Question 1

A client is receiving an infusion of vasopressin (Pitressin)to treat bleeding esophageal varices.Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring?

Accepted Answer

Midsternal chest pain is indicative of acute angina or myocardial infarction,which can be precipitated by vasopressin.The other side effects do not necessarily indicate that a serious side effect has occurred.

Question 2

A client is in the emergency department after a motor vehicle crash.In assessing the client,which clinical sign alerts the nurse to the presence of possible liver trauma?

Accepted Answer

One of the key features of liver trauma is abdominal pain that is increased on deep breathing and is referred to the right shoulder.The liver is on the right,not the left,side of the body.Liver injury does not produce pain that radiates to the spine and down the legs.Rebound tenderness can indicate peritonitis.

Question 3

The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands.The client states this has not happened before.Which action by the nurse is most appropriate?

Accepted Answer

The client may be exhibiting asterixis.Any sign of deteriorating neurologic function could indicate that the new liver is not working properly.The surgeon must be notified,but first the nurse should conduct a thorough assessment of the client.Reviewing today's laboratory work is important,but this is not the best option because the client's liver could have deteriorated after the laboratory work was drawn.Clients with any type of liver problem should not take acetaminophen.Assessing the client's fine and gross motor skills is part of an assessment.

Question 4

The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver?

Accepted Answer

The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause.The other factors do not increase a person's risk for developing liver cancer.

Question 5

The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B?

Accepted Answer

Persistent presence of the serologic marker HBsAg after 6 months indicates a carrier state or chronic hepatitis.The other markers are not indicative of a carrier state.

Question 6

A client who had a liver transplant a month ago is admitted with fever and tachycardia.Which medication does the nurse prepare to administer to this client?

Accepted Answer

This client is showing signs of transplant rejection,which is treated with immune suppressive drugs,such as cyclosporine.Ceftriaxone and azithromycin are antibiotics.Ribavirin is used to treat hepatitis C.

Question 7

A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C)and right flank pain.Which is the nurse's best response?

Accepted Answer

Fever,right quadrant or flank pain,and jaundice are signs of liver transplant rejection; the client should be admitted to the hospital as soon as possible for intervention.The other statements are not appropriate.

Question 8

A client is receiving lactulose (Heptalac).Which laboratory value leads the nurse to intervene?

Accepted Answer

Lactulose can cause the client to have several loose stools daily.The nurse should monitor for hypokalemia and dehydration.This client's potassium level is low,indicating hypokalemia.The serum sodium level is slightly low,but hyponatremia is not a complication of lactulose therapy.The blood glucose is slightly high,but this is unrelated.Blood urea nitrogen (BUN)is normal.

Question 9

A client has been diagnosed with hepatitis A.The nurse evaluates that teaching regarding the disease is understood when the client makes which statement?

Accepted Answer

The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish.The other statements are not accurate.

Question 10

The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit,72%; blood urea nitrogen (BUN),42 mg/dL; and sodium,166 mEq/L.Which action by the nurse is most appropriate?

Accepted Answer

These values are all elevated,which can occur in hypovolemia.The nurse should assess the client for signs of hypovolemia,including tachycardia and hypotension.The nurse should consult with the provider about the client's fluid status before increasing oral fluids but after obtaining vital signs.Documentation should occur after all assessments have been completed and must include actions taken.

Question 11

A client is diagnosed with hepatitis B.Which information does the nurse include in the teaching plan as a priority?

Accepted Answer

Alcohol has a hepatotoxic effect,and clients with any liver disease should not drink it.Serum lipids need control in clients with fatty liver.Once a client has hepatitis B,he or she should not donate blood or organs.Handling contaminated shellfish is a cause of hepatitis A infection.

Question 12

A client is refusing to take lactulose (Heptalac)because of diarrhea.Which is the nurse's best response to this client?

Accepted Answer

The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon.Lactulose draws water into the bowel with its high osmotic gradient,thereby producing a laxative effect and subsequently evacuating ammonia from the bowel.The client must understand that this is an expected and therapeutic effect for him or her to remain compliant.The other statements are inaccurate.

Question 13

A client is in the emergency department after a motor vehicle crash,and the nurse notices a "steering wheel mark" across the client's chest.Which action by the nurse is most appropriate?

Accepted Answer

The liver is often injured by a steering wheel in a motor vehicle crash.Because the client's chest was marked by the steering wheel,the nurse should perform an abdominal assessment.Assessing the client's position in the crash is not needed because of the steering wheel imprint.The client may or may not need a blood transfusion.The client does not need to be in reverse Trendelenburg position.

Question 14

The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene.Which action by the assistant requires intervention by the registered nurse?

