Deck 47: Management of Clients with Hepatic Disorders

Question 1

A client has been admitted for suspected hepatic carcinoma. The client and family are anxious and agitated. Which intervention by the nurse would best support them?

A) Bring the client and family coffee and food from the cafeteria.
B) Educate the client and family about upcoming procedures and tests.
C) Plan care so the family has uninterrupted time with the client.
D) Have the medical social worker stop by and discuss advance directives.

Answer 1

Educate the client and family about upcoming procedures and tests.

Question 2

The nurse preparing to discharge a client with acute hepatitis B instructs the client to avoid

A) acetaminophen and aspirin.
B) laxatives and stool softeners.
C) nicotine and caffeine.
D) oral decongestants.

Answer 2

acetaminophen and aspirin.

Question 3

In caring for a client who has an esophageal tamponade, the nurse would be alerted that the tamponade is inadequate with the assessment of

A) diarrhea.
B) increased abdominal girth.
C) increasing jaundice.
D) rising ammonia level.

Answer 3

rising ammonia level.

Question 4

The nurse would counsel a client that the portosystemic shunt will

A) eliminate the danger of hepatic failure.
B) reduce ascites.
C) reduce portal hypertension only.
D) reverse effects of cirrhosis.

Question 5

The nurse assesses asterixis while monitoring the blood pressure of a client with viral hepatitis. The nurse would interpret this finding as an indication of

A) fluid volume deficit.
B) hepatic encephalopathy.
C) impending seizure.
D) increased bleeding tendency.

Question 6

The nurse notes on a client's chart a report revealing unconjugated hyperbilirubinemia. The nurse explains the presence of unconjugated bilirubin indicates

A) a decreased amount of red cells are being destroyed.
B) biliary obstruction is preventing blood flow through the liver.
C) conjugated bilirubin must be converted to unconjugated bilirubin in the liver.
D) the kidneys are not converting unconjugated to conjugated bilirubin.

Question 7

The client with esophageal varices has a Sengstaken-Blakemore tube in place for esophageal tamponade. As a measure to prevent aspiration of saliva, the nurse would

A) assist the client to cough and spit saliva into an emesis basin.
B) completely deflate the esophageal balloon every 30 minutes.
C) remove saliva through the fourth lumen.
D) suction saliva accumulation with a nasogastric tube.

Question 8

A nurse is serving food trays. From the tray of a client with hepatic encephalopathy, the nurse would remove

A) eggs.
B) fresh fruit.
C) pasta.
D) spinach.

Question 9

A 15-year-old client admitted with severe jaundice is having diagnostic testing. The nursing diagnosis that would have priority is

A) Activity Intolerance related to fatigue
B) Deficient Knowledge related to diet modification
C) Disturbed Body Image related to yellowing of skin and sclera
D) Impaired Skin Integrity related to jaundice

Question 10

To best facilitate an effective breathing pattern, the nurse would place a client with massive ascites in the

A) high-Fowler position.
B) lithotomy position.
C) recumbent position.
D) side-lying position.

Question 11

In caring for a client with severe hepatic abscess, the nurse would assess carefully for the common complication of

A) frequent diarrhea.
B) increasing jaundice.
C) increasing pruritus.
D) pleural effusion.

Question 12

The nursing intervention that takes priority for the nursing diagnosis High Risk for Injury related to presence of Sengstaken-Blakemore tube is

A) massaging bony prominences frequently.
B) offering fluids frequently.
C) placing a pair of scissors at the bedside.
D) restraining the client's hands.

Question 13

In caring for a client admitted to the hospital for treatment of cirrhosis, the nurse would know that priority interventions revolve around the client's

A) hypoglycemia related to pancreatitis.
B) infection related to neutropenia.
C) nerve impairment related to encephalopathy.
D) risk for hemorrhage related to bleeding tendencies.

Question 14

The factor in a client's history that the nurse would recognize as placing the client at risk for developing hepatitis A is

A) donating blood frequently.
B) eating fish caught in the pond on the client's farm.
C) working as a nursing assistant in a nursing home.
D) having multiple colorful tattoos.

Question 15

The nurse is working in an area experiencing an outbreak of hepatitis. The manifestations that the nurse would identify as early manifestations of the disease are

A) clay-colored stools and dark urine.
B) epigastric pain and flu-like manifestations.
C) jaundice and severe pruritus.
D) petechiae and purpura.

Question 16

The nurse caring for a client with jaundice would assess for other findings frequently associated with this condition, such as

A) a change in the texture of the hair.
B) clay-colored stools.
C) excess pigmentation to the hands.
D) friable, ridged nails.

Question 17

A client experiencing hepatic encephalopathy is receiving lactulose. An irate family member asks, "Why in the world would the doctor give my husband something that gives him diarrhea when he is already so sick?" The nurse's response would include that the purpose of the lactulose is to

A) change ammonia to urea.
B) eliminate ascites.
C) empty the bowel of protein.
D) reduce fluid retention.

