GRADE A+ Cirrhosis NCLEX Style Questions with ans 2025
A 54-year-old patient admitted with diabetes mellitus, malnutrition,
osteomyelitis, and alcohol abuse has a serum amylase level of
Alcohol abuse
280 U/L and a serum lipase level of 310 U/L. To what diagnosis
The patient with alcohol abuse could develop pancreatitis as a
does the nurse attribute these findings?
complication, which would increase the serum amylase (normal
Malnutrition
30-122 U/L) and serum lipase (normal 31-186 U/L) levels as
Osteomyelitis
shown.
Alcohol abuse
Diabetes mellitus
The health care provider orders lactulose for a patient with hepatic Decreased ammonia levels
encephalopathy. The nurse will monitor for effectiveness of this
Hepatic encephalopathy is a complication of liver disease and is
medication for this patient by assessing what?
associated with elevated serum ammonia levels. Lactulose traps
Relief of constipation
ammonia in the intestinal tract. Its laxative effect then expels the
Relief of abdominal pain
ammonia from the colon, resulting in decreased serum ammonia
Decreased liver enzymes
levels and correction of hepatic encephalopathy.
Decreased ammonia levels
The family of a patient newly diagnosed with hepatitis A asks the
nurse what they can do to prevent becoming ill themselves. Which
"An injection of immunoglobulin will need to be given to prevent or
response by the nurse is most appropriate?
minimize the effects from this exposure."
"The hepatitis vaccine will provide immunity from this exposure
and future exposures."
Immunoglobulin provides temporary (1-2 months) passive immu-
"I am afraid there is nothing you can do since the patient was
nity and is effective for preventing hepatitis A if given within 2
infectious before admission."
weeks after exposure. It may not prevent infection in all persons,
"You will need to be tested first to make sure you don't have the
but it will at least modify the illness to a subclinical infection. The
virus before we can treat you."
hepatitis vaccine is only used for preexposure prophylaxis.
"An injection of immunoglobulin will need to be given to prevent
or minimize the effects from this exposure."
When planning care for a patient with cirrhosis, the nurse will give
highest priority to which nursing diagnosis?
Ineffective breathing pattern related to pressure on diaphragm and
Impaired skin integrity related to edema, ascites, and pruritus
reduced lung volume
Imbalanced nutrition: less than body requirements related to
anorexia
Although all of these nursing diagnoses are appropriate and im-
Excess fluid volume related to portal hypertension and hyperal-
portant in the care of a patient with cirrhosis, airway and breathing
dosteronism
are always the highest priorities.
Ineffective breathing pattern related to pressure on diaphragm
and reduced lung volume
Use smallest gauge needle possible when giving injections or
drawing blood.
When caring for a patient with liver disease, the nurse recognizes Teach patient to avoid straining at stool, vigorous blowing of nose,
the need to prevent bleeding resulting from altered clotting factors and coughing.
and rupture of varices. Which nursing interventions would be Advise patient to use soft-bristle toothbrush and avoid ingestion
appropriate to achieve this outcome (select all that apply)? of irritating food.
Use smallest gauge needle possible when giving injections or Instruct patient to avoid aspirin and NSAIDs to prevent hemor-
drawing blood. rhage when varices are present.
Teach patient to avoid straining at stool, vigorous blowing of nose,
and coughing. Using the smallest gauge needle for injections will minimize the
Advise patient to use soft-bristle toothbrush and avoid ingestion risk of bleeding into the tissues. Avoiding straining, nose blowing,
of irritating food. and coughing will reduce the risk of hemorrhage at these sites. The
Apply gentle pressure for the shortest possible time period after use of a soft-bristle toothbrush and avoidance of irritating food will
performing venipuncture. reduce injury to highly vascular mucous membranes. The nurse
Instruct patient to avoid aspirin and NSAIDs to prevent hemor- should apply gentle but prolonged pressure to venipuncture sites
rhage when varices are present. to minimize the risk of bleeding. Aspirin and NSAIDs should not
be used in patients with liver disease because they interfere with
platelet aggregation, thus increasing the risk for bleeding.
patient with type 2 diabetes and cirrhosis asks the nurse if it Milk thistle may affect liver enzymes and thus alter drug metabo-
would be okay to take silymarin (milk thistle) to help minimize liver lism.
damage. The nurse responds based on what knowledge?
