Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 922
Surgicalw Nursingw 14ew (Hinklew 2017)
Chapter 49: Assessment and Management of Patients with Hepatic Disorde
w w w w w w w w w
rs
1. Awnursewiswcaringwforwawpatientwwithwliverwfailurewandwiswperformingwanwassessmentwinwthewknowledgewo
fwthewpatientswincreasedwriskwofwbleeding.wThewnursewrecognizeswthatwthiswriskwiswrelatedwtowthewpatients
winabilitywto wsynthesize wprothrombinwinwthewliver. wWhat wfactorwmostwlikelywcontributes wto wthiswlosswofw
function?
A) Alterationswinwglucosewmetabolism
B) Retentionwofwbilewsalts
C) Inadequatewproductionwofwalbuminwbywhepatocytes
D) Inabilitywofwthewliverwtowusewvitaminw
KwAns: D
Feedback:
Decreasedwproductionwofwseveralwclottingwfactorswmaywbewpartiallywduewtowdeficientwabsorptionwofwvita
minwKwfromwthewGIwtract.wThiswprobablywiswcausedwbywthewinabilitywofwliverwcellswtowusewvitaminwKwto
wmakewprothrombin. wThiswbleedingwriskwiswunrelated wto wthewroleswofwglucose, wbilewsalts, wor walbumin.
2. Awnursewiswperformingwanwadmissionwassessmentwofwawpatientwwithwawdiagnosiswofwcirrhosis.w
Whatwtechniquewshouldwthewnursewusewtowpalpatewthewpatientswliver?
A) Placewhandwunderwthewrightwlowerwabdominalwquadrantwandwpresswdownwlightlywwithwthewotherwhand.
B) Placewthewleftwhandwoverwthewabdomenwandwbehindwthewleftwsidewatwthew11thwrib.
C) Placewhandwunderwrightwlowerwribwcagewandwpresswdownwlightlywwithwthewotherwhand.
D) Holdwhandw90wdegreeswtowrightwsidewofwthewabdomenwandwpushwdownwfirmly.
Ans: C
Feedback:
Towpalpatewthewliver,wthewexaminerwplaceswonewhandwunderwthewrightwlowerwribwcagewandwpresseswdown
wardwwithwlightwpressurewwithwthewotherwhand.wThewliverwiswnotwonwthewleftwsideworwinwthewrightwlowerw
abdominalwquadrant.
3. Awpatientwwithwportalwhypertensionwhaswbeenwadmittedwtowthewmedicalwfloor.wThewnursewshouldwprioritize
,Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 923
Surgicalw Nursingw 14ew (Hinklew 2017)
whichwofwthewfollowingwassessmentswrelatedwtowthewmanifestationswofwthiswhealthwproblem?
A) Assessmentwofwbloodwpressurewandwassessmentwforwheadacheswandwvisualwchanges
B) Assessmentswforwsignswandwsymptomswofwvenouswthromboembolism
C) Dailywweightswandwabdominalwgirthwmeasurement
D) Bloodwglucosewmonitoringwq4h
Ans: C
Feedback:
Obstructionwtowbloodwflowwthroughwthewdamagedwliverwresultswinwincreasedwbloodwpressurew(portalwhyp
ertension)wthroughoutwthewportalwvenouswsystem.wThiswcanwresultwinwvariceswandwasciteswinwthewabdomi
nalwcavity.wAssessmentswrelatedwtowasciteswarewdailywweightswandwabdominalwgirths.wPortalwhypertensio
nwiswnotwsynonymouswwithwcardiovascularwhypertensionwandwdoeswnotwcreatewawriskwforwunstablewbloodw
glucoseworwVTE.
4. Awnurseweducatorwiswteachingwawgroupwofwrecentwnursingwgraduateswaboutwtheirwoccupationalwriskswfor
wcontractingwhepatitiswB.wWhatwpreventative wmeasureswshouldwtheweducator wpromote? wSelectwallwthatwa
pply.
