Deck 23: Alterations in Liver Function

Question 1

A patient with acute hepatic dysfunction is prescribed lactulose (Cephulac)45 mL by mouth four times a day.Which findings will the nurse evaluate as indicating the medication is having its desired effect? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The patient's abdominal girth is smaller.
B)The patient has no more oozing from esophageal varices.
C)The patient's hemoglobin has increased.
D)The patient's mentation is clearer.
E)The patient has had three stools in the last 24 hours.

Answer 1

The patient's mentation is clearer.
The patient has had three stools in the last 24 hours.

Question 2

A patient in acute liver failure has developed increased intracranial pressure.Hypothermia has been induced.Which nursing intervention should be added to the patient's plan of care?

A)Keep the patient's temperature below 33°C.
B)Monitor the patient for development of frostbite.
C)Stimulate the patient at least every hour to assess for neurological changes.
D)Monitor for the development of infection.

Answer 2

Monitor for the development of infection.

Question 3

A patient reports taking two 500-mg acetaminophen tablets "at least 3 or 4 times a day" to treat muscle pain in his back.What nursing assessment question is priority?

A)"Do you drink plenty of water when you take these pills?"
B)"What other medications do you take?"
C)"Have you had your back reassessed lately?"
D)"What other measures do you take to relieve your back pain?"

Answer 3

"What other medications do you take?"

Question 4

The nurse is monitoring a patient for progression through the grades of hepatic encephalopathy (HE).This morning the patient is exhibiting a positive Babinski reflex.The nurse would conduct additional assessment about which HE grade?

A)I
B)II
C)III
D)IV

Question 5

The nurse is caring for a patient admitted with acute hepatic dysfunction caused by acetaminophen toxicity.Which clinical findings would indicate that the patient's condition is deteriorating?

A)Sweet odor on the breath
B)Tachycardia
C)Hyperresponsive pupillary responses
D)Change in level of consciousness

Question 6

A patient with a history of chronic liver disease is admitted with acute hemorrhage from esophageal varices.The nurse would expect treatment interventions for which causative condition?

A)The patient has developed gallstones as a result of poor liver function.
B)The patient has portal hypertension with shunting of blood.
C)The nonsteroidal anti-inflammatory drug (NSAID)use that caused the patient's chronic liver failure has also resulted in gastritis.
D)The abdominal distention caused by ascites has resulted in reflux esophagitis.

Question 7

A patient with severe ascites has undergone abdominal paracentesis with removal of 2 liters of fluid.The nurse anticipates administration of which product?

A)2 liters of normal saline
B)4 liters of lactated ringer's solution
C)16 to 20 grams of albumin
D)6 to 10 units of platelets

Question 8

A patient will be given rifaximin (Xifaxan)to reduce ammonia production by intestinal bacteria.The nurse would add which intervention to this patient's plan of care?

A)Monitor IV site for infiltration.
B)Monitor for development of abdominal cramping.
C)Increase fluids to reduce risk of constipation.
D)Monitor serum potassium levels daily.

Question 9

A patient is admitted with suspected acute hepatic failure.Which findings would the nurse evaluate as supporting this suspected diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The patient complains of thirst.
B)The patient has a dry cough.
C)The patient's hemoglobin is elevated.
D)The patient's international normalized ratio (INR)is elevated.
E)The patient has new onset of confusion.

Question 10

A patient admitted with general malaise,nausea,and vomiting tells the nurse that he started to feel sick a few weeks after getting a new tattoo on his leg.Which type of hepatitis should the nurse suspect is causing this patient's symptoms?

A)A
B)E
C)C
D)A combination of A and D

Question 11

A patient with acute hepatic dysfunction is experiencing a gastrointestinal bleed.The nurse should be prepared to administer which products? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Mannitol
B)Antibiotics
C)Albumin
D)Vitamin K
E)Fresh frozen plasma

Question 12

A patient has been admitted to the intensive care unit with the diagnosis of hyperacute liver failure.Which assessment findings would the nurse anticipate in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)INR (international normalized ratio)greater than 1.5
B)History of alcohol abuse
C)Jaundice
D)Mental status changes
E)Serum glucose greater than 125 mg/dL

Question 13

The nurse is assessing a patient admitted with acute liver failure of unknown etiology.Which statement made by the family requires additional investigation?

A)"I thought her skin color change was due to going to the indoor tanning booth."
B)"She has been exercising by gathering wild berries and greens for salads."
C)"We went to the mall last week and she got pretty tired while shopping."
D)"She was exposed to influenza last week when she went to visit her sister."

Question 14

A patient with acute hepatic dysfunction demonstrates slow slurred speech and cold clammy skin.The nurse would collaborate with the primary care provider for treatment of which condition?

A)Cerebral embolism
B)Hypoglycemia
C)Bleeding esophageal varices
D)Increased ammonia level

Question 15

While assessing a patient admitted with acute hepatic dysfunction,the nurse notes abnormal involuntary movements of the patient's hands.How should the nurse document this finding?

A)As seizure activity
B)As asterixis
C)As decorticate posturing
D)As hyperreflexia

Question 16

A patient is prescribed N-acetylcysteine (NAC)140 mg/kg via nasogastric tube.What is the priority nursing intervention?

A)Give the dose slowly over at least 15 minutes.
B)Warn the patient that the medication smells like burning rubber.
C)Give all follow-up doses exactly on time.
D)Ask the patient what he weighs.

Question 17

A pregnant woman is admitted to the high-risk maternity unit with HELLP syndrome.The nurse would provide which interventions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Protect the woman from inadvertent injury.
B)Monitor IV sticks for bleeding.
C)Monitor the woman for development of seizure.
D)Monitor the patient for the development of hypernatremia.
E)Prepare the woman for immediate intubation and mechanical ventilation.

Question 18

A teenage girl is admitted to the intensive care unit after taking an overdose of acetaminophen.What nursing assessment question is priority?

A)"Did you take the pills on purpose?"
B)"Do you have diabetes?"
C)"Could you be pregnant?"
D)"Do you feel at all sick to your stomach?"

Question 19

A patient with acute hepatic dysfunction is having difficulty completing his menu and "can't seem to remember" how to use the bed controls.The nurse realizes these changes might indicate which stage of hepatic encephalopathy?

A)I
B)II
C)III
D)IV

Question 20

A patient with acute hepatic dysfunction has abdominal ascites.The nurse would anticipate which laboratory finding?

A)Serum sodium less than 135 mEq/L
B)Hematocrit less than 36%
C)High-density lipoprotein (HDL)level greater than 40 mg/dL
D)Albumin level lower than 3.5 g/L