Accepted Answer

Clients with advanced cirrhosis often have pruritus.These clients should use cool,not warm,water on their skin,and should not use excessive amounts of soap.The other actions are appropriate.

Question 15

The nurse is assessing health fair participants for risks for hepatitis.The nurse recognizes which client as being at greatest risk for developing hepatitis B?

Accepted Answer

Hepatitis B can be spread through sexual contact,needle sharing,needle sticks,blood transfusions,hemodialysis,acupuncture,and the maternal-fetal route.A person with multiple sexual partners has more opportunities to contract the infection.

Question 16

A client is admitted with jaundice and suspected hepatitis B.Which intervention does the nurse add to the client's care plan?

Accepted Answer

During the icteric phase,the client is encouraged to rest.Rest reduces the metabolic demands of the liver and promotes hepatic cell regeneration.The client may or may not need assistance with ambulation.The diet should be high in carbohydrates and calories for energy; clear liquids may be needed if the client is nauseated.The client may or may not need antiemetics.

Question 17

Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis?

Accepted Answer

The client should be advised to avoid fresh,raw fruits and vegetables because they can be contaminated by tap water.Drinking bottled water,not sharing glasses (or eating utensils),and careful handwashing are all good ways to prevent illness.

Question 18

A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS)insertion.The nurse determines that teaching has been effective when the client makes which statement?

Accepted Answer

This procedure is performed in the radiology department under heavy sedation or general anesthesia.The client will be monitored as would any other postoperative client.The other statements are inaccurate.

Question 19

A client with hepatitis C is being treated with ribavirin (Copegus).What nursing action takes priority?

Accepted Answer

Treatment with ribavirin takes up to 48 weeks,making compliance a serious issue.The nurse should work with the client on a strategy to remain compliant for this length of time.The other actions are not warranted.

Question 20

A thin,cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE).The family expresses distress that the client is receiving so little protein in the diet.Which explanation by the nurse is most appropriate?

Accepted Answer

A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE.A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria.Encephalopathy is caused by excess ammonia.The other statements are not correct.

Quiz 61: Care of Patients With Liver Problems

A client is receiving an infusion of vasopressin (Pitressin) to treat bleeding esophageal varices.Which client complaint indicates to the nurse that a serious adverse effect of the drug may be occurring?

A client is in the emergency department after a motor vehicle crash.In assessing the client,which clinical sign alerts the nurse to the presence of possible liver trauma?

The nurse is meeting a client post-liver transplantation for the first time and notices a tremor as they shake hands.The client states this has not happened before.Which action by the nurse is most appropriate?

The nurse recognizes which client as being at greatest risk for the development of carcinoma of the liver?

The nurse monitors for which serologic marker in the client who is a carrier of chronic hepatitis B?

A client who had a liver transplant a month ago is admitted with fever and tachycardia.Which medication does the nurse prepare to administer to this client?

A client who underwent liver transplantation 2 weeks ago reports a temperature of 101° F (38.3° C) and right flank pain.Which is the nurse's best response?

A client is receiving lactulose (Heptalac) .Which laboratory value leads the nurse to intervene?

A client has been diagnosed with hepatitis A.The nurse evaluates that teaching regarding the disease is understood when the client makes which statement?

The nurse reviews laboratory results for a client with cirrhosis and finds the following: hematocrit,72%; blood urea nitrogen (BUN) ,42 mg/dL; and sodium,166 mEq/L.Which action by the nurse is most appropriate?

A client is diagnosed with hepatitis B.Which information does the nurse include in the teaching plan as a priority?

A client is refusing to take lactulose (Heptalac) because of diarrhea.Which is the nurse's best response to this client?

A client is in the emergency department after a motor vehicle crash,and the nurse notices a "steering wheel mark" across the client's chest.Which action by the nurse is most appropriate?

The nursing assistant is helping a client who has advanced cirrhosis with a bath and other hygiene.Which action by the assistant requires intervention by the registered nurse?

The nurse is assessing health fair participants for risks for hepatitis.The nurse recognizes which client as being at greatest risk for developing hepatitis B?

A client is admitted with jaundice and suspected hepatitis B.Which intervention does the nurse add to the client's care plan?

Which statement made by a client traveling to a nonindustrialized country indicates the need for further teaching regarding the prevention of viral hepatitis?

A client with severe esophageal varices is scheduled for trans-jugular intrahepatic portal-systemic shunt (TIPS) insertion.The nurse determines that teaching has been effective when the client makes which statement?

A client with hepatitis C is being treated with ribavirin (Copegus) .What nursing action takes priority?

A thin,cachectic-appearing client has hepatic portal-systemic encephalopathy (PSE) .The family expresses distress that the client is receiving so little protein in the diet.Which explanation by the nurse is most appropriate?