PU-CH43
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? a. Respiratory assessment related to increased thoracic pressure b. Urinary output related to increased sodium retention c. Peripheral vascular assessment related to immobility d. Skin assessment related to increase in bile salts
A
What is the recommended dietary treatment for a client with chronic cholecystitis? a. low-fat diet b. high-fiber diet c. low-residue diet d. low-protein diet
A
Which of the following diagnostic studies definitely confirms the presence of ascites? a. Ultrasound of liver and abdomen b. Abdominal x-ray c. Colonoscopy d. Computed tomography of abdomen
A
Which type of deficiency results in macrocytic anemia? a. Folic acid b. Vitamin C c. Vitamin A d. Vitamin K
A
A nursing student is reviewing for an upcoming anatomy and physiology examination. Which of the following would the student correctly identify as a function of the liver? Select all that apply. a. Glucose metabolism b. Ammonia conversion c. Protein metabolism d. Carbohydrate metabolism e. Zinc storage
A, B, C
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? a. Controlling bleeding b. Maintaining the airway c. Maintaining fluid volume d. Relieving the client's anxiety
B
A client with right upper quadrant pain and weight loss is diagnosed with liver cancer. For which treatment will the nurse prepare the client when it is determined that the disease is confined to one lobe of the liver? a. Radiation b. Liver resection c. Chemotherapy d. Laser hyperthermia
B
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? a. Thoracentesis b. Abdominal paracentesis c. Abdominal CT scan d. Upper endoscopy
B
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? a. Hemolytic jaundice b. Hepatocellular jaundice c. Obstructive jaundice d. Cirrhosis of the liver
C
A client has undergone a liver biopsy. After the procedure, the nurse should place the client in which position? a. On the left side b. Trendelenburg c. On the right side d. High Fowler
C
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. Coagulation studies b. Magnetic resonance imaging c. Radioisotope liver scan d. Liver biopsy
D
When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? a. Weight loss of 2 pounds in 3 days b. Change in the client's handwriting and/or cognitive performance c. Anorexia for more than 3 days d. Constipation for more than 2 days
B
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? a. Report the condition to the physician immediately. b. Measure abdominal girth according to a set routine. c. Provide the client with nonprescription laxatives. d. ask the client about food intake
B
A client has undergone a liver biopsy. Which postprocedure position is appropriate? a. On the left side b. Trendelenburg c. On the right side d. High Fowler
C
A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? a. Cure the cirrhosis. b. Treat the esophageal varices. c. Reduce fluid accumulation and venous pressure. d. Promote optimal neurologic function.
C
Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction? a. Magnetic resonance imaging b. Angiography c. Radioisotope liver scan d. Electroencephalography
C
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? a. Creatinine b. Urobilinogen c. Chloride d. Albumin
D
The nurse is assessing a client with cirrhosis of the liver. Which stool characteristic would the nurse expect the client to report? a. Yellow-green b. Black and tarry c. Blood tinged d. Clay-colored or whitish
D
Which is the most common cause of esophageal varices? a. Jaundice b. Portal hypertension c. Ascites d. Asterixis
B
Which of the following would the nurse expect to assess in a conscious client with hepatic encephalopathy? a. Increased motor activity b. Asterixis c. Negative Babinski reflex d. Little desire to sleep
B
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? a. Hepatitis B is transmitted primarily by the oral-fecal route. b. Hepatitis A is frequently spread by sexual contact. c. Hepatitis C increases a person's risk for liver cancer. d. Infection with hepatitis G is similar to hepatitis A.
C
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? a. Dyspnea and fatigue b. Ascites and orthopnea c. Purpura and petechiae d. Gynecomastia and testicular atrophy
C
After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. A healthcare provider orders a liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain, and seems increasingly confused. What should the nurse suspect? a. Peritonitis from bleeding in the liver caused by the liver biopsy b. Perforation of the colon caused by the liver biopsy c. An allergic reaction to the contrast media used during the liver biopsy d. Normal postprocedural pain, with a change in the level of consciousness resulting from the pre-existing fever
A
A critically ill client is diagnosed with acute liver failure caused by an overdose of acetaminophen. Which treatment will the nurse anticipate being prescribed for the client? a. Penicillin b. Prostaglandins c. N-acetylcysteine d. Plasma exchange
C
The nurse is caring for a client suspected of having stones that have collected in the common bile duct. What test should the nurse prepare the client for that will locate these stones? a. Colonoscopy b. Abdominal x-ray c. Cholecystectomy d. Endoscopic retrograde cholangiopancreatography (ERCP)
D
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? a. Hepatic encephalopathy b. Esophageal varices c. Hepatitis C d. Portal hypertension
A
A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? a. Hepatic encephalopathy b. Portal hypertension c. Asterixis d. Cirrhosis
A
A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client? a. Octreotide b. Spironolactone c. Propranolol d. Lactulose
A
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. A liver biopsy b. A CT scan c. A prothrombin time d. Platelet count
A
A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? a. Vitamin A b. Thiamine c. Riboflavin d. Vitamin K
A
A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider? a. tachycardia and tachypnea b. tachycardia and bradypnea c. bradycardia and bradypnea d. bradycardia and tachypnea
A
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? a. The client's hepatic function is decreasing. b. The client didn't take his morning dose of lactulose (Cephulac). c. The client is relaxed and not in pain. d. The client is avoiding the nurse.
