Deck 25: Liver Disease and Gallstones

Question 1

Treatment of fatty liver includes

A)eliminating the cause.
B)a liver transplant.
C)weight loss if overweight.
D)a and c
E)a, b, and c

Answer 1

D

Question 2

What diet recommendation is most appropriate for a normal-weight hepatitis patient who is experiencing steatorrhea?

A)Regular diet
B)Low-fat diet
C)High-kcalorie, high-protein diet
D)Low-sodium diet

Answer 2

B

Question 3

The roles of the liver include which of the following?

A)Production of bile
B)Detoxification of drugs and alcohol
C)Excretion of metabolic wastes
D)a and b
E)All of the above

Answer 3

D

Question 4

All of the following are symptoms of hepatitis except

A)jaundice.
B)anorexia.
C)kidney failure.
D)nausea.

Question 5

Which of the following does not cause cirrhosis?

A)cystic fibrosis
B)galactosemia
C)alcohol abuse
D)hepatitis A infection

Question 6

One of the two most common causes of cirrhosis in the U.S.is

A)bile duct blockage.
B)heart disease.
C)environment toxins.
D)hepatitis C infection.

Question 7

In liver disease, serum alanine aminotransferase levels _____ and serum aspartate aminotransferase levels _____.

A)increase, decrease
B)decrease, increase
C)increase, increase
D)decrease, decrease

Question 8

A client with hepatitis who has persistent vomiting should be started on

A)a bland diet.
B)enteral nutrition.
C)IV fluids.
D)a low-protein diet.

Question 9

A client with a fatty liver is at risk for developing:

A)heart disease.
B)diabetes.
C)kwashiorkor.
D)cirrhosis.

Question 10

A diet plan for a malnourished person with hepatitis would be

A)a low-kcalorie, low-protein diet.
B)a high-kcalorie, low-protein diet.
C)a high-kcalorie, high-protein diet.
D)not required.

Question 11

Causes of fatty liver include which of the following?

A)Obesity
B)Exposure to drugs and toxic metals
C)Kwashiorkor or marasmus
D)a and b
E)a, b, and c

Question 12

About _____ of people with cirrhosis are asymptomatic.

A)25%
B)30%
C)40%
D)45%

Question 13

Which of the following herbal remedies is reported to cause hepatitis?

A)Chaparral
B)Germander
C)Ma haung
D)a and c
E)All of the above

Question 14

Treatment for fatty liver includes all of the following except:

A)rapid weight loss.
B)blood glucose control.
C)reduction in blood lipids.
D)avoidance of alcohol.

Question 15

Chronic cases of HBV or HCV can lead to

A)cirrhosis.
B)liver cancer.
C)HAV.
D)a and b
E)b and c

Question 16

All of the following are consequences of metabolic disorders that can cause cirrhosis except

A)excessive accumulation of iron.
B)excessive accumulation of copper.
C)excessive accumulation of zinc.
D)excessive accumulation of fat.

Question 17

The characteristic yellowing of the skin and whites of the eyes associated with jaundice is caused by the accumulation of _____ in the blood.

A)bilirubin
B)bile
C)triglycerides
D)alkaline phosphatase

Question 18

What circumstance results in fat accumulation in the liver?

A)Exportation of VLDL is balanced with collection of lipids from the blood
B)Exportation of VLDL exceeds collection of lipids from the blood
C)Fat synthesis is balanced with exportation of VLDL
D)Fat synthesis exceeds exportation of VLDL

Question 19

Which of the following is responsible for returning blood to the heart from the liver?

A)Hepatic artery
B)Hepatic vein
C)GI tract vein
D)Portal vein

Question 20

The liver synthesizes which of the following?

A)Albumin
B)Bile
C)Clotting proteins
D)All of the above

Question 21

Which of these statements by an adult male with alcoholic cirrhosis of the liver indicates the greatest need for further education?

A)"I will not eat an 8-oz.steak every night."
B)"I will eat hard candy and drink soft drinks for extra calories."
C)"I will limit my drinking to a glass of wine a few times per week."
D)"I will limit my sodium intake if I develop ascites."

Question 22

When blood flow through the portal vein is obstructed, blood travels through smaller vessels around the liver called

A)ascites.
B)collaterals.
C)bypass.
D)varices.

Question 23

As liver disease develops, albumin levels _____ and ammonia levels _____.

A)increase, increase
B)increase, decrease
C)decrease, decrease
D)decrease, increase

Question 24

In a cirrhotic liver, portal hypertension is the result of

A)increased pressure in the hepatic artery.
B)increased pressure in the portal vein.
C)normal pressure.
D)blood flow through the liver.

Question 25

_____ is the abnormal accumulation of fluid in the abdominal cavity.

A)Edema
B)Ascites
C)Cirrhosis
D)Sludge

Question 26

Which statement is true?