There is good scientific evidence that there is no real benefit from
Milk thistle may affect liver enzymes and thus alter drug metab-
using milk thistle to protect the liver cells from toxic damage in the
olism.
treatment of cirrhosis. Milk thistle does affect liver enzymes and
Milk thistle is generally safe in recommended doses for up to 10
thus could alter drug metabolism. Therefore patients will need to
years.
be monitored for drug interactions. It is noted to be safe for up to
There is unclear scientific evidence for the use of milk thistle in
1/6
, GRADE A+ Cirrhosis NCLEX Style Questions with ans 2025
treating cirrhosis.
6 years, not 10 years, and it may lower, not elevate, blood glucose
Milk thistle may elevate the serum glucose levels and is thus
levels.
contraindicated in diabetes.
When caring for a patient with a biliary obstruction, the nurse will Vitamin A Correct
anticipate administering which vitamin supplements (select all that Vitamin D Correct
apply)? Vitamin E Correct
Vitamin A Vitamin K Correct
Vitamin D Biliary obstruction prevents bile from entering the small intestine
Vitamin E and thus prevents the absorption of fat-soluble vitamins. Vitamins
Vitamin K A, D, E, and K are all fat-soluble and thus would need to be
Vitamin B supplemented in a patient with biliary obstruction.
A patient who has hepatitis B surface antigen (HBsAg) in the
Hydrocodone with acetaminophen (Vicodin)
serum is being discharged with pain medication after knee
surgery. Which medication order should the nurse question be-
The analgesic with acetaminophen should be questioned because
cause it is most likely to cause hepatic complications?
this patient is a chronic carrier of hepatitis B and is likely to
Tramadol (Ultram)
have impaired liver function. Acetaminophen is not suitable for this
Hydromorphone (Dilaudid)
patient because it is converted to a toxic metabolite in the liver
Oxycodone with aspirin (Percodan)
after absorption, increasing the risk of hepatocellular damage.
Hydrocodone with acetaminophen (Vicodin)
The condition of a patient who has cirrhosis of the liver has
Hepatic structure ultrasound
deteriorated. Which diagnostic study would help determine if the
Hepatic structure ultrasound, CT, and MRI are used to screen and
patient has developed liver cancer?
diagnose liver cancer. Serum ±f-etoprotein level may be elevat-
Serum ±f-etoprotein level
ed with liver cancer or other liver problems. Ventilation/perfusion
Ventilation/perfusion scan
scans do not diagnose liver cancer. Abdominal girth measurement
Hepatic structure ultrasound
would not differentiate between cirrhosis and liver cancer.
Abdominal girth measurement
The patient with right upper quadrant abdominal pain has an Control abdominal pain.
abdominal ultrasound that reveals cholelithiasis. What should the
Patients with cholelithiasis can have severe pain, so controlling
nurse expect to do for this patient?
pain is important until the problem can be treated. NPO status may
Prevent all oral intake.
be needed if the patient will have surgery but will not be used for all
Control abdominal pain.
patients with cholelithiasis. Enteral feedings should not be needed,
Provide enteral feedings.
and avoiding dietary cholesterol is not used to treat cholelithiasis.