Question 18

Preparing for travel to an area of Africa where hepatitis A is endemic, a client receives immune serum. The nurse would remind the client that this prophylaxis is effective for up to

A) 2 weeks.
B) 1 month.
C) 3 months.
D) 6 months.

Question 19

The nurse counseling a client who has used oral contraceptives (OCs) since age 17 would make the client aware that the use of OCs has increased the incidence of

A) adenomas of the liver.
B) gallbladder disease.
C) gastric ulcerations.
D) pancreatitis.

Question 20

A nurse explains to a client who recently ate in a fast-food restaurant where several people have developed hepatitis that the incubation period for this type of hepatitis is

A) 1 to 10 days.
B) 15 to 30 days.
C) 1 to 6 months.
D) up to 1 year.

Question 21

A client has been admitted with a diagnosis of "fatty liver." The nurse is aware that manifestations of this condition are

A) likely to worsen even after the cause is eliminated.
B) related to the degree of fat infiltration.
C) severe even in mild cases of the condition.
D) vague and nonspecific.

Question 22

A client has ascites and the nursing diagnosis Excess Fluid Volume. The nurse has orders to administer albumin and furosemide (Lasix). Which action by the nurse regarding this order is correct?

A) Call the physician to clarify the order.
B) Give the albumin first and then give the furosemide.
C) Give the furosemide first and then give the albumin.
D) Have the pharmacy mix both drugs in the same IV bag.

Question 23

A client with jaundice is experiencing uncomfortable itching of the skin. The nurse would anticipate an order to administer

A) acetaminophen (Tylenol).
B) diphenhydramine (Benadryl).
C) oral cholestyramine (Questran).
D) phenobarbital (Luminal).

Question 24

The nurse would be aware that the condition present in a client that is a predisposing factor in development of liver abscess is

A) acute diabetes insipidus.
B) alcoholic hepatitis of several months.
C) bile duct obstruction with a stone.
D) pancreatitis of long-standing duration.

Question 25

A client admitted with a diagnosis of Laënnec's cirrhosis would be questioned by the nurse about the etiologic factor of

A) alcohol ingestion.
B) food-borne illness.
C) gallstones.
D) heart failure.

Question 26

A nurse asks a client with cirrhosis to write his/her name on a piece of paper each day. A student asks why the nurse does this. The best response by the nurse is that

A) "If the client can't write his/her name, it means the client is very confused."
B) "Part of the mini-mental exam and we assess this on all clients."
C) "The physician left orders for this but I don't know why we are doing it."
D) "This is an important safety assessment for the client with cirrhosis."

Question 27

The nurse is preparing to immunize a client who has had sexual contact with a known carrier of hepatitis B. The nurse would know that the medication providing the best immediate protection against hepatitis B is

A) hepatitis B immune globulin.
B) hepatitis B surface antigen.
C) hepatitis B vaccine.
D) standard immune globulin.

Question 28

The nurse providing information about the hepatitis B vaccine would include the information that the inoculation

A) consists of a single injection but is extremely uncomfortable.
B) is given by three separate injections over 6 months.
C) is recommended only for adults and those at risk.
D) works best when it is given in the gluteal muscle.

Question 29

The nurse would explain to a client that to combat the rising rate of primary hepatocellular cancer in the United States public health measures need to be directed towards decreasing the

A) incidence of HIV infection and AIDS.
B) increasing prevalence of hepatitis C.
C) level of alcoholism in America.
D) long-term use of NSAIDs.

Question 30

A client with ascites has the nursing diagnosis Activity Intolerance. An appropriate goal for this client would be: the client will

A) not experience complications of bed rest.
B) learn to balance activity with rest.
C) return to normal activity.
D) tolerate bed rest and use diversional activities.

Question 31

A client with massive ascites had a paracentesis. The site continues to leak through several layers of dressings, despite the nurse holding pressure. Which intervention should the nurse do first?

A) Call the physician and request the puncture site be sutured.
B) Have the client lie on the side with the puncture site.
C) Obtain a urostomy pouch and apply it at the puncture site.
D) Use a roll of Kerlex to hold the dressing in place.

Question 32

A client with cirrhosis is on the transplant list and is now admitted for end-stage liver failure. The spouse breaks down crying, stating "I just can't cope any more. I already have to do every thing at home and for the kids, now if he/she dies, I just don't know what I will do!" The best response by the nurse is

A) "I see you are upset. I will come back in 10 minutes and we can talk."
B) "I'm sure they will find a donor before it is too late."
C) "We do a lot of transplants here and our outcomes are very good."
D) "What has helped you handle all the family responsibilities so far?"

Question 33

In a client with esophageal varices who is receiving vasopressin, the nurse would closely monitor for

A) chest pain.
B) dramatic onset of hypotension.
C) perforated esophagus.
D) pulmonary effusion.

Question 34

The nurse would explain to a client that the persistent presence of hepatitis B surface antigen (HBsAg) without overt manifestations strongly suggests that the client is

A) a carrier of hepatitis B.
B) immune to hepatitis B.
C) not contagious for hepatitis B.
D) pre-morbid for hepatitis B.