Chapter 53: Concepts of Care for Patients With Liver Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading
cause of cirrhosis?
a. Metabolic syndrome
b. Liver cancer
c. Nonalcoholic fatty liver disease
d. Hepatitis C
ANS: D
Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with
nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Cirrhosis, Risk factors
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
2. The nurse is caring for a client who has cirrhosis of the liver. What nursing action is
appropriate to help control ascites?
a. Monitor intake and output.
b. Provide a low-sodium diet.
c. Increase oral fluid intake.
d. Weigh the patient daily.
ANS: B
A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake
and output does not control fluid accumulation, nor does weighing the client. These
interventions merely assess or monitor the situation. Increasing fluid intake would not be
helpful.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation
KEY: Cirrhosis, Diet therapy
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
3. The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which
assessment finding would require immediate action by the nurse?
a. Urine output via indwelling urinary catheter is 20 mL/hr
b. Blood pressure increases from 110/58 to 120/62 mm Hg
c. Respiratory rate decreases from 22 to 16 breaths/min
d. A decrease in the client9s weight by 3 lb (1.4 kg)
ANS: A
467
, Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to
hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A
slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate
indicates that breathing has been made easier by the procedure. The nurse would expect the
client9s weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000
mL are usually removed from the abdomen at one time. The patient9s weight typically only
decreases by less than 2 kg or 4.4 lb.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Cirrhosis, Management
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
4. The nurse is caring for a client who has a risk gene for developing cirrhosis. Which
racial/ethnic group has this gene most often?
a. Blacks
b. Asian/Pacific Islanders
c. Latinos
d. French
ANS: C
The Patatin-like phospholipase domain containing 3 gene (PNPLA3) has been identified as a
risk gene for cirrhosis, which occurs most often in Latinos when compared to other
populations.
DIF: Remembering TOP: Integrated Process: Culture and Spirituality
KEY: Cirrhosis, Risk factors
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
5. The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client
is thin and cachectic, and the family expresses distress that the patient is receiving little
dietary protein. How would the nurse respond?
a. <A low-protein diet will help the liver rest and will restore liver function.=
b. <Less protein in the diet will help prevent confusion associated with liver failure.=
c. <Increasing dietary protein will help the patient gain weight and muscle mass.=
d. <Low dietary protein is needed to prevent fluid from leaking into the abdomen.=
ANS: B
A low-protein diet is prescribed when serum ammonia levels increase and/or the client shows
signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia
by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has
no impact on restoring liver function. Increasing the patient9s dietary protein will cause
complications of liver failure and would not be suggested. Increased intravascular protein will
help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary
protein.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Cirrhosis, Diet therapy
MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort
6. The nurse is caring for a client who is prescribed lactulose. The client states, <I do not want to
take this medication because it causes diarrhea.= How would the nurse respond?
468
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading
cause of cirrhosis?
a. Metabolic syndrome
b. Liver cancer
c. Nonalcoholic fatty liver disease
d. Hepatitis C
ANS: D
Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with
nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis.
DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment
KEY: Cirrhosis, Risk factors
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
2. The nurse is caring for a client who has cirrhosis of the liver. What nursing action is
appropriate to help control ascites?
a. Monitor intake and output.
b. Provide a low-sodium diet.
c. Increase oral fluid intake.
d. Weigh the patient daily.
ANS: B
A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake
and output does not control fluid accumulation, nor does weighing the client. These
interventions merely assess or monitor the situation. Increasing fluid intake would not be
helpful.
DIF: Applying TOP: Integrated Process: Nursing Process: Planning and Implementation
KEY: Cirrhosis, Diet therapy
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
3. The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which
assessment finding would require immediate action by the nurse?
a. Urine output via indwelling urinary catheter is 20 mL/hr
b. Blood pressure increases from 110/58 to 120/62 mm Hg
c. Respiratory rate decreases from 22 to 16 breaths/min
d. A decrease in the client9s weight by 3 lb (1.4 kg)
ANS: A
467
, Rapid removal of ascitic fluid causes decreased abdominal pressure, which can contribute to
hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A
slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate
indicates that breathing has been made easier by the procedure. The nurse would expect the
client9s weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000
mL are usually removed from the abdomen at one time. The patient9s weight typically only
decreases by less than 2 kg or 4.4 lb.
DIF: Applying TOP: Integrated Process: Nursing Process: Analysis
KEY: Cirrhosis, Management
MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
4. The nurse is caring for a client who has a risk gene for developing cirrhosis. Which
racial/ethnic group has this gene most often?
a. Blacks
b. Asian/Pacific Islanders
c. Latinos
d. French
ANS: C
The Patatin-like phospholipase domain containing 3 gene (PNPLA3) has been identified as a
risk gene for cirrhosis, which occurs most often in Latinos when compared to other
populations.
DIF: Remembering TOP: Integrated Process: Culture and Spirituality
KEY: Cirrhosis, Risk factors
MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation
5. The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client
is thin and cachectic, and the family expresses distress that the patient is receiving little
dietary protein. How would the nurse respond?
a. <A low-protein diet will help the liver rest and will restore liver function.=
b. <Less protein in the diet will help prevent confusion associated with liver failure.=
c. <Increasing dietary protein will help the patient gain weight and muscle mass.=
d. <Low dietary protein is needed to prevent fluid from leaking into the abdomen.=
ANS: B
A low-protein diet is prescribed when serum ammonia levels increase and/or the client shows
signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia
by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has
no impact on restoring liver function. Increasing the patient9s dietary protein will cause
complications of liver failure and would not be suggested. Increased intravascular protein will
help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary
protein.
DIF: Applying TOP: Integrated Process: Teaching/Learning
KEY: Cirrhosis, Diet therapy
MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort
6. The nurse is caring for a client who is prescribed lactulose. The client states, <I do not want to
take this medication because it causes diarrhea.= How would the nurse respond?
468
