Question 1

What should the nurse expect to assess in a patient with acute liver failure? Select all that apply.

Accepted Answer

1. Severe acute liver injury can lead to impaired elimination of bilirubin leading to jaundice, which may appear immediately before or soon after presentation.
2. Acute bleeding is an indication of coagulopathy, which is seen in acute liver failure.
3. Ascites is a manifestation of chronic liver failure.
4. Peripheral edema is a manifestation of chronic liver failure.
5. Asterixis is a manifestation of chronic liver failure.

Question 2

A patient who ingests five alcoholic drinks per day demonstrates neuropsychiatric effects of alcohol withdrawal. What should the nurse expect to assess in this patient? Select all that apply.

Accepted Answer

1. Anger is a neuropsychiatric manifestation of alcohol withdrawal.
2. Argumentative behavior is a neuropsychiatric manifestation of alcohol withdrawal.
3. Disorientation is a neuropsychiatric manifestation of alcohol withdrawal.
4. Confusion is a neuropsychiatric manifestation of alcohol withdrawal.
5. Hyperreflexia is an autonomic manifestation of alcohol withdrawal.

Question 3

What should the nurse include when planning care for a patient experiencing pruritus associated with decompensated liver disease? Select all that apply.

Accepted Answer

1. Cholestyramine binds and prevents the accumulation of bile acids under the skin, reducing pruritus.
2. Colestipol binds and prevents the accumulation of bile acids under the skin, reducing pruritus.
3. Diphenhydramine relieves symptoms of pruritus and has a mild sedative effect.
4. Keeping the nails short will reduce the injury caused when scratching the skin because of pruritus.
5. Restricting fluids will not help reduce pruritus caused by decompensated liver disease.

Question 4

A patient with esophageal varices received octreotide (Sandostatin) 100 microgram intravenous bolus, and the nurse prepares to start a continuous infusion of the medication. The drug is diluted 500 micrograms in 250 mL of 0.9% normal saline to be administered at 50 mcg/hour. How many milliliters per hour should the intravenous infusion pump be set to in order to deliver the correct dose?

Accepted Answer

1. The rate of 25 L/hr may be correctly calculated by using this formula: Dose divided by concentration equals rate. The dose is 50 mcg/hour divided by the concentration (500 mcg / 250 mL). This is 50 divided by 2 = 25 mL/hour.
2. The rate of 25 L/hr may be correctly calculated by using this formula: Dose divided by concentration equals rate. The dose is 50 mcg/hour divided by the concentration (500 mcg / 250 mL). This is 50 divided by 2 = 25 mL/hour.
3. The rate of 25 L/hr may be correctly calculated by using this formula: Dose divided by concentration equals rate. The dose is 50 mcg/hour divided by the concentration (500 mcg / 250 mL). This is 50 divided by 2 = 25 mL/hour.
4. The rate of 25 L/hr may be correctly calculated by using this formula: Dose divided by concentration equals rate. The dose is 50 mcg/hour divided by the concentration (500 mcg / 250 mL). This is 50 divided by 2 = 25 mL/hour.

Question 5

A patient with chronic alcohol use demonstrates confusion, abnormal gait, and visual disturbances. What should the nurse expect to be prescribed for this patient? Select all that apply.

Accepted Answer

1. Thiamine (vitamin B1) deficiency is frequently seen in alcohol-dependent individuals because of insufficient dietary intake, impaired gastrointestinal absorption, and impaired utilization.
2. A benzodiazepine is not used to correct a nutritional deficiency.
3. The patient's manifestations do not indicate a bleeding disorder.
4. The patient's manifestations do not suggest that the patient is at risk for developing a seizure disorder.
5. Administration of intravenous (IV) dextrose without thiamine administration increases the patient's risk for developing Wernicke's encephalopathy.

Question 6

A patient with a history of alcohol dependency is demonstrating signs of a thiamine deficiency. What did the nurse assess in this patient? Select all that apply.

Accepted Answer

1. Ataxia is a manifestation of a thiamine deficiency.
2. Nystagmus is a manifestation of a thiamine deficiency.
3. Peripheral neuropathy is a manifestation of thiamine deficiency.
4. Fatigue is a general manifestation of a nutritional deficiency and not specific to a thiamine deficiency.
5. Muscle wasting is a general manifestation of a nutritional deficiency and not specific to a thiamine deficiency.

Question 7

A patient comes into the emergency department after ingesting 50 650-mg tablets of arthritis-strength acetaminophen (Tylenol) 2 hours ago. What intervention should the nurse prepare to implement at this time? Select all that apply.

Accepted Answer

1. If the time of ingestion was less than 4 hours ago, induction of emesis may be considered.
2. If the time of ingestion was less than 4 hours ago, gastric lavage of pill fragments may be considered for treatment.
3. If the time of ingestion was less than 4 hours ago, administration of activated charcoal to reduce absorption may be considered.
4. If the time of ingestion is greater than 4 but less than 24 hours ago, a serum acetaminophen level should be immediately drawn.
5. This medication is used if the patient is at risk for hepatotoxicity.

Question 8

A patient with bleeding esophageal varices is scheduled to receive a bolus followed by a continuous infusion of octreotide (Sandostatin). What care should the nurse expect when providing this medication?