A)Patients with hepatic encephalopathy should avoid excessive protein consumption.
B)Insulin resistance is uncommon in cirrhosis patients.
C)MCT oil can be helpful for cirrhosis patients with steatorrhea because it provides essential fatty acids.
D)Liquid dietary supplements should not be administered orally to cirrhosis patients.

Question 27

Branched-chain amino acids may be supplemented in the diets of clients with hepatic encephalopathy because they

A)increase the synthesis of albumin.
B)reduce bilirubin levels.
C)may contribute to mental status improvement.
D)prevent a false positive on a hemacult test for blood in the stool.

Question 28

Typical drug therapy used to treat cirrhosis includes

A)antibiotics to alter bacterial populations.
B)lactulose to reduce ammonia production and absorption.
C)diuretics to control portal hypertension.
D)a and c
E)all of the above

Question 29

Hepatic encephalopathy in the early stages is characterized by

A)jerking movements.
B)irritability.
C)disorientation.
D)all of the above

Question 30

Normal values for serum albumin are

A)1.5 to 2.5 g/dL.
B)3.4 to 4.8 g/dL.
C)5.0 to 6.2 g/dL.
D)none of the above

Question 31

A physical sign of altered liver function is

A)ascites.
B)hair loss.
C)jaundice.
D)a and c
E)b and c

Question 32

When signs and symptoms of hepatic encephalopathy appear, the nurse should anticipate

A)a moderate-protein diet, spread throughout the day.
B)a high-protein diet.
C)the use of agents to slow peristalsis.
D)a reduction of dietary branched-chain amino acids.

Question 33

Normal blood ammonia levels are

A)less than 45 μg N/dL.
B)greater than 45 μg N/dL.
C)less than 60 μg N/dL.
D)greater than 60 μg N/dL.

Question 34

For a client with ascites, the nurse should expect a reduction of dietary

A)sodium.
B)potassium.
C)calcium.
D)magnesium.

Question 35

Energy needs for a person with liver disease:

A)are increased.
B)are decreased
C)remain the same.
D)none of the above

Question 36

Which of the following is a reason for the malnutrition and wasting commonly seen in patients with cirrhosis?

A)Increased bile flow causes fat malabsorption
B)Sodium restrictions cause GI symptoms
C)Ascites causes early satiety
D)a and c
E)a, b and c

Question 37

Which statement is false?

A)In hepatic encephalopathy, insufficient levels of sulfur compounds and short-chain fatty acids in brain cells are thought to disturb brain function.
B)The symptoms of hepatic encephalopathy can be reversed.
C)Hepatic encephalopathy can lead to amnesia, seizures, and hepatic coma.
D)One theory of the etiology of encephalopathy is that brain neurotransmitters are altered by increased ratios of aromatic to branched-chain amino acids in brain tissue.

Question 38

Which nutritional intervention should be encouraged for a client with cirrhosis and steatorrhea?

A)Increasing the intake of polyunsaturated fat
B)Reducing kcalorie intake by 20%
C)Limiting vitamin B intake
D)Limiting fat intake and using MCT oil

Question 39

Ascites is worsened by

A)reduced albumin synthesis.
B)increased pressure in the portal vein.
C)water retention due to altered kidney function.
D)all of the above

Question 40

Which of the following findings would be unexpected in a client with cirrhosis?

A)Portal hypertension
B)Esophageal varices
C)Hypoammonemia
D)Ascites

Question 41

Jean has had her annual physical.Her doctor discovers that she has asymptomatic gallstones.The doctor recommends:

A)no treatment.
B)cholecystectomy.
C)ursodiol treatment.
D)shock-wave lithotropsy.

Question 42

James has had a liver transplant.The registered dietitian is completing his nutritional assessment.Which diet will be recommended?

A)2 grams Na
B)2 grams Na, high protein
C)High kcalorie, high protein
D)Regular diet

Question 43

The daily sodium recommendation for a person with ascites equals

A)1 gram.
B)2 grams.
C)3 grams.
D)no sodium restrictions

Question 44

Which of the following nutrients is not one of the nutrient deficiencies that most frequently upsets red blood cell production?

A)Iron
B)Vitamin E
C)Folate
D)Vitamin B₁₂

Question 45

Vitamin _____ status may be affected by steatorrhea related to liver damage.

A)C
B)A
C)B₁₂
D)B₆
E)all of the above

Question 46

The dietitian evaluates a patient whose status is post liver transplant.Her education plan should include:

A)food safety.
B)alcohol abstinence.
C)portion control.
D)hepatitis information.

Question 47

Which of the following individuals is the least likely to develop gallstones?

A)A woman with diabetes
B)A woman taking birth control pills
C)A 35-year-old man who is physically active
D)A 60-year-old man with poor appetite

Question 48

Where does the synthesis of erythropoietin occur?

A)Kidneys
B)Pancreas
C)Liver
D)a and b

Question 49

Specialized tube feeding formulas for patients with cirrhosis often have which of the following properties?