A) Immunization
B) Usewofwstandardwprecautions
C) Consumptionwofwawvitamin-richwdiet
D) AnnualwvitaminwKwinjections
E) AnnualwvitaminwB12winjections
Ans: A,wB
Feedback:
Peoplewwhowarewatwhighwrisk,wincludingwnurseswandwotherwhealthwcarewpersonnelwexposedwtowbloodworwb
loodwproducts,wshouldwreceivewactivewimmunization.wThewconsistentwusewofwstandardwprecautionswiswals
owhighlywbeneficial.wVitaminwsupplementationwiswunrelatedwtowanwindividualswriskwofwHBV.
5. Awnursewiswcaringwforwawpatientwwithwcancerwofwthewliverwwhosewconditionwhaswrequiredwthewinsertion
wofwawpercutaneouswbiliarywdrainage wsystem. wThewnurseswmostwrecentwassessmentwreveals wthewpresenc
ewofwdarkwgreenwfluidwinwthewcollectionwcontainer.wWhatwiswthewnurseswbestwresponsewtowthiswassessm
entwfinding?
,Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 924
Surgicalw Nursingw 14ew (Hinklew 2017)
A) Documentwthewpresencewofwnormalwbilewoutput.
B) Irrigatewthewdrainagewsystemwwithwnormalwsalinewaswordered.
C) Aspiratewawsamplewofwthewdrainagewforwculture.
D) Promptlywreportwthiswassessmentwfindingwtowthewprimarywcarewprovider.
Ans: A
Feedback:
Bilewiswusuallywawdarkwgreenworwbrownish-
yellowwcolor,wsowthiswwouldwconstitutewanwexpectedwassessmentwfinding,wwithwnowotherwactionwnecessar
y.
6. Awpatientwwhowhaswundergonewliverwtransplantationwiswreadywtowbewdischargedwhome.wWhichwoutcom
ewofwhealthweducationwshouldwthewnursewprioritize?
A) ThewpatientwwillwobtainwmeasurementwofwdrainagewfromwthewT-tube.
B) Thewpatientwwillwexercisewthreewtimeswawweek.
C) Thewpatientwwillwtakewimmunosuppressivewagentswaswrequired.
D) Thewpatientwwillwmonitorwforwsignswofwliverwdysfunction.
Ans: C
Feedback:
Thewpatientwiswgivenwwrittenwandwverbalwinstructionswaboutwimmunosuppressivewagentwdoseswandwdosin
gwschedules.wThewpatientwiswalsowinstructedwonwstepswtowfollowwtowensurewthatwanwadequatewsupplywofw
medicationwiswavailablewsowthatwtherewiswnowchancewofwrunningwoutwofwthewmedicationworwskippingwawdo
se.wFailurewtowtakewmedicationswaswinstructedwmaywprecipitatewrejection.wThewnursewwouldwnotwteachwthe
wpatientwtowmeasure wdrainage wfromwawT-tubewaswthewpatientwwouldntwgo whomewwithwawT-
tube.wThewnursewmaywteachwthewpatientwaboutwthewneedwtowexerciseworwwhatwthewsignswofwliverwdysfunct
ionware,wbutwthewnursewwouldwnotwstresswthesewtopicswoverwthewimmunosuppressivewdrugwregimen.
7. Awtriagewnursewinwthewemergencywdepartmentwiswassessingwawpatientwwhowpresentedwwithwcomplaint
swofwgeneralwmalaise.wAssessmentwrevealswthewpresencewofwjaundicewandwincreasedwabdominalwgirt
h.wWhatwassessmentwquestionwbestwaddresseswthewpossiblewetiologywofwthiswpatientswpresentation?
A) Howwmanywalcoholicwdrinkswdowyouwtypicallywconsumewinwawweek?
B) Towthewbestwofwyourwknowledge,warewyourwimmunizationswupwtowdate?
C) Havewyouweverwworkedwinwanwoccupationwwherewyouwmightwhavewbeenwexposedwtowtoxins?
, Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 925
Surgicalw Nursingw 14ew (Hinklew 2017)
D) Haswanyonewinwyourwfamilyweverwexperiencedwsymptomswsimilarwtowyours?
