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Liver Dysfunction Brunner and Suddarth Chapter 49

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

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.

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

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 precaution

Vitamin rich diet

Annual vitamin K injections

Annual vitamin B12 injections

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.

6. A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

A) The patient will obtain measurement of drainage from the T-tube.

B) The patient will exercise three times a week.

C) The patient will take immunosuppressive agents as required.

D) The patient will monitor for signs of liver dysfunction.

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient’s presentation?

A) How many alcoholic drinks do you typically consume in a week?

B) To the best of your knowledge, are your immunizations up to date?

C) Have you ever worked in an occupation where you might have been exposed to toxins?

D) Has anyone in your family ever experienced symptoms similar to yours?

8. A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?

A) Infusion of intravenous heparin

B) IV administration of albumin

C) STAT administration of vitamin K by the intramuscular route

D) IV administration of octreotide (Sandostatin)

9. A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?

A) Asterixis

B) Constructional apraxia

C) Fetor hepaticus

D) Palmar erythema

10. A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

A. The hepatitis A vaccine

B. Albumin infusion

C. The hepatitis A and B vaccine

D. An immune globulin injection

A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis?

A) Finish all prescribed courses of antibiotics, regardless of symptom resolution

B) Adhere to dosing recommendations of OTC analgesics.

C) Ensure that expired medications are disposed of safely.

D) Ensure that pharmacists regularly review drug regimens for potential interactions.

12. Diagnostic testing has revealed that a patient’s hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patient’s plan of care will focus on what intervention?

A. Cryosurgury

B. Liver transplantation

C. Lobectomy

D. Laser hyperthermia

13. A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?

A. Persistent fever and cognitive changes

B. Abdominal pain and hepatomeagly

C. Peripheral edema unresponsive to diuresis

D) Spontaneous bleeding and jaundice

14. A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patient’s continuing care, the nurse should prioritize which of the following risk diagnoses?

A) Risk for Infection Related to Immunosuppressant Use

B) Risk for Injury Related to Decreased Hemostasis

C) Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis

D) Risk for Contamination Related to Accumulation of Ammonia

15. A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

A) Position the patient on the right side with a pillow under the costal margin after the procedure.

B) Administer 1 unit of albumin 90 minutes before the procedure as ordered.

C) Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure.

D) Confirm that the patient’s electrolyte levels have been assessed prior to the procedure

16. A nurse is caring for a patient with hepatic encephalopathy. The nurse’s assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?

A. Stage 1

B. Stage 2

C. Stage 3

D. Stage 4

17. A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient’s current medication regimen includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

A) Two to 3 soft bowel movements daily

B) Significant increase in appetite and food intake

C) Absence of nausea and vomiting

D) Absence of blood or mucus in stool

18. A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

A) Similar liver size and texture as in younger adults

B) A nonpalpable liver

C) A slightly enlarged liver with palpably hard edges

D) A slightly decreased size of the liver

19. A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

A) Watery, blood-streaked diarrhea

B) Orange and foamy urine

C) Increased abdominal girth

D) Decreased cognition

20. During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?

A) Following proper hand-washing techniques

B) Avoiding chemicals that are toxic to the liver

C) Wearing a condom during sexual contact

D) Limiting alcohol intake

21. A patient’s physician has ordered a liver panel in response to the patient’s development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.

A) Alanine aminotransferase (ALT)

B) C-reactive protein (CRP)

C) Gamma-glutamyl transferase (GGT)

D) Aspartate aminotransferase (AST)

E) E) B-type natriuretic peptide (BNP)

22. A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient’s plan?

A) Increased potassium intake

B) Fluid restriction of 2 L/ day

C) Reduction in sodium intake

D) High protein, low fat diet

23. A nurse is amending a patient’s plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient’s care plan?

A) Mobilization with assistance at least 4 times a day

B) Administration of beta blockers as ordered

C) Vitamin B12 injections

D) Administration of diuretics as ordered

24. A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient’s plan of care?

A) Measurement of abdominal girth and body weight

B) Assessment for variceal bleeding

C) Assessment for signs and symptoms of jaundice

D) Monitoring of liver function testing

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patient’s treatment?

