Question 1

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

Accepted Answer

Manifestations are directly related to the degree of fat infiltration. Recovery can begin after the causative factor is eliminated unless there is permanent residual damage. Clients can be asymptomatic even with moderate or severe disease. Specific manifestations are anorexia, abdominal pain, sometimes jaundice, and elevated serum alkaline phosphatase and bilirubin levels.

Question 2

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?

Accepted Answer

The nurse should give the albumin first to pull fluid back into the vascular space, and then follow it with the diuretic so the client excretes the excess fluid.

Question 3

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

Accepted Answer

Oral cholestyramine resin provides some relief by binding bile salts in the intestine so that they can be excreted. Antihistamines and phenobarbital (which enhances bile flow) may also relieve itching. Remember that acetaminophen is hepatotoxic.

Question 4

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

Accepted Answer

Liver abscesses usually develop after one of three conditions: (a) bacterial cholangitis, which results from obstruction of the bile ducts by stone or stricture; (b) portal vein bacteremia, which may develop after bowel inflammation or organ perforation; and (c) amebiasis. Other predisposing factors are diabetes mellitus, infected hepatic cysts, metastatic liver tumors with secondary infection, and diverticulitis.

Question 5

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

Accepted Answer

Laënnec's cirrhosis is associated with alcohol abuse.

Question 6

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

Accepted Answer

An important consideration for clients with cirrhosis is the development of encephalopathy and their resulting safety needs. Safety is a priority in health care. Deterioration of handwriting is an early, subtle sign of impending decrease in level of consciousness. If the nurse assesses a subtle change in level of consciousness, the nurse can implement safety precautions. Option c is the poorest choice; if the nurse does not know why she/he is doing something, the nurse needs to find out. Nurses should not just blindly follow orders without understanding the rationale.

Question 7

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

Accepted Answer

Although standard immune globulin may contain antibodies against hepatitis B, hepatitis B immune globulin contains much higher levels of antibody.

Question 8

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

Accepted Answer

This injection is best given in the deltoid muscle. Hepatitis B vaccine is given in three doses, with the first and second doses separated by at least 1 month; the third dose is administered at least 4 months after the initial dose. Hepatitis B vaccine is now included in the routine vaccination schedule for children.

Question 9

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

Accepted Answer

The increasing incidence of hepatitis C is responsible for the rising rate of primary hepatocellular cancer.

Question 10

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

Accepted Answer

A client with ascites and chronic liver disease will have an ongoing problem with Activity Intolerance. He or she will need to adapt by learning how to balance rest and activity. Bed rest is not commonly prescribed for extended periods of time and in fact the amount of rest to prescribe is debated. The client will probably not return to normal levels of activity.

Question 11

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?

Accepted Answer

Sometimes a pouch can be used to collect fluid draining from the paracentesis site if it is excessive. This allows the nurse to objectively measure the output and helps preserve the client's skin. This is an independent nursing action. In extreme cases, the physician can suture the puncture wound shut.

Question 12

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

Accepted Answer

Because this client has been admitted for end-stage liver failure, without a transplant, he/she will die. The spouse needs support to deal with this crisis. Providing support and knowledge are two key responsibilities pre-transplant. The best response by the nurse is to try to help the spouse utilize support systems he/she may already have in place but is too upset to recall. Options b and c offer false hope and are dismissive of the spouse's feelings. Option a is a great response when a client is acting out and you need to set some limits on behavior, but is not appropriate here.

Question 13

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

Accepted Answer

Vasopressin is a very strong vasoconstrictor that increases blood pressure and can cause myocardial infarction and cerebrovascular accident.

Question 14

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

Accepted Answer

The persistent presence of HBsAg in a client without manifestations of hepatitis is indicative of a carrier state in which the carrier is asymptomatic but still contagious.

Quiz 47: Management of Clients with Hepatic Disorders