Ans: A
Feedback:
Signsworwsymptomswofwhepaticwdysfunctionwindicatewawneedwtowassesswforwalcoholwuse.wImmunizationwsta
tus,woccupationalwrisks,wandwfamilywhistorywarewalsowrelevantwconsiderations,wbutwalcoholwusewiswawmore
wcommonwetiologicwfactor winwliver wdisease.
8. Awnursewiswparticipatingwinwthewemergencywcarewofwawpatientwwhowhaswjustwdevelopedwvaricealwbleed
ing.wWhatwinterventionwshouldwthewnursewanticipate?
A) Infusionwofwintravenouswheparin
B) IVwadministrationwofwalbumin
C) STATwadministrationwofwvitaminwKwbywthewintramuscularwroute
D) IVwadministrationwofwoctreotidew(Sandostatin
)wAns: D
Feedback:
Octreotidew(Sandostatin)awsyntheticwanalogwofwthewhormonewsomatostatinisweffectivewinwdecreasingwble
edingwfromwesophagealwvarices,wandwlackswthewvasoconstrictiveweffectswofwvasopressin.wBecausewofwthis
wsafetywand wefficacywprofile, woctreotidewiswconsideredwthewpreferredwtreatment wregimenwforwimmediate w
controlwofwvaricealwbleeding.wVitaminwKwandwalbuminwarewnotwadministeredwandwheparinwwouldwexacerb
ate,wnotwalleviate,wbleeding.
9. Awnursewiswcaringwforwawpatientwwithwhepaticwencephalopathy.wWhilewmakingwthewinitialwshiftwassessm
ent,wthewnursewnoteswthatwthewpatientwhaswawflappingwtremorwofwthewhands.wThewnursewshouldwdocume
ntwthewpresencewofwwhatwsignwofwliverwdisease?
A) Asterixis
B) Constructionalw apraxia
C) Fetorwhepaticus
D) Palmarwerythema
Ans: A
Surgicalw Nursingw 14ew (Hinklew 2017)
Chapter 49: Assessment and Management of Patients with Hepatic Disorde
w w w w w w w w w
rs
1. Awnursewiswcaringwforwawpatientwwithwliverwfailurewandwiswperformingwanwassessmentwinwthewknowledgewo
fwthewpatientswincreasedwriskwofwbleeding.wThewnursewrecognizeswthatwthiswriskwiswrelatedwtowthewpatients
winabilitywto wsynthesize wprothrombinwinwthewliver. wWhat wfactorwmostwlikelywcontributes wto wthiswlosswofw
function?
A) Alterationswinwglucosewmetabolism
B) Retentionwofwbilewsalts
C) Inadequatewproductionwofwalbuminwbywhepatocytes
D) Inabilitywofwthewliverwtowusewvitaminw
KwAns: D
Feedback:
Decreasedwproductionwofwseveralwclottingwfactorswmaywbewpartiallywduewtowdeficientwabsorptionwofwvita
minwKwfromwthewGIwtract.wThiswprobablywiswcausedwbywthewinabilitywofwliverwcellswtowusewvitaminwKwto
wmakewprothrombin. wThiswbleedingwriskwiswunrelated wto wthewroleswofwglucose, wbilewsalts, wor walbumin.
2. Awnursewiswperformingwanwadmissionwassessmentwofwawpatientwwithwawdiagnosiswofwcirrhosis.w
Whatwtechniquewshouldwthewnursewusewtowpalpatewthewpatientswliver?
A) Placewhandwunderwthewrightwlowerwabdominalwquadrantwandwpresswdownwlightlywwithwthewotherwhand.
B) Placewthewleftwhandwoverwthewabdomenwandwbehindwthewleftwsidewatwthew11thwrib.
C) Placewhandwunderwrightwlowerwribwcagewandwpresswdownwlightlywwithwthewotherwhand.
D) Holdwhandw90wdegreeswtowrightwsidewofwthewabdomenwandwpushwdownwfirmly.