Avoid dietary cholesterol.
ctivated partial thromboplastin time (aPTT) of 54 seconds
A patient with cholelithiasis needs to have the gallbladder re-
Multiple obstructions in the cystic and common bile duct
moved. Which patient assessment is a contraindication for a
An aPTT of 54 seconds is above normal and indicates insufficient
cholecystectomy?
clotting ability. If the patient had surgery, significant bleeding com-
Low-grade fever of 100° F and dehydration
plications postoperatively are very likely. Fluids can be given to
Abscess in the right upper quadrant of the abdomen
eliminate the dehydration; the abscess can be assessed, and the
Activated partial thromboplastin time (aPTT) of 54 seconds
obstructions in the cystic and common bile duct would be relieved
with the cholecystectomy.
"I will need to be checked for chronic HCV and other liver prob-
lems."
When teaching the patient with acute hepatitis C (HCV), the pa-
The majority of patients who acquire HCV usually develop chronic
tient demonstrates understanding when the patient makes which
infection, which may lead to cirrhosis or liver cancer. HCV is not
statement?
transmitted via saliva, but percutaneously and via high-risk sexual
"I will use care when kissing my wife to prevent giving it to her."
activity exposure. The treatment for acute viral hepatitis focuses
"I will need to take adofevir (Hepsera) to prevent chronic HCV."
on resting the body and adequate nutrition for liver regeneration.
"Now that I have had HCV, I will have immunity and not get it
Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with
again."
liver failure. Chronic HCV is treated with pegylated interferon with
"I will need to be checked for chronic HCV and other liver prob-
ribavirin. Immunity with HCV does not occur as it does with HAV
lems."
and HBV, so the patient may be reinfected with another type of
HCV.
The patient with cirrhosis has an increased abdominal girth from There is decreased colloid oncotic pressure from the liver's inabil-
ascites. The nurse should know that this fluid gathers in the ab- ity to synthesize albumin. Correct
domen for which reasons (select all that apply)? Hyperaldosteronism related to damaged hepatocytes increases
There is decreased colloid oncotic pressure from the liver's in- sodium and fluid retention. Correct
ability to synthesize albumin. Portal hypertension pushes proteins from the blood vessels,
Hyperaldosteronism related to damaged hepatocytes increases causing leaking into the peritoneal cavity. Correct
2/6
A 54-year-old patient admitted with diabetes mellitus, malnutrition,
osteomyelitis, and alcohol abuse has a serum amylase level of
Alcohol abuse
280 U/L and a serum lipase level of 310 U/L. To what diagnosis
The patient with alcohol abuse could develop pancreatitis as a
does the nurse attribute these findings?
complication, which would increase the serum amylase (normal
Malnutrition
30-122 U/L) and serum lipase (normal 31-186 U/L) levels as
Osteomyelitis
shown.
Alcohol abuse
Diabetes mellitus
The health care provider orders lactulose for a patient with hepatic Decreased ammonia levels
encephalopathy. The nurse will monitor for effectiveness of this
Hepatic encephalopathy is a complication of liver disease and is
medication for this patient by assessing what?
associated with elevated serum ammonia levels. Lactulose traps
Relief of constipation
ammonia in the intestinal tract. Its laxative effect then expels the
Relief of abdominal pain
ammonia from the colon, resulting in decreased serum ammonia
Decreased liver enzymes
levels and correction of hepatic encephalopathy.
Decreased ammonia levels
The family of a patient newly diagnosed with hepatitis A asks the
nurse what they can do to prevent becoming ill themselves. Which
"An injection of immunoglobulin will need to be given to prevent or
response by the nurse is most appropriate?
minimize the effects from this exposure."
"The hepatitis vaccine will provide immunity from this exposure
and future exposures."
Immunoglobulin provides temporary (1-2 months) passive immu-
"I am afraid there is nothing you can do since the patient was
nity and is effective for preventing hepatitis A if given within 2
infectious before admission."
weeks after exposure. It may not prevent infection in all persons,
"You will need to be tested first to make sure you don't have the
but it will at least modify the illness to a subclinical infection. The
virus before we can treat you."
hepatitis vaccine is only used for preexposure prophylaxis.
"An injection of immunoglobulin will need to be given to prevent
or minimize the effects from this exposure."
