Deck 61: Care of Patients With Liver Problems

Question 1

A client is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube.Which nursing intervention is the priority?

A) Keep the client sedated to prevent tube dislodgement.
B) Maintain balloon pressure at between 15 and 20 mm Hg.
C) Irrigate the gastric lumen with normal saline.
D) Maintain the client's airway.

Answer 1

Maintain the client's airway.

Question 2

Which laboratory findings does the nurse recognize as potentially causing complications of liver disease?

A) Elevated aspartate transaminase (AST) and lactate dehydrogenase (LDH) levels
B) Elevated prothrombin time and international normalized ratio (INR)
C) Decreased serum albumin and serum globulin levels
D) Decreased serum alkaline phosphatase and alanine aminotransferase (ALT) levels

Answer 2

Elevated prothrombin time and international normalized ratio (INR)

Question 3

A client has cirrhosis.Which nursing intervention would be most effective in controlling ascites?

A) Monitoring intake and output
B) Providing a low-sodium diet
C) Increasing oral fluid intake
D) Weighing the client daily

Answer 3

Providing a low-sodium diet

Question 4

The nurse is assessing a client for asterixis.Which instruction to the client is most appropriate?

A) "Close your eyes and take turns touching your nose with your fingers."
B) "Sit on the edge of the bed and hold your legs straight out for 30 seconds."
C) "Extend your arm, flex your wrist upward, and extend your fingers."
D) "Say 'EEEEE' while I listen to your lungs in the back on both sides."

Question 5

A client is admitted with cirrhosis and hepatopulmonary syndrome.Which clinical manifestation does the nurse monitor for progression or resolution of this problem?

A) Right upper quadrant pain
B) Crackles on auscultation
C) Skin and scleral jaundice
D) Nausea and vomiting

Question 6

The nurse correlates which data in the client's history as a predisposing factor for Laënnec's cirrhosis?

A) Gallstones
B) Alcohol abuse
C) Viral hepatitis
D) Heart disease

Question 7

The client with end-stage cirrhosis presents with GI bleeding,combativeness,and confusion.The nurse anticipates an order to administer which medication?

A) Omeprazole (Prilosec)
B) Somatostatin (Octreotide)
C) Propranolol (Inderal)
D) Lactulose (Heptalac)

Question 8

The nurse recognizes that fetor hepaticus is consistent with which assessment finding?

A) Purpuric lesions on the extremities
B) A fruity or musty breath odor
C) Warm and bright red palms
D) Jaundice of the sclera

Question 9

A client just had a paracentesis.Which nursing intervention is a priority for this client?

A) Monitor urine output.
B) Maintain bedrest as per protocol.
C) Position the client flat in bed.
D) Secure the trocar to the abdomen with tape.

Question 10

A client is bleeding from esophageal varices.The health care provider is arranging sclerotherapy for the client.Before the client goes to interventional radiology,the nurse prepares to administer which medication?

A) Terlipressin (Glypressin)
B) Enoxaparin (Lovenox)
C) Lactulose (Heptalac)
D) Spironolactone (Aldactone)

Question 11

The nursing care plan specifies obtaining abdominal girth measurements each shift.The nurse takes the measurement,but when compared with the previous measurement,the new finding is several millimeters off.Which action by the nurse is best?

A) Document the finding in the client's chart.
B) Look to see when the client last had a dose of diuretic.
C) Ensure that the client's abdomen and flanks are marked with pen.
D) Obtain the measurement while the client sits upright.

Question 12

A client with an esophagogastric tube suddenly experiences acute respiratory distress.Which is the nurse's first action?

A) Call the health care provider.
B) Cut the balloon ports and remove the tube.
C) Place the client upright and apply oxygen.
D) Reduce the balloon pressure slightly.

Question 13

A client is admitted with end-stage cirrhosis and severe vomiting.Which problem should the nurse monitor the client most carefully for?

A) Intrahepatic bile stasis
B) Bleeding esophageal varices
C) Decreased excretion of bilirubin
D) Accumulation of ascites in the abdomen

Question 14

The nurse is assessing a client with mild liver disease.Which assessment does the nurse perform to detect the presence of ascites in this client?

A) Measure lower extremities to assess for edema.
B) Inspect and palpate the abdomen for distention.
C) Palpate the abdomen in assessing for a fluid wave.
D) Percuss the liver while listening for dullness.

Question 15

The nurse is reviewing a client's history.Which statement by the client indicates a need for health teaching?

A) "I drink 1 to 2 glasses of red wine a week."
B) "Because of my arthritis, I take a lot of Tylenol."
C) "One of my cousins died of liver cancer 10 years ago."
D) "I got a hepatitis vaccine before traveling last year."