Ans: C
Feedback:
Towpalpatewthewliver,wthewexaminerwplaceswonewhandwunderwthewrightwlowerwribwcagewandwpresseswdown
wardwwithwlightwpressurewwithwthewotherwhand.wThewliverwiswnotwonwthewleftwsideworwinwthewrightwlowerw
abdominalwquadrant.
3. Awpatientwwithwportalwhypertensionwhaswbeenwadmittedwtowthewmedicalwfloor.wThewnursewshouldwprioritize
,Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 923
Surgicalw Nursingw 14ew (Hinklew 2017)
whichwofwthewfollowingwassessmentswrelatedwtowthewmanifestationswofwthiswhealthwproblem?
A) Assessmentwofwbloodwpressurewandwassessmentwforwheadacheswandwvisualwchanges
B) Assessmentswforwsignswandwsymptomswofwvenouswthromboembolism
C) Dailywweightswandwabdominalwgirthwmeasurement
D) Bloodwglucosewmonitoringwq4h
Ans: C
Feedback:
Obstructionwtowbloodwflowwthroughwthewdamagedwliverwresultswinwincreasedwbloodwpressurew(portalwhyp
ertension)wthroughoutwthewportalwvenouswsystem.wThiswcanwresultwinwvariceswandwasciteswinwthewabdomi
nalwcavity.wAssessmentswrelatedwtowasciteswarewdailywweightswandwabdominalwgirths.wPortalwhypertensio
nwiswnotwsynonymouswwithwcardiovascularwhypertensionwandwdoeswnotwcreatewawriskwforwunstablewbloodw
glucoseworwVTE.
4. Awnurseweducatorwiswteachingwawgroupwofwrecentwnursingwgraduateswaboutwtheirwoccupationalwriskswfor
wcontractingwhepatitiswB.wWhatwpreventative wmeasureswshouldwtheweducator wpromote? wSelectwallwthatwa
pply.
A) Immunization
B) Usewofwstandardwprecautions
C) Consumptionwofwawvitamin-richwdiet
D) AnnualwvitaminwKwinjections
E) AnnualwvitaminwB12winjections
Ans: A,wB
Feedback:
Peoplewwhowarewatwhighwrisk,wincludingwnurseswandwotherwhealthwcarewpersonnelwexposedwtowbloodworwb
loodwproducts,wshouldwreceivewactivewimmunization.wThewconsistentwusewofwstandardwprecautionswiswals
owhighlywbeneficial.wVitaminwsupplementationwiswunrelatedwtowanwindividualswriskwofwHBV.
5. Awnursewiswcaringwforwawpatientwwithwcancerwofwthewliverwwhosewconditionwhaswrequiredwthewinsertion
wofwawpercutaneouswbiliarywdrainage wsystem. wThewnurseswmostwrecentwassessmentwreveals wthewpresenc
ewofwdarkwgreenwfluidwinwthewcollectionwcontainer.wWhatwiswthewnurseswbestwresponsewtowthiswassessm
entwfinding?
,Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 924
Surgicalw Nursingw 14ew (Hinklew 2017)
A) Documentwthewpresencewofwnormalwbilewoutput.
B) Irrigatewthewdrainagewsystemwwithwnormalwsalinewaswordered.
C) Aspiratewawsamplewofwthewdrainagewforwculture.
D) Promptlywreportwthiswassessmentwfindingwtowthewprimarywcarewprovider.
Ans: A
Feedback:
Bilewiswusuallywawdarkwgreenworwbrownish-
yellowwcolor,wsowthiswwouldwconstitutewanwexpectedwassessmentwfinding,wwithwnowotherwactionwnecessar
y.
6. Awpatientwwhowhaswundergonewliverwtransplantationwiswreadywtowbewdischargedwhome.wWhichwoutcom
ewofwhealthweducationwshouldwthewnursewprioritize?
A) ThewpatientwwillwobtainwmeasurementwofwdrainagewfromwthewT-tube.
B) Thewpatientwwillwexercisewthreewtimeswawweek.
C) Thewpatientwwillwtakewimmunosuppressivewagentswaswrequired.