When planning care for a patient with cirrhosis, the nurse will give
highest priority to which nursing diagnosis?
Ineffective breathing pattern related to pressure on diaphragm and
Impaired skin integrity related to edema, ascites, and pruritus
reduced lung volume
Imbalanced nutrition: less than body requirements related to
anorexia
Although all of these nursing diagnoses are appropriate and im-
Excess fluid volume related to portal hypertension and hyperal-
portant in the care of a patient with cirrhosis, airway and breathing
dosteronism
are always the highest priorities.
Ineffective breathing pattern related to pressure on diaphragm
and reduced lung volume
Use smallest gauge needle possible when giving injections or
drawing blood.
When caring for a patient with liver disease, the nurse recognizes Teach patient to avoid straining at stool, vigorous blowing of nose,
the need to prevent bleeding resulting from altered clotting factors and coughing.
and rupture of varices. Which nursing interventions would be Advise patient to use soft-bristle toothbrush and avoid ingestion
appropriate to achieve this outcome (select all that apply)? of irritating food.
Use smallest gauge needle possible when giving injections or Instruct patient to avoid aspirin and NSAIDs to prevent hemor-
drawing blood. rhage when varices are present.
Teach patient to avoid straining at stool, vigorous blowing of nose,
and coughing. Using the smallest gauge needle for injections will minimize the
Advise patient to use soft-bristle toothbrush and avoid ingestion risk of bleeding into the tissues. Avoiding straining, nose blowing,
of irritating food. and coughing will reduce the risk of hemorrhage at these sites. The
Apply gentle pressure for the shortest possible time period after use of a soft-bristle toothbrush and avoidance of irritating food will
performing venipuncture. reduce injury to highly vascular mucous membranes. The nurse
Instruct patient to avoid aspirin and NSAIDs to prevent hemor- should apply gentle but prolonged pressure to venipuncture sites
rhage when varices are present. to minimize the risk of bleeding. Aspirin and NSAIDs should not
be used in patients with liver disease because they interfere with
platelet aggregation, thus increasing the risk for bleeding.
patient with type 2 diabetes and cirrhosis asks the nurse if it Milk thistle may affect liver enzymes and thus alter drug metabo-
would be okay to take silymarin (milk thistle) to help minimize liver lism.
damage. The nurse responds based on what knowledge?
There is good scientific evidence that there is no real benefit from
Milk thistle may affect liver enzymes and thus alter drug metab-
using milk thistle to protect the liver cells from toxic damage in the
olism.
treatment of cirrhosis. Milk thistle does affect liver enzymes and
Milk thistle is generally safe in recommended doses for up to 10
thus could alter drug metabolism. Therefore patients will need to
years.
be monitored for drug interactions. It is noted to be safe for up to
There is unclear scientific evidence for the use of milk thistle in
1/6
, GRADE A+ Cirrhosis NCLEX Style Questions with ans 2025
treating cirrhosis.
6 years, not 10 years, and it may lower, not elevate, blood glucose
Milk thistle may elevate the serum glucose levels and is thus
levels.
contraindicated in diabetes.
When caring for a patient with a biliary obstruction, the nurse will Vitamin A Correct
anticipate administering which vitamin supplements (select all that Vitamin D Correct
apply)? Vitamin E Correct
Vitamin A Vitamin K Correct
Vitamin D Biliary obstruction prevents bile from entering the small intestine
Vitamin E and thus prevents the absorption of fat-soluble vitamins. Vitamins
Vitamin K A, D, E, and K are all fat-soluble and thus would need to be
Vitamin B supplemented in a patient with biliary obstruction.
A patient who has hepatitis B surface antigen (HBsAg) in the
Hydrocodone with acetaminophen (Vicodin)
serum is being discharged with pain medication after knee
surgery. Which medication order should the nurse question be-
The analgesic with acetaminophen should be questioned because
cause it is most likely to cause hepatic complications?
this patient is a chronic carrier of hepatitis B and is likely to
Tramadol (Ultram)
have impaired liver function. Acetaminophen is not suitable for this
Hydromorphone (Dilaudid)
patient because it is converted to a toxic metabolite in the liver
Oxycodone with aspirin (Percodan)
after absorption, increasing the risk of hepatocellular damage.