A
A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding? a. Document the presence of normal bile output. b. Irrigate the drainage system with normal saline as prescribed. c. Aspirate a sample of the drainage for culture. d. Promptly report this assessment finding to the primary provider.
A
A nurse is teaching a client about the types of chronic liver disease. The teaching is determined to be effective when the client correctly identifies which type of cirrhosis as being caused by scar tissue surrounding portal areas? a. Alcoholic cirrhosis b. Postnecrotic cirrhosis c. Biliary cirrhosis d. Compensated cirrhosis
A
A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for? a. Transjugular intrahepatic portosystemic shunting (TIPS) b. Vasopressin (Pitressin) c. Sclerotherapy d. Balloon tamponade
A
Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should generally be limited to the equivalent of: a. 1 drink b. 2 drinks c. 3 drinks d. 4 drinks
A
A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus (HAV). They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? Select all that apply. a. Infection at school b. Suboptimal sanitary habits c. Consumption of sewage-contaminated water or shellfish d. Sexual activity e. Ingestion of undercooked beef
A, B, C, D
A client is seeing the physician for a suspected tumor of the liver. What laboratory study results would indicate that the client may have a primary malignant liver tumor? a. Elevated white blood cell count b. Elevated alpha-fetoprotein c. Decreased AST levels d. Decreased alkaline phosphatase levels
B
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: a. elevated liver enzymes and low serum protein level. b. subnormal serum glucose and elevated serum ammonia levels. c. subnormal clotting factors and platelet count. d. elevated blood urea nitrogen and creatinine levels and hyperglycemia.
B
A client with liver cirrhosis develops ascites. Which medication will the nurse prepare teaching for this client? a. Furosemide b. Acetazolamide c. Spironolactone d. Ammonium chloride
C
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? a. Constructional apraxia b. Fetor hepaticus c. Ataxia d. Asterixis
D
When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function? a. Jaundice b. Pruritus of the arms and legs c. Fatigue during ambulation d. Irritability and drowsiness
D
Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: a. The digestion of dietary and blood proteins. b. Excessive diuresis and dehydration. c. Severe infections and high fevers. d. Excess potassium loss subsequent to prolonged use of diuretics.
A
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: a. Acetaminophen b. Ibuprofen c. Dextromethorphan d. Benadryl
A
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? a. Polyuria b. Bradycardia c. Hypotension d. Warm moist skin
C
Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? a. Night blindness b. Hypoprothrombinemia c. Scurvy d. Beriberi
C
A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? a. Potassium b. Vitamin K c. Vitamin B d. Oral bile acids
B
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? a. Spironolactone b. Cholestyramine c. Lactulose d. Kanamycin
C
The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? a. Hemolytic b. Hepatocellular c. Obstructive d. Nonobstructive
A
Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? a. Spironolactone b. Vasopressin c. Nitroglycerin d. Cimetidine
B
A 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
The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? a. Watery diarrhea b. Vomiting c. Ringing in the ears d. Asterixis
A
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? a. Serum potassium level of 3.5 mEq/L b. Loss of 2.2 lb (1 kg) in 24 hours c. Serum sodium level of 135 mEq/L d. Blood pH of 7.25
B
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? a. "You must have the second one in 2 weeks and the third in 1 month." b. "You must have the second one in 1 month and the third in 6 months." c. "You must have the second one in 6 months and the third in 1 year." d. "You must have the second one in 1 year and the third the following year."
B
Which is an age-related change of the hepatobiliary system? a. Increased drug clearance capability b. Decreased blood flow c. Enlarged liver d. Decreased prevalence of gallstones
B
A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? a. Straw-colored urine b. Reduced hematocrit c. Clay-colored stools d. Elevated urobilinogen in the urine
C
A previously healthy adult's sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the client has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this client is what? a. IV administration of immune globulins b. Transfusion of packed red blood cells and fresh-frozen plasma (FFP) c. Liver transplantation d. Lobectomy
C
A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce? Select all that apply. a. fluid accumulation b. venous pressure c. blood coagulation d. fluid output
A, B
Which of the following the are early manifestations of liver cancer? Select all that apply. a. Pain b. Continuous aching in the back c. Increased appetite d. Fever e. Jaundice f. Vomiting
A, B
While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the liklihood of liver problems? Select all that apply. a. Jaundice b. Petechiae c. Ecchymoses d. Cyanosis of the lips e. Aphthous stomatitis
A, B, C
After undergoing a liver biopsy, a client should be placed in which position? a. Semi-Fowler's position b. Right lateral decubitus position c. Supine position d. Prone position
B
Which type of jaundice is the result of increased destruction of red blood cells? a. Hemolytic b. Hepatocellular c. Obstructive d. Nonobstructive
A
Which type of jaundice seen in adults is the result of increased destruction of red blood cells? a. Hemolytic b. Hepatocellular c. Obstructive d. Nonobstructive
A
When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following? a. Gynecomastia b. Cutaneous spider angioma c. Caput medusae d. Palmar erythema
C