D) Thewpatientwwillwmonitorwforwsignswofwliverwdysfunction.
Ans: C
Feedback:
Thewpatientwiswgivenwwrittenwandwverbalwinstructionswaboutwimmunosuppressivewagentwdoseswandwdosin
gwschedules.wThewpatientwiswalsowinstructedwonwstepswtowfollowwtowensurewthatwanwadequatewsupplywofw
medicationwiswavailablewsowthatwtherewiswnowchancewofwrunningwoutwofwthewmedicationworwskippingwawdo
se.wFailurewtowtakewmedicationswaswinstructedwmaywprecipitatewrejection.wThewnursewwouldwnotwteachwthe
wpatientwtowmeasure wdrainage wfromwawT-tubewaswthewpatientwwouldntwgo whomewwithwawT-
tube.wThewnursewmaywteachwthewpatientwaboutwthewneedwtowexerciseworwwhatwthewsignswofwliverwdysfunct
ionware,wbutwthewnursewwouldwnotwstresswthesewtopicswoverwthewimmunosuppressivewdrugwregimen.
7. Awtriagewnursewinwthewemergencywdepartmentwiswassessingwawpatientwwhowpresentedwwithwcomplaint
swofwgeneralwmalaise.wAssessmentwrevealswthewpresencewofwjaundicewandwincreasedwabdominalwgirt
h.wWhatwassessmentwquestionwbestwaddresseswthewpossiblewetiologywofwthiswpatientswpresentation?
A) Howwmanywalcoholicwdrinkswdowyouwtypicallywconsumewinwawweek?
B) Towthewbestwofwyourwknowledge,warewyourwimmunizationswupwtowdate?
C) Havewyouweverwworkedwinwanwoccupationwwherewyouwmightwhavewbeenwexposedwtowtoxins?
, Testw Bankw -w Brunnerw &w Suddarth'swTextbookw ofw Medical- 925
Surgicalw Nursingw 14ew (Hinklew 2017)
D) Haswanyonewinwyourwfamilyweverwexperiencedwsymptomswsimilarwtowyours?
Ans: A
Feedback:
Signsworwsymptomswofwhepaticwdysfunctionwindicatewawneedwtowassesswforwalcoholwuse.wImmunizationwsta
tus,woccupationalwrisks,wandwfamilywhistorywarewalsowrelevantwconsiderations,wbutwalcoholwusewiswawmore
wcommonwetiologicwfactor winwliver wdisease.
8. Awnursewiswparticipatingwinwthewemergencywcarewofwawpatientwwhowhaswjustwdevelopedwvaricealwbleed
ing.wWhatwinterventionwshouldwthewnursewanticipate?
A) Infusionwofwintravenouswheparin
B) IVwadministrationwofwalbumin
C) STATwadministrationwofwvitaminwKwbywthewintramuscularwroute
D) IVwadministrationwofwoctreotidew(Sandostatin
)wAns: D
Feedback:
Octreotidew(Sandostatin)awsyntheticwanalogwofwthewhormonewsomatostatinisweffectivewinwdecreasingwble
edingwfromwesophagealwvarices,wandwlackswthewvasoconstrictiveweffectswofwvasopressin.wBecausewofwthis
wsafetywand wefficacywprofile, woctreotidewiswconsideredwthewpreferredwtreatment wregimenwforwimmediate w
controlwofwvaricealwbleeding.wVitaminwKwandwalbuminwarewnotwadministeredwandwheparinwwouldwexacerb
ate,wnotwalleviate,wbleeding.
9. Awnursewiswcaringwforwawpatientwwithwhepaticwencephalopathy.wWhilewmakingwthewinitialwshiftwassessm
ent,wthewnursewnoteswthatwthewpatientwhaswawflappingwtremorwofwthewhands.wThewnursewshouldwdocume
ntwthewpresencewofwwhatwsignwofwliverwdisease?
A) Asterixis
B) Constructionalw apraxia
C) Fetorwhepaticus
D) Palmarwerythema
Ans: A
