Chapter 43 Assessment and Management of Patients With Hepatic
Disorders
1. A nurse is caring for a patient with liver failure and is performing an assessment in the
knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is
related to the patient's inability to synthesize prothrombin in the liver. What factor most likely
contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: D
Feedback:
Decreased production of several clotting factors may be partially due to deficient absorption of
vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K
to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or
albumin.
2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What
technique should the nurse use to palpate the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other
hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly. Ans: C
Feedback:
To palpate the liver, the examiner places one hand under the right lower rib cage and
, presses downward with light pressure with the other hand. The liver is not on the left side or in
the right lower abdominal quadrant.
3. A patient with portal hypertension has been admitted to the medical floor. The nurse should
prioritize which of the following assessments related to the manifestations of this health
problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
Ans: C
Feedback:
Obstruction to blood flow through the damaged liver results in increased blood pressure
(portal hypertension) throughout the portal venous system. This can result in varices and
ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal
girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not
create a risk for unstable blood glucose or VTE.
, 4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks
for contracting hepatitis B. What preventative measures should the educator promote? Select
all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections E) Annual vitamin B12 injections Ans: A, B
Feedback:
People who are at high risk, including nurses and other health care personnel exposed to blood
or blood products, should receive active immunization. The consistent use of standard
precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual's risk
of HBV.
5. A nurse is caring for a patient with cancer of the liver whose condition has required the
insertion of a percutaneous biliary drainage system. The nurse's most recent
assessment reveals the presence of dark green fluid in the collection container. What is the
nurse's best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
Ans: A
Feedback:
Bile is usually a dark green or brownish-yellow color, so this would constitute an expected
assessment finding, with no other action necessary.
Disorders
1. A nurse is caring for a patient with liver failure and is performing an assessment in the
knowledge of the patient's increased risk of bleeding. The nurse recognizes that this risk is
related to the patient's inability to synthesize prothrombin in the liver. What factor most likely
contributes to this loss of function?
A) Alterations in glucose metabolism
B) Retention of bile salts
C) Inadequate production of albumin by hepatocytes
D) Inability of the liver to use vitamin K
Ans: D
Feedback:
Decreased production of several clotting factors may be partially due to deficient absorption of
vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K
to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or
albumin.
2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What
technique should the nurse use to palpate the patient's liver?
A) Place hand under the right lower abdominal quadrant and press down lightly with the other
hand.
B) Place the left hand over the abdomen and behind the left side at the 11th rib.
C) Place hand under right lower rib cage and press down lightly with the other hand.
D) Hold hand 90 degrees to right side of the abdomen and push down firmly. Ans: C
Feedback:
To palpate the liver, the examiner places one hand under the right lower rib cage and
, presses downward with light pressure with the other hand. The liver is not on the left side or in
the right lower abdominal quadrant.
3. A patient with portal hypertension has been admitted to the medical floor. The nurse should
prioritize which of the following assessments related to the manifestations of this health
problem?
A) Assessment of blood pressure and assessment for headaches and visual changes
B) Assessments for signs and symptoms of venous thromboembolism
C) Daily weights and abdominal girth measurement
D) Blood glucose monitoring q4h
Ans: C
Feedback:
Obstruction to blood flow through the damaged liver results in increased blood pressure
(portal hypertension) throughout the portal venous system. This can result in varices and
ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal
girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not
create a risk for unstable blood glucose or VTE.
, 4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks
for contracting hepatitis B. What preventative measures should the educator promote? Select
all that apply.
A) Immunization
B) Use of standard precautions
C) Consumption of a vitamin-rich diet
D) Annual vitamin K injections E) Annual vitamin B12 injections Ans: A, B
Feedback:
People who are at high risk, including nurses and other health care personnel exposed to blood
or blood products, should receive active immunization. The consistent use of standard
precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual's risk
of HBV.
5. A nurse is caring for a patient with cancer of the liver whose condition has required the
insertion of a percutaneous biliary drainage system. The nurse's most recent
assessment reveals the presence of dark green fluid in the collection container. What is the
nurse's best response to this assessment finding?
A) Document the presence of normal bile output.
B) Irrigate the drainage system with normal saline as ordered.
C) Aspirate a sample of the drainage for culture.
D) Promptly report this assessment finding to the primary care provider.
Ans: A
Feedback:
Bile is usually a dark green or brownish-yellow color, so this would constitute an expected
assessment finding, with no other action necessary.