Question 16

A client just returned to the nursing unit after having a trans-jugular intrahepatic portal-systemic shunt (TIPS)procedure.Which clinical finding does the nurse expect to observe in this client?

A) Decreased level of consciousness
B) Decreased urinary volume
C) Increased blood pressure
D) Increased abdominal girth

Question 17

A client had a paracentesis 1 hour ago.Which assessment finding requires action by the nurse?

A) Urine output of 20 mL/hr
B) Systolic blood pressure increase of 10 mm Hg
C) Respiratory rate drop from 18 to 14
D) A 3-pound drop in weight

Question 18

The nurse monitors for which clinical manifestation in a client with a decreased fecal urobilinogen concentration?

A) Clay-colored stools
B) Petechiae
C) Asterixis
D) Melena

Question 19

Which laboratory data does the nurse correlate with advanced disease in a client with cirrhosis?

A) Elevated serum protein level
B) Elevated serum ammonia level
C) Decreased serum ammonia level
D) Decreased lactate dehydrogenase level

Question 20

A client has cirrhosis and has developed ascites and edema.Which laboratory value does the nurse correlate with this condition?

A) Blood glucose, 120 mg/dL
B) Serum sodium, 135 mEq/L
C) Serum albumin, 2.1 g/dL
D) Blood urea nitrogen, 18 mg/dL

Question 21

A client is receiving an infusion of vasopressin (Pitressin)to treat bleeding esophageal varices.Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring?

A) Acute nausea and vomiting
B) A pounding frontal headache
C) Vertigo and syncope
D) Midsternal chest pain

Question 22

A client is in the emergency department after a motor vehicle crash.In assessing the client,which clinical sign alerts the nurse to the presence of possible liver trauma?

A) Abdominal pain referred to the right shoulder
B) Left upper quadrant abdominal pain and swelling
C) Abdominal pain referred to the spine and legs
D) Abdominal pain with accompanying rebound tenderness

Question 23

The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands.The client states this has not happened before.Which action by the nurse is most appropriate?

A) Conduct a thorough assessment, then notify the surgeon of the findings.
B) Review today's laboratory work, including liver function studies.
C) Assess the client's vital signs, and offer acetaminophen if the client is febrile.
D) Perform an assessment of the client's gross and fine motor skills.

Question 24

The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver?

A) Middle-aged client with a history of diabetes mellitus
B) Young adult client with a history of blunt liver trauma
C) Older adult client with a history of cirrhosis
D) Older adult client with malnutrition

Question 25

The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B?

A) Anti-hepatitis C virus (HCV) antibodies
B) Anti-hepatitis B (HBs) antibodies
C) Hepatitis B surface antigen (HBsAg) antibodies
D) Hepatitis A virus (HAV) antibodies

Question 26

A client who had a liver transplant a month ago is admitted with fever and tachycardia.Which medication does the nurse prepare to administer to this client?

A) Ceftriaxone (Rocephin)
B) Cyclosporine (Sandimmune)
C) Azithromycin (Zithromax)
D) Ribavirin (Copegus)

Question 27

A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C)and right flank pain.Which is the nurse's best response?

A) "The anti-rejection drugs you are taking made you susceptible to infection."
B) "You should go to the hospital immediately to have your new liver checked out."
C) "You should take an additional dose of cyclosporine today."
D) "Take acetaminophen (Tylenol) every 4 hours until you feel better."

Question 28

A client is receiving lactulose (Heptalac).Which laboratory value leads the nurse to intervene?

A) Serum potassium, 2.6 mEq/L
B) Serum sodium, 132 mEq/L
C) Serum glucose, 108 mg/dL
D) Blood urea nitrogen, 16 mg/dL

Question 29

A client has been diagnosed with hepatitis A.The nurse evaluates that teaching regarding the disease is understood when the client makes which statement?

A) "Some medications have been known to induce hepatitis A."
B) "I may have been exposed when we ate shrimp last weekend."
C) "I may have been infected through a recent blood transfusion."
D) "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

Question 30

The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit,72%; blood urea nitrogen (BUN),42 mg/dL; and sodium,166 mEq/L.Which action by the nurse is most appropriate?

A) Check the client's blood pressure and pulse.
B) Increase the client's oral fluid intake.
C) Call the health care provider.
D) Document the results in the chart.

Question 31

A client is diagnosed with hepatitis B.Which information does the nurse include in the teaching plan as a priority?

A) "Avoid drinking any alcohol until the doctor says you can."
B) "You will need aggressive control of your serum lipids."
C) "Once your lab work returns to normal, you can donate blood again."
D) "Wash your hands well after handling meat and shellfish."

Question 32

A client is refusing to take lactulose (Heptalac)because of diarrhea.Which is the nurse's best response to this client?

