Chapter_49_Med_Surg

MED-SURG Chapter 49: Assessment and Management of Patients With Hepatic Disorders Question A client who has just been diagnosed with hepatitis A asks, "How did I get this disease?" What is the nurse's best response? • "You may have eaten contaminated restaurant food." Question A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? • Loss of 2.2 lb (1 kg) in 24 hours Question The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? • Purpura and petechiae Question A nurse is caring for a client newly diagnosed with hepatitis A. Which statement by the client indicates the need for further teaching? • "How did this happen? I've been faithful my entire marriage." Question Which is an age-related change of the hepatobiliary system? • Decreased blood flow Question Which is the most common cause of esophageal varices? • Portal hypertension Question Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia? • Hypotension Question When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? • Measure abdominal girth according to a set routine. Question A client and spouse are visiting the clinic. The client recently experienced a seizure and says she has been having difficulty writing. Before the seizure, the client says that for several weeks she was sleeping late into the day but having restlessness and insomnia at night. The client’s husband says that he has noticed the client has been moody and slightly confused. Which of the following problems is most consistent with the client’s clinical manifestations? • Hepatic encephalopathy Question A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? • Vitamin A Question A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate: • liver disorder. Question Which symptoms will a nurse observe most commonly in clients with pancreatitis? • severe, radiating abdominal pain Question A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis? • A liver biopsy Question The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? • Hemolytic Question A client with hepatic cirrhosis questions the nurse about the possible use of an herbal supplement—milk thistle—to help heal the liver. Which is the most appropriate response by the nurse? • "Silymarin from milk thistle has anti-inflammatory and antioxidant properties that may have beneficial effects, especially in hepatitis. However, you should always notify your primary care provider of any herbal remedies being used so drug interactions can be evaluated." Question The nurse completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem? • Arrange for a low air loss bed. Question The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler’s position. What is the nurse’s priority assessment of this patient? • Respiratory assessment related to increased thoracic pressure Question The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? • Asterixis Question A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? • “You must have the second one in 1 month and the third in 6 months.” Question A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? • Hepatic encephalopathy Question A client is being prepared to undergo laboratory and diagnostic testing to confirm the diagnosis of cirrhosis. Which test would the nurse expect to be used to provide definitive confirmation of the disorder? • Liver biopsy Question Which of the following is the most effective strategy to prevent hepatitis B infection? • Vaccine Question When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? • Change in the client’s handwriting and/or cognitive performance Question A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185-pound (84-kilogram) male consume? • 100 to 126 grams Question A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note: • anorexia, nausea, and vomiting. Question Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? • Vasopressin Question When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? • Clay-colored or whitish Question A client with cirrhosis has a massive hemorrhage from esophageal varices. Balloon tamponade is used temporarily to control hemorrhage and stabilize the client. In planning care, the nurse gives the highest priority to which goal? • Maintaining the airway Question Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: • The digestion of dietary and blood proteins. Question Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency? • Scurvy Question A client is actively bleeding from esophageal varices. Which of the following medications would the nurse most expect to be administered to this client? • Vasopressin (Pitressin) Question A nurse educator is providing an in-service to a group of nurses working on a medical floor that specializes in liver disorders. What is an important education topic regarding ingestion of medications? • metabolism of medications Question A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing? • Vitamin K deficiency Question A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has: • cirrhosis. Question A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation? • The client's hepatic function is decreasing. Question 3 See full question 23s The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease? • Purpura and petechiae Question A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice? • Clay-colored stools Question Which is an age-related change of the hepatobiliary system? • Decreased blood flow Question When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider? • Measure abdominal girth according to a set routine. Question A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered? • Tacrolimus Question A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client? • Vitamin A Question Which of the following diagnostic studies definitely confirms the presence of ascites? • Ultrasound of liver and abdomen Question Total parental nutrition (TPN) should be used cautiously in clients with pancreatitis because such clients: • cannot tolerate high-glucose concentration. Question A preoperative client scheduled to have an open cholecystectomy says to the nurse, “The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?” What most common reason for a client having a nasogastric tube in place after abdominal surgery should the nurse include in a response? • decompression Question The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent? • Lactulose Question A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide? • Reduce fluid accumulation and venous pressure. Question What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct? • Endoscopic retrograde cholangiopancreatography (ERCP) Question When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately? • Change in the client’s handwriting and/or cognitive performance Question The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction? • Hemolytic Question The nurse is providing care to a patient with gross ascites who is maintaining a position of comfort in the high semi-Fowler’s position. What is the nurse’s priority assessment of this patient? • Respiratory assessment related to increased thoracic pressure Question The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand-flapping tremors. What does the nurse document this finding as? • Asterixis Question A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor? • “You must have the second one in 1 month and the third in 6 months.” Question A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy? • Stage 2 Question A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect? • Loss of 2.2 lb (1 kg) in 24 hours Question A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition? • Hepatic encephalopathy Question Which medication is used to decrease portal pressure, halting bleeding of esophageal varices? • Vasopressin Question A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include? • Hepatitis C increases a person's risk for liver cancer. Question Which of the following would the nurse expect to assess in a client with hepatic encephalopathy? • Asterixis Question Which type of deficiency results in macrocytic anemia? • Folic acid Question Which of the following symptoms would indicate that a client with chronic pancreatitis has developed secondary diabetes? • Increased appetite and thirst Question A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery? • Vitamin K Question When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report? • Clay-colored or whitish Question Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from: • The digestion of dietary and blood proteins. Question 1 After undergoing a liver biopsy, a client should be placed in which position? • Right lateral decubitus position Question 2 See full question 40s A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal? • Albumin Question A client with acute liver failure exhibits confusion, a declining level of consciousness, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is: • subnormal serum glucose and elevated serum ammonia levels. Question The nurse is preparing to interview a client with cirrhosis. Based on an understanding of this disorder, which question would be most important to include? • “How often do you drink alcohol?” Question While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply. • Jaundice • Petechiae • Ecchymoses Question Gynecomastia is a common side effect of which of the following diuretics? • Spironolactone (Aldactone) Question What is the recommended dietary treatment for a client with chronic cholecystitis? • low-fat diet Question A client has a blockage of the passage of bile from a stone in the common bile duct. What type of jaundice does the nurse suspect this client has? • Obstructive jaundice Question The nurse is concerned about potassium loss when a diuretic is prescribed for a patient with ascites and edema. What diuretic may be ordered that spares potassium and prevents hypokalemia? • Spironolactone (Aldactone) Question The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose? • Watery diarrhea