge teaching to a patient with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

An unconscious patient brought to the emergency department has a history of Laennec's cirrhosis and esophageal varices. What is the priority assessment for this patient?

Noting the presence of bloody emesis or stool

A patient who was previously treated for hepatitis B virus (HBV) is tested for the presence of the hepatitis B surface antigen (HBsAg) in the blood. The test is positive. What does this result indicate?

Patient is infectious

The community health nurse is exploring the cause of an outbreak of hepatitis A. Which individual does the nurse suspect may be the source?

Patients who were infected after eating at the same restaurant

When assessing a patient for possible liver dysfunction, the nurse notices round, pinpoint, red-purple lesions on the patient's skin. What term should the nurse use to document such lesions?

Petechiae

A patient has undergone liver transplantation for the treatment of liver cancer. Which findings may indicate impaired function of the transplanted liver? Select all that apply.

Petechiae Ecchymosis Encephalopathy

The nurse is caring for a patient with suspected liver cancer. Which diagnostic test would confirm the diagnosis?

Ultrasound-guided liver biopsy

What type of cirrhosis is caused by hepatitis C?

Postnecrotic

The nurse is administering spironolactone to a patient with portal hypertension and portal systemic encephalopathy. Which additional medication order does the nurse question?

Potassium chloride

Which problem for a patient with cirrhosis takes priority?

Potential for injury related to hemorrhage

A patient with liver cancer who underwent liver transplantation reports reduced urine output. Other laboratory parameters are given below. What nursing interventions should be taken? Select all that apply.

Prevent hypotension. Monitor the drugs and its dosage regimens.

The nurse administers lactulose to a patient with cirrhosis for which purpose?

Promotes gastrointestinal excretion of ammonia

A computed tomography (CT) scan of a patient shows a small tumor that is confined to one liver lobe. However, the patient is not a candidate for surgery. Which treatment does the nurse anticipate to be given by the primary health care provider?

Radiofrequency ablation

A health care worker believes that he or she may have been exposed to hepatitis A. Which intervention is the highest priority to prevent the health care worker from developing the disease?

Requesting an injection of immunoglobulin

How does the home care nurse best modify the patient's home environment to manage side effects of lactulose?

Requests a bedside commode for the patient

What is a feature of hepatic abscess?

Right upper abdominal pain is a common manifestation.

A patient is suspected of having liver cancer. What region of the abdomen would have pain on palpation?

Right upper quadrant region

A patient is diagnosed with liver cancer, and the tumor is found to be unresectable. Which targeted therapy would be prescribed by the primary health care provider?

Sorafenib

Which drug is used to treat liver cancer and acts by kinase inhibition?

Sorafenib

A patient is diagnosed with metastatic liver cancer. Which treatment regimen would the primary health care provider prescribe?

Symptomatic treatment

The nurse is caring for a patient who has liver trauma as a result of a motor vehicle crash. What sign/symptom, if present in the patient, would prompt the nurse to suspect internal hemorrhage and hypovolemic shock?

Tachypnea

Which vitamin may be especially important for a patient who is alcoholic with liver disease?

Thiamine

The primary health care provider prescribes cyclosporin A to a patient who underwent a liver transplant for the treatment of primary liver cancer. What is the rationale behind this intervention?

To prevent acute graft rejection

A patient with hepatic encephalopathy may require which dietary or pharmacologic therapy to help decrease serum ammonia levels?

Trial of lactulose to increase the excretion of ammonia

A patient with cirrhosis is preparing for discharge home. What instruction does the nurse include when teaching this patient about dietary supplements?

Use only supplements prescribed by the provider.