A) "Diarrhea is expected; that's how your body gets rid of ammonia."
B) "You may take Kaopectate liquid daily for loose stools."
C) "Do not take any more of the medication until your stools firm up."
D) "We will need to send a stool specimen to the laboratory."

Question 33

A client is in the emergency department after a motor vehicle crash,and the nurse notices a "steering wheel mark" across the client's chest.Which action by the nurse is most appropriate?

A) Ask the client where in the car he or she was during the crash.
B) Assess the client by gently palpating the abdomen for tenderness.
C) Notify the laboratory to come draw blood for blood type and crossmatch.
D) Place the client on the stretcher in reverse Trendelenburg position.

Question 34

The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene.Which action by the assistant requires intervention by the registered nurse?

A) Helping the client apply lotion to dry skin areas
B) Giving the client a basin of warm water and soap to use
C) Providing a soft toothbrush for oral care
D) Helping the client keep nails trimmed short

Question 35

The nurse is assessing health fair participants for risks for hepatitis.The nurse recognizes which client as being at greatest risk for developing hepatitis B?

A) College student who has had several sexual partners
B) Woman who takes acetaminophen daily for headaches
C) Businessman who travels frequently
D) Older woman who has eaten raw shellfish

Question 36

A client is admitted with jaundice and suspected hepatitis B.Which intervention does the nurse add to the client's care plan?

A) Encourage rest during this period.
B) Assist the client with ambulation.
C) Place the client on a clear liquid diet.
D) Administer PRN prochlorperazine maleate (Compazine).

Question 37

Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis?

A) "I will drink bottled water while I'm gone."
B) "I will not share my drinking glass."
C) "I should eat plenty of fresh fruits and vegetables."
D) "I will use careful handwashing."

Question 38

A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS)insertion.The nurse determines that teaching has been effective when the client makes which statement?

A) "I will be discharged home after I wake up completely."
B) "The procedure may be painful because I get only light sedation."
C) "My liver will function normally within 8 hours of placement of the shunt."
D) "I will be monitored closely for a while after the procedure is over."

Question 39

A client with hepatitis C is being treated with ribavirin (Copegus).What nursing action takes priority?

A) Educating the client on ways to remain complaint with the drug regimen
B) Teaching the client that transient muscle aching is a common side effect
C) Ensuring that the client returns to the clinic each week for follow-up care
D) Showing the client how to take and record a radial pulse for 1 minute

Question 40

A thin,cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE).The family expresses distress that the client is receiving so little protein in the diet.Which explanation by the nurse is most appropriate?

A) "A low-protein diet will help the liver rest and will restore liver function."
B) "Less protein in the diet will help with the confusion."
C) "Despite looking so thin, protein will not help with weight gain."
D) "Less protein is needed to prevent fluid from leaking into the abdomen."

Question 41

The infection control nurse wants to decrease the number of health care professionals who contract viral hepatitis at work.Which actions does the nurse initiate?

A) Strengthen policies related to consistent use of Standard Precautions.
B) Mandate hepatitis vaccination for workers in high-risk areas.
C) Implement a needleless system for IV therapy.
D) Reduce the number of "sharps" needed for client care where possible.
E) Provide postexposure prophylaxis in a timely manner.

Question 42

A client has liver cancer.Which statement by the client about treatment options demonstrates an accurate understanding?

A) "I guess it's a good thing that surgery is usually so successful."
B) "I choose hepatic arterial infusion of chemo to limit side effects."
C) "Because I have only local metastases, I am thinking about transplant."
D) "This disease is so rare, no wonder no good treatments are available."

Question 43

A client is scheduled for a paracentesis.Which activity does the nurse delegate to the unlicensed assistive personnel?

A) Have the client sign the informed consent form.
B) Assist the client to void before the procedure.
C) Help the client lie flat in bed, on the right side.
D) Get the client into a chair after the procedure.

Question 44

Which statement by a client with alcohol-induced cirrhosis indicates the need for further teaching?

A) "I cannot drink any alcohol at all anymore."
B) "I need to avoid protein in my diet."
C) "I should not take over-the-counter medications."
D) "I should eat small, frequent, balanced meals."

Question 45

A client admitted with hepatopulmonary syndrome is experiencing dyspnea but does not want oxygen increased because the client's nose keeps bleeding from it.The client becomes agitated when discussing this with the nurse.The client's oxygen saturation is 92%.What intervention by the nurse is best?

A) Instruct the client to sit in as upright a position as possible.
B) Tell the client that humidity can be added, but that the oxygen must be worn.
C) Document the client's refusal in the chart, and call the health care provider.
D) Call the health care provider to request an extra dose of the client's diuretic.