A) Decisional conflict

B) Deficient knowledge

C) Death anxiety

D) Disturbed thought process

A patient with a diagnosis of esophageal varices has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?

A) Keep patient NPO until the results of test are known

B) Keep patient NPO until the patient’s gag reflex returns

C) Administer analgesia until post-procedure tenderness is relieved

D) Give the patient a cold beverage to promote swallowing ability.

A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer’s lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient?

A) Arterial line

B) Diuretics

C) Foley catheter

D) Volume expanders

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient’s treatment, the nurse should anticipate what intervention?

A) Administration of immune globulins

B) A regimen on antiviral medications

C) Rest and watchful waiting

D) Administration of FFP (fresh- frozen plasma)

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse’s risk of acquiring hepatitis C in the workplace?

A) Disposing of sharps appropriately and not recapping needles

B) Performing meticulous hand hygiene at the appropriate moments in care

C) Adhering to the recommended schedule of immunizations

D) Wearing an N95 mask when providing care for patients on airborne precautions

A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient’s care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.

A) 1, 2, 5, 4, 3

B) 1, 2, 3, 4, 5

C) 2, 3, 1, 4, 5

D) 3, 1, 2, 5, 4

31. A previously healthy adult’s sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what?

A) IV administration of immune globulins

B) Transfusion of packed red blood cells and fresh-frozen plasma (FFP)

C) Liver transplantation

D) Lobectomy

32. A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse’s most recent assessment reveals subtle changes in the patient’s cognition and behavior. What is the nurse’s most appropriate response?

A) Ensure that the patient’s sodium intake does not exceed recommended levels.

B) Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.

C) Inform the primary care provider that the patient should be assessed for alcoholic hepatitis.

D) Implement interventions aimed at ensuring a calm and therapeutic care environment.

33. A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient’s fluid volume excess? Select all that apply.

A) Administer diuretics

B) Administering calcium channel blockers

C) Implementing fluid restrictions

D) Implementing a 1500 kcal/day restriction

E) Enhancing patient positioning

34. A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient’s family how to safely perform which of the following actions?

A) Aspirating bile from the catheter using a syringe

B) Removing the catheter when output is £ 15 mL in 24 hours

C) Instilling antibiotics into the catheter

D) Assessing the patency of the drainage catheter

35. A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patient’s prioritization for receiving a donor liver be determined?

A) By considering the patient’s age and prognosis

B) By objectively determining the patient’s medical need

C) By objectively assessing the patient’s willingness to adhere to post-transplantation care

D) By systematically ruling out alternative treatment options

36. A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patient’s vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse’s most appropriate action?

A) Remove the patient’s commode and supply a bedpan.

B) Complete an incident report and submit it to the unit supervisor.

C) Have the patient assessed by the physician due to the risk of internal bleeding.

D) Perform a focused abdominal assessment in order to rule out injury.

37. A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following?

A) Continuous monitoring for portal hypertension

B) Administration of immunosuppressive drugs during the first weeks after transplantation

C) Real-time monitoring of vascular changes in the hepatic system

D) Delivery of a continuous chemotherapeutic dose

38. A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse’s priority?

A) Implementation of infection-control measures

B) Close monitoring of skin integrity and color

C) Frequent assessment of the patient’s psychosocial status

D) Administration of antiretroviral medications

39. A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

A) Destruction of the patient’s liver tumor

B) Restoration of portal vein patency

C) Destruction of a liver abscess

D) Reversal of metastasis

40. A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24 mg/dL. For what complication is this patient at risk?

A) Chronic jaundice

B) Pigment stones in portal circulation

C) Central nervous system damage

D) Hepatomegaly

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