Accepted Answer

1. This medication is effective in temporarily stopping the bleeding in approximately 80% of patients.
2. Octreotide (Sandostatin) has an excellent safety margin and is safe for patients with cardiac disease.
3. Doses greater than 50 mcg/hr may increase systemic venous pressure and do not increase the portal hypotensive effects.
4. To evaluate response to the octreotide (Sandostatin) infusion, the nurse would continue to monitor the patient's hemodynamic status and expect to see the patient's vital signs return to normal, urine output increase, and a decrease in overt bleeding: hematemesis, melena, and hematochezia. Serial hematocrit levels should be evaluated.

Question 9

The nurse plans care for a patient with alcohol withdrawal syndrome. Which criteria should the nurse use to determine the severity of the patient's symptoms from this syndrome? Select all that apply.

Accepted Answer

1. Severity is believed to be dose dependent with more severe withdrawal associated with higher blood alcohol concentrations.
2. Severe withdrawal is intensified by the stress of concurrent illnesses.
3. Having a history of previous withdrawals suggests that additional withdrawals can be progressively more severe. This is the kindling effect.
4. The use of other addictive drugs impacts the severity of withdrawal.
5. Current vital signs will not impact the severity of alcohol withdrawal.

Question 10

A nurse cares for a patient during a transjugular intrahepatic portosystemic shunt (TIPS) procedure. For which complication should the nurse assess during the procedure?

Accepted Answer

1. The patient is either sedated or under anesthesia, so the potential of the alcohol withdrawal symptoms is not likely to occur.
2. The primary complication of this procedure is dysrhythmias due to endocardial irritation from the guide wire. The nurse should monitor the EKG continuously during the procedure.
3. The liver is not decompressed-the venous flow is increased due to the placement of a stent.
4. Vagal stimulation is not a complication of TIPS because this is a venous procedure and there is no contact with the baroreceptors located in the arterial system.

Question 11

Which manifestation experienced by a patient having vasopressin (Pitressin) therapy for bleeding esophageal varices indicates a serious adverse effect of the medication?

Accepted Answer

1. A headache is not a side effect of this medication.
2. Vasopressin can cause vasoconstriction, resulting in myocardial ischemia.
3. Abdominal cramping is not a side effect of this medication.
4. Vertigo is not a side effect of this medication.

Question 12

A patient with a history of taking acetaminophen (Tylenol) for osteoarthritis pain is surprised to learn the diagnosis of liver failure. What should the nurse explain to the patient about this diagnosis? Select all that apply.

Accepted Answer

1. When the maximum daily dose is repeatedly exceeded, the normal pathways of metabolism become saturated and more of the toxic metabolite is produced.
2. When hepatic glutathione stores are depleted, the toxic substances accumulate, causing hepatic injury.
3. The minimal dose that produces liver injury varies between 4 to 10 grams.
4. The minimal dose that produces liver injury varies between 4 to 10 grams per day.
5. Liver damage from acetaminophen occurs with or without the ingestion of alcohol.

Question 13

During a focused assessment, the nurse learns that a patient consumes one 1,000-mL box of wine each day. If the patient is using a 5-ounce glass, how many drinks should the nurse document that this patient consumes daily? Round your number to the nearest whole number.

Accepted Answer

The answer of During a focused assessment, the nurse learns...

Question 14

A patient with hepatic encephalopathy has an increased ammonia level. Which should the nurse expect to be prescribed for this patient?

Accepted Answer

1. Lactulose (Cephulac), a nonabsorbable disaccharide, is recommended as the first choice for initial treatment of overt HE and for the prevention of recurrent episodes.
2. Rifaximin, an oral antibiotic, is recommended as an add-on therapy to lactulose for reducing the risk of HE reoccurrence.
3. Carvedilol is a beta blocker used to promote vasoconstriction and decrease portal venous flow.
4. N-acetylcysteine is the antidote for acetaminophen toxicity.

Question 15

A patient with a history of alcohol use arrives at the clinic for a routine physical examination. What finding should indicate to the nurse that the patient has an alcohol use disorder (AUD)? Select all that apply.

Accepted Answer

1. Repeated excessive consumption of alcohol provides empty calories, suppresses the appetite, and causes early satiety. Fatigue is an indication of a nutritional (folic acid/folate) deficiency.
2. Palmar erythema is a skin change associated with liver disease caused by chronic alcohol use.
3. Blurred vision is not associated with chronic alcohol use.
4. Peripheral edema is an indication of liver disease caused by chronic alcohol use.
5. Jaundice is an indication of liver disease caused by chronic alcohol use.

Question 16

The nurse assesses a patient with chronic liver disease. What information should the nurse use from the patient's medical record to complete the Child-Pugh classification system? Select all that apply.

Accepted Answer

1. Bowel sounds are not used to assess the severity of chronic liver disease.
2. The albumin level is a parameter of the Child-Pugh classification system. This information would be obtained from the patient's medical record.
3. Bilirubin level is a parameter of the Child-Pugh classification system. This information would be obtained from the patient's medical record.
4. Intake and output is not used to assess the severity of chronic liver disease.
5. Prothrombin time is a parameter of the Child-Pugh classification system. This information would be obtained from the patient's medical record.

Quiz 12: Care of the Critically Ill Patient Experiencing Alcohol Withdrawal Andor Liver Failure