Hydrocodone with acetaminophen (Vicodin)
The condition of a patient who has cirrhosis of the liver has
Hepatic structure ultrasound
deteriorated. Which diagnostic study would help determine if the
Hepatic structure ultrasound, CT, and MRI are used to screen and
patient has developed liver cancer?
diagnose liver cancer. Serum ±f-etoprotein level may be elevat-
Serum ±f-etoprotein level
ed with liver cancer or other liver problems. Ventilation/perfusion
Ventilation/perfusion scan
scans do not diagnose liver cancer. Abdominal girth measurement
Hepatic structure ultrasound
would not differentiate between cirrhosis and liver cancer.
Abdominal girth measurement
The patient with right upper quadrant abdominal pain has an Control abdominal pain.
abdominal ultrasound that reveals cholelithiasis. What should the
Patients with cholelithiasis can have severe pain, so controlling
nurse expect to do for this patient?
pain is important until the problem can be treated. NPO status may
Prevent all oral intake.
be needed if the patient will have surgery but will not be used for all
Control abdominal pain.
patients with cholelithiasis. Enteral feedings should not be needed,
Provide enteral feedings.
and avoiding dietary cholesterol is not used to treat cholelithiasis.
Avoid dietary cholesterol.
ctivated partial thromboplastin time (aPTT) of 54 seconds
A patient with cholelithiasis needs to have the gallbladder re-
Multiple obstructions in the cystic and common bile duct
moved. Which patient assessment is a contraindication for a
An aPTT of 54 seconds is above normal and indicates insufficient
cholecystectomy?
clotting ability. If the patient had surgery, significant bleeding com-
Low-grade fever of 100° F and dehydration
plications postoperatively are very likely. Fluids can be given to
Abscess in the right upper quadrant of the abdomen
eliminate the dehydration; the abscess can be assessed, and the
Activated partial thromboplastin time (aPTT) of 54 seconds
obstructions in the cystic and common bile duct would be relieved
with the cholecystectomy.
"I will need to be checked for chronic HCV and other liver prob-
lems."
When teaching the patient with acute hepatitis C (HCV), the pa-
The majority of patients who acquire HCV usually develop chronic
tient demonstrates understanding when the patient makes which
infection, which may lead to cirrhosis or liver cancer. HCV is not
statement?
transmitted via saliva, but percutaneously and via high-risk sexual
"I will use care when kissing my wife to prevent giving it to her."
activity exposure. The treatment for acute viral hepatitis focuses
"I will need to take adofevir (Hepsera) to prevent chronic HCV."
on resting the body and adequate nutrition for liver regeneration.
"Now that I have had HCV, I will have immunity and not get it
Adofevir (Hepsera) is taken for severe hepatitis B (HBV) with
again."
liver failure. Chronic HCV is treated with pegylated interferon with
"I will need to be checked for chronic HCV and other liver prob-
ribavirin. Immunity with HCV does not occur as it does with HAV
lems."
and HBV, so the patient may be reinfected with another type of
HCV.
The patient with cirrhosis has an increased abdominal girth from There is decreased colloid oncotic pressure from the liver's inabil-
ascites. The nurse should know that this fluid gathers in the ab- ity to synthesize albumin. Correct
domen for which reasons (select all that apply)? Hyperaldosteronism related to damaged hepatocytes increases
There is decreased colloid oncotic pressure from the liver's in- sodium and fluid retention. Correct
ability to synthesize albumin. Portal hypertension pushes proteins from the blood vessels,
Hyperaldosteronism related to damaged hepatocytes increases causing leaking into the peritoneal cavity. Correct
2/6
