Detailed Answer Key
Liver
1. A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the
following interventions should the nurse plan to implement to decrease the client's ammonia level?
A. Administer diuretics.
Rationale: Diuretics do not help to decrease ammonia levels.
B. Restrict the client's intake of fluids.
Rationale: Restricting fluid intake does not help to decrease a client's ammonia level.
C. Reduce the client's intake of protein.
Rationale: Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting
dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary
for healing, so strict limitation of dietary protein is not recommended.
D. Administer vitamin K.
Rationale: Vitamin K does not help to decrease a client's ammonia level.
2. A nurse is teaching a community education course about the physical complications related to substance use
disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis?
A. Alcohol
Rationale: Chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver.
B. Caffeine
Rationale: Chronic ingestion of caffeine can result in many physical complications; however, it is not
associated with liver cirrhosis.
C. Cocaine
Rationale: Cocaine can result in many physical complications; however, it is not associated with liver
cirrhosis.
D. Inhalants
Rationale: Inhalants can result in many physical complications; however, they are not associated with liver
cirrhosis.
3. A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving
spironolactone. Which of the following findings should the nurse expect?
A. Decreased sodium level
Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing
Created on:03/15/2020 Page 1
, Detailed Answer Key
Liver
diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.
B. Decreased phosphate level
Rationale: The nurse should not expect a decreased phosphate level. Spironolactone inhibits the action of
aldosterone, resulting in the retention of phosphate.
C. Decreased potassium level
Rationale: The nurse should not expect a decreased potassium level. Spironolactone is a
potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of
potassium.
D. Decreased chloride level
Rationale: The nurse should not expect a decreased chloride level. Spironolactone is a potassium-sparing
diuretic that inhibits the action of aldosterone, resulting in the retention of chloride.
4. A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal
hypertension. The nurse recognizes which of the following laboratory findings as indicating the client’s
gastrointestinal (GI) tract is digesting and absorbing blood?
A. Elevated blood urea nitrogen (BUN)
Rationale: As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.
B. Elevated HbA1c
Rationale: Chronic blood loss can lower HbA1c and alcohol toxicity can raise it. But digestion of blood does
not elevate it.
C. Decreased chloride
Rationale: Neither liver disease nor GI bleeding affects chloride levels, although severe vomiting and GI
suction can decrease chloride levels.
D. Decreased bilirubin
Rationale: Bilirubin levels rise with cirrhosis and with hemolysis of red blood cells.
5. A nurse is caring for a client who has cirrhosis and has a prescription for bumetanide. When delivering the client's
lunch tray, which of the following items should the nurse identify as contraindicated for the client?
A. Baked potato
Rationale: The client who has cirrhosis requires a diet that is high in carbohydrates. A baked potato
contains 33.62 g of carbohydrates.
B. Stewed tomatoes
Rationale: Clients who are prescribed loop diuretics such as bumetanide are at risk for potassium
Created on:03/15/2020 Page 2
Liver
1. A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the
following interventions should the nurse plan to implement to decrease the client's ammonia level?
A. Administer diuretics.
Rationale: Diuretics do not help to decrease ammonia levels.
B. Restrict the client's intake of fluids.
Rationale: Restricting fluid intake does not help to decrease a client's ammonia level.
C. Reduce the client's intake of protein.
Rationale: Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting
dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary
for healing, so strict limitation of dietary protein is not recommended.
D. Administer vitamin K.
Rationale: Vitamin K does not help to decrease a client's ammonia level.
2. A nurse is teaching a community education course about the physical complications related to substance use
disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis?
A. Alcohol
Rationale: Chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver.
B. Caffeine
Rationale: Chronic ingestion of caffeine can result in many physical complications; however, it is not
associated with liver cirrhosis.
C. Cocaine
Rationale: Cocaine can result in many physical complications; however, it is not associated with liver
cirrhosis.
D. Inhalants
Rationale: Inhalants can result in many physical complications; however, they are not associated with liver
cirrhosis.
3. A nurse is reviewing the laboratory results of a client who has liver failure with ascites and is receiving
spironolactone. Which of the following findings should the nurse expect?
A. Decreased sodium level
Rationale: The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing
Created on:03/15/2020 Page 1
, Detailed Answer Key
Liver
diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium.
B. Decreased phosphate level
Rationale: The nurse should not expect a decreased phosphate level. Spironolactone inhibits the action of
aldosterone, resulting in the retention of phosphate.
C. Decreased potassium level
Rationale: The nurse should not expect a decreased potassium level. Spironolactone is a
potassium-sparing diuretic that inhibits the action of aldosterone, resulting in the retention of
potassium.
D. Decreased chloride level
Rationale: The nurse should not expect a decreased chloride level. Spironolactone is a potassium-sparing
diuretic that inhibits the action of aldosterone, resulting in the retention of chloride.
4. A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal
hypertension. The nurse recognizes which of the following laboratory findings as indicating the client’s
gastrointestinal (GI) tract is digesting and absorbing blood?
A. Elevated blood urea nitrogen (BUN)
Rationale: As the body digests blood, BUN rises. An elevated BUN is an indication of GI bleeding.
B. Elevated HbA1c
Rationale: Chronic blood loss can lower HbA1c and alcohol toxicity can raise it. But digestion of blood does
not elevate it.
C. Decreased chloride
Rationale: Neither liver disease nor GI bleeding affects chloride levels, although severe vomiting and GI
suction can decrease chloride levels.
D. Decreased bilirubin
Rationale: Bilirubin levels rise with cirrhosis and with hemolysis of red blood cells.
5. A nurse is caring for a client who has cirrhosis and has a prescription for bumetanide. When delivering the client's
lunch tray, which of the following items should the nurse identify as contraindicated for the client?
A. Baked potato
Rationale: The client who has cirrhosis requires a diet that is high in carbohydrates. A baked potato
contains 33.62 g of carbohydrates.
B. Stewed tomatoes
Rationale: Clients who are prescribed loop diuretics such as bumetanide are at risk for potassium
Created on:03/15/2020 Page 2