A)High in kcalories
B)Low in sodium
C)High in protein
D)a and b
E)all of the above
Questions for Section 25.3 Liver Transplantation

Question 50

Which of the following is the most appropriate snack for a patient with ascites?

A)Canned tomato soup
B)Hard candy
C)Potato chips
D)Ham sandwich

Question 51

The majority of gallstones are composed primarily of _____.

A)cholesterol
B)bile pigment
C)chloride salts
D)uric acid

Question 52

Which of the following conditions is associated with pigment stone formation?

A)Biliary tract infections
B)Peritonitis
C)Long-term parenteral nutrition
D)All of the above

Question 53

Clients with poor nutrition status and gastrointestinal bleeding should be provided with

A)duodenal tube feedings.
B)a soft diet.
C)parenteral nutrition.
D)gastrostomy feedings.

Question 54

Which of the following statements is false?

A)Anemia may result when red blood cells aren't produced in sufficient amounts.
B)The major stimulus for the production of red blood cells is a low oxygen content of the blood.
C)When red blood cells are lost due to bleeding, anemia may result.
D)Only a small percentage of hospital patients exhibit anemia.

Question 55

Nisha has had her gallbladder removed.Which of the following complications may arise?

A)Diarrhea
B)Abdominal pain
C)Vomiting
D)a and b
E)b and c
Questions for Section 25.5 Anemia in Illness

Question 56

Where is iron primarily absorbed?

A)Duodenum
B)Upper jejunum
C)Upper ileum
D)a and b
E)a and c

Question 57

John has severe ascites due to advanced cirrhosis.He is scheduled to undergo a procedure that will use a surgical puncture to draw excess fluid out of his abdomen.What is this procedure called?

A)Shock-wave lithotripsy
B)Paracentesis
C)Peritoneovenous shunt
D)Parenteral support

Question 58

Where does erythropoiesis take place?

A)In the stomach
B)In the small intestines
C)In the bone marrow
D)In the large intestine

Question 59

The complications that can develop due to gallstones do not include

A)bacterial cholangitis.
B)cholecystitis.
C)pancreatitis.
D)renal colic.

Question 60

Elizabeth had a liver transplant two weeks ago.She is on immunosuppressive therapy.What side effect of these medications might interfere with her nutrition status?

A)Steatorrhea
B)Hypoglycemia
C)Gastroesophageal reflux
D)Abdominal pain
E)All of the above

Question 61

Which type of anemia is the most common type affecting hospitalized patients with long-term illnesses?

A)Aplastic anemia
B)Anemia of chronic disease
C)Macrocytic anemia
D)Hemolytic anemia

Question 62

Case Studies
Karen Bauman is a 27 year old employed in the cosmetic and fashion industry.Lately, she has reported feeling fatigued.But, she feels her long hours and hectic schedule are the main contributors.Her past medical history includes type 1 diabetes.She returns to her doctor due to abnormal lab results from her last physical.
Karen is surprised to be diagnosed with fatty liver disease.Which laboratory value would you expect to be elevated?

A)Potassium
B)Triglycerides
C)Albumin
D)Essential fatty acids

Question 63

An appropriate treatment for Veronica's gallbladder disease would be:

A)hormone replacement.
B)a low-fat/ -cholesterol diet.
C)surgery.
D)all of the above
E)none of the above

Question 64

To improve her health status, Karen will need to:

A)adjust her diet and exercise regimen.
B)adjust her medications.
C)change her job.
D)a and b
E)b and c
Veronica Riley-O'Brien is a 30-year-old mother of two young boys (Tyler, 4 years old, and Ethan, 6 weeks old).Veronica is 5 feet, 4 inches tall and weighs 186 pounds.She is having difficulty sleeping due to pain in her abdomen and back.She calls her doctor this morning as the pain has intensified.

Question 65

_____ is a complication of gallstones that can lead to infection.

A)Cirrhosis
B)Ascites
C)Edema
D)Cholecystitis

Question 66

Veronica is diagnosed with gallstones.All of the following are symptoms she may suffer from except:

A)nausea.
B)bloating.
C)headache.
D)vomiting.

Question 67

The combination of low serum iron, low total iron binding capacity, and normal or elevated serum ferritin levels suggests which of the following anemias?

A)Aplastic anemia
B)Macrocytic anemia
C)Anemia of chronic disease
D)Iron-deficiency anemia

Question 68

Veronica's gallstone risk was high during her recent pregnancy due to hormonal changes that affect the secretion of _____.

A)cholesterol into bile
B)cholesterol into estrogen
C)cholesterol into progesterone
D)cholesterol into bilirubin

Question 69

Which of the following risk factors puts Veronica at risk for gallstones?

A)Ethnicity
B)Weight
C)Gender
D)a and b
E)b and c

Question 70

Which of the following statements is true?

A)Rapid weight loss is encouraged as a treatment for fatty liver disease.
B)Elevated liver enzymes are a good indicator for liver disease.
C)Metabolic syndrome is not a risk factor for liver disease.
D)Hepatomegaly includes liver inflammation.