Question 1

Which of the following clients should alert the nurse that screening for hepatitis C should be done?

Accepted Answer

Any client with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992, when an antibody test for hepatitis C became available, do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by travelling in underdeveloped countries.

Question 2

The nurse is caring for a client who is diagnosed with acute hepatitis B. Which of the following information should the nurse include in the teaching plan?

Accepted Answer

Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended.

Question 3

Which of the following actions should the nurse implement to evaluate the effectiveness of treatment for a client who has hepatic encephalopathy?

Accepted Answer

Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests also might be done as part of the neurological assessment but would not be diagnostic for hepatic encephalopathy.

Question 4

The nurse is caring for a client with cirrhosis who has 4+ pitting edema of the feet and legs. Which of the following assessments is priority for the nurse to monitor?

Accepted Answer

The low oncotic pressure caused by hypoalbuminemia is a major pathophysiological factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the client's current symptoms.

Question 5

The nurse is caring for a client with chronic hepatitis C who is prescribed combination therapy of ?-interferon and ribavirin. Which of the following findings should the nurse monitor for the presence of hepatitis C in the client?

Accepted Answer

Therapy with ribavirin and ?-interferon may cause leukopenia. The other problems are not associated with this drug therapy.

Question 6

Which of the following findings in a blood specimen indicates that the administration of hepatitis B vaccine to a client has been effective?

Accepted Answer

The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV.

Question 7

Aclient in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection. Which of the following actions by the nurse is best?

Accepted Answer

Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most clients with acute HCV infection convert to the chronic state, the nurse should not teach the client that the HCV will resolve in a few months.
Immune globulin or vaccine is not available for HCV. Ribavirin is used for chronic HCV infection.

Question 8

The nurse is assessing a client who had a liver transplant a week previously and obtains the following data. Which of the following findings is most important to communicate to the health care provider?

Accepted Answer

Infection risk is high in the first few months after liver transplant and fever is frequently the only sign of infection. The other client data indicate the need for further assessment or nursing actions, but do not indicate a need for urgent action.

Question 9

Aclient contracts hepatitis from contaminated food. During the acute (icteric) phase of the client's illness, which of the following serological findings should the nurse expect?

Accepted Answer

Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The client would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.

Question 10

Which of the following nursing actions should be included in the plan of care for a client with cirrhosis who has ascites and 4+ edema of the feet and legs?

Accepted Answer

To maintain skin integrity, restrict sodium intake as ordered to prevent additional fluid retention. The client should be weighed daily, not weekly. Repositioning the client every 4 hours will not be adequate to maintain skin integrity; clients should be repositioned at least every two hours. Passive range of motion will not take pressure off areas like the sacrum that are vulnerable to breakdown.

Question 11

The nurse is caring for a client who is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serological testing is negative for viral causes of hepatitis. Which of the following questions by the nurse is best?

Accepted Answer

The client's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen. Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.

Question 12

The nurse is caring for a client with severe cirrhosis who has an episode of bleeding esophageal varices. Which of the following laboratory tests should the nurse monitor to detect possible complications of the bleeding episode?

Accepted Answer

The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an increase in ammonia level because the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels also should be monitored, but these will not be affected by the bleeding episode.

Question 13

The health care provider plans a paracentesis for a client with ascites caused by liver cancer. Which of the following actions should the nurse implement to prepare the client for the procedure?

Accepted Answer

The client should empty the bladder to decrease the risk of bladder perforation during the procedure. The client would be positioned in Fowler's position and would not be able to lie flat without compromising breathing. Since no sedation is required for paracentesis, the client does not need to be NPO.

Question 14

The nurse is caring for a client with cirrhosis who has scheduled doses of spironolactone and furosemide and has a serum potassium level of 3.2 mmol/L. Which of the following actions should the nurse take?

Accepted Answer

Spironolactone is a potassium-sparing diuretic and will help to increase the client's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the client's potassium level and should be held until the nurse talks with the health care provider.

Question 15

Which of the following nursing actions should be included in the plan of care for a client who is being treated for bleeding esophageal varices with balloon tamponade?

Accepted Answer

A common complication of balloon tamponade is occlusion of the airway by the balloon so it is important to monitor the client's respiratory status. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway.
Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8-12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.

Question 16

The nurse is caring for a client who has advanced cirrhosis and is receiving lactulose. Which of the following findings by the nurse indicates that the medication is effective?

Accepted Answer

The purpose for lactulose in the client with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this client. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.

Question 17

Which of the following laboratory test results is most important for the nurse to monitor when evaluating the effects of therapy for a client who has acute pancreatitis?

Accepted Answer

Amylase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be as useful in evaluating whether the prescribed therapies have been effective.

Question 18

Which of the following assessment findings in a client with acute pancreatitis should the nurse report most quickly to the health care provider?

Accepted Answer

Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. Although the other findings also should be reported to the health care provider, they do not indicate complications that require rapid action.

Question 19

The nurse is preparing a teaching plan for a young adult client who is diagnosed with early alcoholic cirrhosis. Which of the following topics is most important to include in client teaching?

Accepted Answer

The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this client is to stop the progression of the disease.

Question 20

The nurse is caring for a client who has had a transjugular intrahepatic portosystemic shunt (TIPS) placement. Which of the following findings indicate that the procedure has been effective?

Accepted Answer

TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

Quiz 46: Nursing Management Liver