Question 1

Which of the following diagnoses is often a misdiagnosis for older-adult clients with liver disease?

Accepted Answer

In older adults with liver disease, hepatic encephalopathy may be misdiagnosed as dementia.

Question 2

The nurse is admitting a client to the emergency department with pancreatitis who has been vomiting blood. Which of the following actions should the nurse take first?

Accepted Answer

The nurse's first action should be to determine the client's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter also are appropriate. However, the vital signs may indicate the need for more urgent actions. Since aspiration is a concern for this client, the nurse will need to assess the client's vital signs and neurological status before placing the client in the supine position.

Question 3

The nurse is admitting a client with acute bleeding from esophageal varices who asks the nurse the purpose for the ordered pantoprazole. Which of the following responses by the nurse is best?

Accepted Answer

Pantoprazole is a proton pump inhibitor. Supportive measures during an acute variceal bleed include administration of fresh-frozen plasma and packed red blood cells, vitamin K, and proton pump inhibitors. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purpose for H2 receptor blockade in this client.

Question 4

During change-of-shift report, the nurse learns about the following four clients. Which client requires the most rapid assessment?

Accepted Answer

This client's history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other client are consistent with their diagnoses and do not indicate complications are occurring.

Question 5

The nurse is admitting a client with acute cholecystitis. Which of the following findings is most important for the nurse to report to the health care provider?

Accepted Answer

The clay-coloured stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a client with this diagnosis, although the nurse also would report the other assessment information to the health care provider.

Question 6

The nurse is obtaining a health history from a client with acute pancreatitis. Which of the following information should the nurse specifically assess when conducting a health history?

Accepted Answer

Alcohol use is one of the most common risk factors for pancreatitis in Canada. In Canada, the most common cause is gallbladder disease (gallstones) followed by alcoholism.
Cigarette smoking, diabetes, and high-protein diets are not risk factors.

Question 7

The nurse is caring for a client with cirrhosis and esophageal varices who has a new prescription for propranolol. Which of the following assessment findings is the best indicator that the medication has been effective?

Accepted Answer

Since the purpose of ? -blocker therapy for clients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this client is to decrease the risk for bleeding from esophageal varices.

Question 8

The nurse is providing discharge instructions to a client following a laparoscopic cholecystectomy. Which of the following client statements indicate that the teaching has been effective?

Accepted Answer

After a laparoscopic cholecystectomy, the client will have Band-Aids in place over the incisions. Clients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the client should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.

Question 9

The nurse is admitting a client who is homeless and has viral hepatitis with symptoms of severe anorexia and fatigue. Which of the following client goals should have the highest priority when the nurse is developing the plan of care?

Accepted Answer

The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the client and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as
ensuring adequate nutrition. Although the client's activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

Question 10

The nurse is caring for a client with acute pancreatitis. Which of the following findings is of most concern?

Accepted Answer

A palpable abdominal mass in the epigastric area may indicate the presence of a pancreatic pseudocyst, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

Question 11

The nurse is taking the BP of a client with severe acute pancreatitis and notices carpal spasm of the client's hand. Which of the following actions should the nurse take next?

Accepted Answer

The client with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau's sign. The health care provider should be notified after the nurse checks the client's calcium level. There is no indication that the client needs to have the BP rechecked or that there is any arm pain.

Question 12

The nurse is caring for a client with acute pancreatitis who has a nasogastric (NG) tube to suction and is NPO. Which of the following information obtained by the nurse indicates that these therapies have been effective?

Accepted Answer

NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status have been effective. Electrolyte levels will be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective.

Question 13

The nurse is planning care for a client with acute severe pancreatitis. Which of the following client outcomes is priority?

Accepted Answer

Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of adequate respiratory function is the priority goal. The other outcomes also would be appropriate for the client.

Question 14

The nurse is educating a client with chronic pancreatitis about the prescribed pancrelipase? At which of the following times should the nurse teach the client to take the medication?

Accepted Answer

Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal or snacks.

Question 15

The nurse is caring for a client following an incisional cholecystectomy for cholelithiasis. Which of the following actions is priority for the nurse to implement?

Accepted Answer

Postoperative nursing care for incisional cholecystectomy is the same as general postoperative nursing care. Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions also are important to implement but are not as high a priority as ensuring adequate ventilation.

Question 16

After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which of the following actions should the nurse plan to take? (Select all that apply.)

Accepted Answer

The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.

Question 17

Which of the following nursing actions is a priority when the nurse is caring for a client with pancreatic cancer?

Accepted Answer

Effective pain management will be necessary in order for the client to improve nutrition, be receptive to education, or manage anxiety or depression.

Question 18

The nurse is caring for a client with chronic hepatitis C infection who has these medications prescribed. Which of the following medications require further discussion with the health care provider prior to administration?

Accepted Answer

Pegylated ? -interferon is administered once weekly not daily. The other medications are appropriate for a client with chronic hepatitis C infection.

Question 19

Which of the following actions should be included in the plan of care for a client who has recently been diagnosed with asymptomatic non-alcoholic fatty liver disease (NAFLD)?

Accepted Answer

Some medications can increase the risk for NAFLD and these should be eliminated. NAFLD is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would not be a concern in a client with asymptomatic NAFLD.

Question 20

Which of the following data obtained by the nurse during the assessment of a client with cirrhosis is of most concern?

Accepted Answer

The asterixis indicates that the client has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the client with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurological status.

Quiz 46: Nursing Management Liver