ATI Primary Care, Art and Science of Advanced Practice Nursing - Test Bank, Cirrhosis and Liver Failure, Questions and Answers with Explanations, 100% Correct, Download to Score A

1. The nurse clarifies that unconjugated bilirubin, which is made up of broken-down red cells, is: water insoluble bilirubin that must be converted by the liver. Unconjugated bilirubin is a water-insoluble product that must be converted in the liver to conjugated bilirubin (water soluble) so that it may be excreted through the bowel 2. The patient with cirrhosis has an albumin of 2.8 g/dL. The nurse is aware that normal is 3.5 g/dL to 5 g/dL. Based on these findings, what would the nurse expect the patient to exhibit? Edema Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema. 3. What is an essential nursing measure to prevent injury to the patient who is to receive a paracentesis? Have patient void immediately before procedure To prevent the puncturing of the bladder, the patient must void immediately before the procedure. A permit is required but it is not a safety precaution for the patient. There is no contrast media used in a paracentesis. 4. What should the nurse expect of a patient with a malabsorption of vitamin K? Increased prothrombin time Prothrombin times are increased because malabsorption of vitamin K or inability to produce the clotting factors VII, IX, and X cause the patient to have bleeding tendencies. 5. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. What is the purpose of the T-tube? To keep the duct open and allow drainage of the bile until edema resolves. If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves. 6. The nurse caring for a patient who has had an open cholecystectomy with a T-Tube will: position and secure the drainage bag at the chest level. The T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated. 7. Which nursing intervention should be completed immediately after the physician has performed a needle liver biopsy? Keeping the patient on the right side for a minimum of 2 hours Keep the patient lying on the right side for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours. 8. Immediately following a liver biopsy, the patient becomes dyspneic, the pulse increases to 100, and no breath sounds can be heard on the affected side. What should the nurse suspect? Pneumothorax Pneumothorax is a possible complication of paracentesis. The patients head of the bed should be raised slightly, but kept on the right side. Oxygen should be administered and the assessment reported to the charge nurse and documented. 9. Which patient statement indicates that the patient requires additional teaching about an endoscopic retrograde cholangiopancreatography? Right after the test, I want breakfast with black coffee After the procedure, keep the patient NPO until the gag reflex returns. 10. The nurse assisting in the treatment of a patient with ruptured esophageal varices who has received vasopressin IV will carefully assess for: Evidence of cardiac ischemia Vasopressin is a strong vasoconstrictor given to try to stop the hemorrhage of the varices. Unfortunately it also constricts all vessels and may cause cardiac ischemia 11. What should the nurse point out as a significant advantage of the laparoscopic cholecystectomy? Less invasive procedure The laparoscopic cholecystectomy is less invasive and causes less pain and a quick recovery. If there are large stones present a sphincterotomy is done before the laparoscopic cholecystectomy. Persons with bleeding tendencies, pathologic conditions of the abdomen, stones in the bile duct, and extensive adhesions are not good candidates. 12. What should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)? Control esophageal varices bleeding The major purpose of the S/B tube is to control bleeding by pressure against the vessels in the esophagus. The two balloons of the tube are inflated to put direct pressure on the esophagus and are anchored by the inflated balloon in the stomach. The tube can suction blood from the stomach as well. 13. The patients cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of the complication of: esophageal varices. Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. 14. The patient with cirrhosis has a rising ammonia level and is becoming disoriented. The patient waves to the nurse as she enters the room. How should the nurse interpret this As asterixis Asterixis is the flapping tremor seen as the patient deteriorates into ammonia intoxication or hepatic encephalopathy. 15. How does the administration of neomycin (Mycifradin) reduce the production of ammonia? By decreasing the bacteria in the gut The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Ammonia is produced in the gut by bacterial action. By reducing the bacteria, less ammonia is produced. 16. What is the most common procedure for the removal of the gallbladder? Laparoscopic cholecystectomy The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder.