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Assessment and Management of Patients With Hepatic Disorders

Chapter 39:
Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses?

a) Angiography
b) Ultrasonography
c) Electroencephalogram
d) Magnetic resonance imaging

Explanation: A ultrasonography will show the size of the abdominal organs and the presence of masses. Magnetic resonance imaging is used to detect hepatic neoplasms. An angiography is used to visualize hepatic circulation and detect the presence and nature of hepatic masses. An electroencephalogram is used to detect abnormalities that occur with hepatic coma.
A patient has undergone a liver biopsy. Which of the following postprocedure positions is appropriate?

a) On the right side
b) Trendelenburg
c) High Fowler's
d) On the left side
On the right side

Explanation: In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded. Positioning the patient on his left side is not indicated. Positioning the patient in the Trendelenburg position may be indicated if the patient is in shock, but is not the position designed for the patient after liver biopsy. High Fowler's position is not indicated for the patient after liver biopsy.
Which type of jaundice seen in adults is the result of increased destruction of red blood cells?

a) Hepatocellular
b) Nonobstructive
c) Obstructive
d) Hemolytic

Explanation: Hemolytic jaundice results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive jaundice is the result of liver disease. Nonobstructive jaundice occurs with hepatitis. Hepatocellular jaundice is the result of liver disease.
A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:

a) appendicitis.
b) peptic ulcer disease.
c) cholelithiasis.
d) cirrhosis.

Explanation: Muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendencies are all symptoms of cirrhosis. The client may also have mild fever, edema, abdominal pain, and an enlarged liver. Clients with peptic ulcer disease complain of a dull, gnawing epigastric pain that's relieved by eating. Appendicitis is characterized by a periumbilical pain that moves to the right lower quadrant and rebound tenderness. Cholelithiasis is characterized by severe abdominal pain that presents several hours after a large meal.
Which of the following indicates an overdose of lactulose?

a) Constipation
b) Watery diarrhea
c) Hypoactive bowel sounds
d) Fecal impaction
Watery diarrhea

Explanation: The patient receiving lactulose is monitored closely for the development of watery diarrheal stool, which indicates a medication overdose.
Patients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which of the following is a sign of potential hypovolemia?

a) Bradycardia
b) Warm moist skin
c) Hypotension
d) Polyuria

Explanation: Signs of potential hypovolemia include cool, clammy skin, tachycardia, decreased blood pressure, and decreased urine output.
The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

a) Dyspnea and fatigue
b) Gynecomastia and testicular atrophy
c) Purpura and petechiae
d) Ascites and orthopnea
Purpura and petechiae

Explanation: A hepatic disorder, such as cirrhosis, may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Dyspnea and fatigue suggest anemia. Ascites and orthopnea are unrelated to vitamin K absorption. Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver.
Which of the following is an age-related change of the hepatobiliary system?

a) Decreased prevalence of gallstones
b) Decreased blood flow
c) Increased drug clearance capability
d) Liver enlargement
Decreased blood flow

Explanation: Age-related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in size and weight of the liver.
A physician orders spironolactone (Aldactone), 50 mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

a) Serum sodium level of 135 mEq/L
b) Blood pH of 7.25
c) Serum potassium level of 3.5 mEq/L
d) Loss of 2.2 lb (1 kg) in 24 hours
Loss of 2.2 lb (1 kg) in 24 hours

Explanation: Daily weight measurement is the most accurate indicator of fluid status; a loss of 2.2 lb (1 kg) indicates loss of 1 L of fluid. Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness. This client's serum potassium and sodium levels are normal. A blood pH of 7.25 indicates acidosis, an adverse reaction to spironolactone.
A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?

a) Increase intake of potassium-rich food.
b) Avoid intake of sodium-rich food.
c) Abstain from drinking alcohol.
d) Use aspirin at least once a day.
Abstain from drinking alcohol.

Explanation: A soft diet and elimination of alcohol, aspirin, and other locally irritating substances minimize the risk for developing esophageal varices. Intake of sodium- or potassium-rich food has no effect on the formation of varices.
A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

a) Hepatitis C increases a person's risk for liver cancer.
b) Infection with hepatitis G is similar to hepatitis A.
c) Hepatitis A is frequently spread by sexual contact.
d) Hepatitis B is transmitted primarily by the oral-fecal route.
Hepatitis C increases a person's risk for liver cancer.

Explanation: Infection with hepatitis C increases the risk of a person developing hepatic (liver) cancer. Hepatitis A is transmitted primarily by the oral-fecal route; hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.
The most common cause of esophageal varices includes which of the following?

a) Ascites
b) Portal hypertension
c) Asterixis
d) Jaundice
Portal hypertension

Explanation: Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver. Jaundice occurs when the bilirubin concentration in the blood is abnormally elevated. Ascites results from circulatory changes within the diseased liver. Asterixis is an involuntary flapping movement of the hands associated with metabolic liver dysfunction.
The mode of transmission of hepatitis A virus (HAV) includes which of the following?

a) Fecal-oral
b) Blood
c) Semen
d) Saliva

Explanation: The mode of transmission of hepatitis A virus (HAV) occurs through fecal-oral route, primarily through person to person contact and/or ingestion of fecal contaminated food or water. Hepatitis B virus (HBV) is transmitted primarily through blood. HBV can be found in blood, saliva, semen, and can be transmitted through mucous membranes and breaks in the skin.
Which of the following medications would the nurse expect the physician to order for a client with cirrhosis who develops portal hypertension?

a) Kanamycin (Kantrex)
b) Cyclosporine (Sandimmune)
c) Spironolactone (Aldactone)
d) Lactulose (Cephulac)
Spironolactone (Aldactone)

Explanation: For portal hypertension, a diuretic usually an aldosterone antagonist such as spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to treat hepatic encephalopathy to destroy intestinal microorganisms and decrease ammonia production. Lactulose would be used to reduce serum ammonia concentration in a client with hepatic encephalopathy. Cyclosporine (Sandimmune) would be used to prevent graft rejection after a transplant.
Which of the following is the most effective strategy to prevent hepatitis B infection?

a) Vaccine
b) Barrier protection during intercourse
c) Avoid sharing toothbrushes
d) Covering open sores

Explanation: The most effective strategy to prevent hepatitis B infection is through vaccination. Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.
Which type of deficiency results in macrocytic anemia?

a) Folic acid
b) Vitamin A
c) Vitamin C
d) Vitamin K
Folic acid

Explanation: Folic acid deficiency results in macrocytic anemia. Vitamin C deficiency results in hemorrhagic lesions of scurvy. Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency results in hypoprothrombinemia, which is characterized by spontaneous bleeding and ecchymosis.
Which of the following would be the least important assessment in a patient diagnosed with ascites?

a) Palpation of abdomen for a fluid shift
b) Measurement of abdominal girth
c) Foul-smelling breath
d) Weight
Foul-smelling breath

Explanation: Foul-smelling breath would not be considered an important assessment for this patient. Measurement of abdominal girth, weight, and palpation of the abdomen for a fluid shift are all important assessment parameters for the patient diagnosed with ascites.
A client with liver and renal failure has severe ascites. On initial shift rounds, his primary nurse finds his indwelling urinary catheter collection bag too full to store more urine. The nurse empties more than 2,000 ml from the collection bag. One hour later, she finds the collection bag full again. The nurse notifies the physician, who suspects that a bladder rupture is allowing the drainage of peritoneal fluid. The physician orders a urinalysis to be obtained immediately. The presence of which substance is considered abnormal?

a) Albumin
b) Creatinine
c) Urobilinogen
d) Chloride

Explanation: Albumin is an abnormal finding in a routine urine specimen. Ascites present in liver failure contain albumin; therefore, if the bladder ruptured, ascites containing albumin would drain from the indwelling urinary catheter because the catheter is no longer contained in the bladder. Creatinine, urobilinogen, and chloride are normally found in urine.
When performing a physical examination on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?

a) Ask the client about food intake.
b) Report the condition to the physician immediately.
c) Provide the client with nonprescription laxatives.
d) Measure abdominal girth according to a set routine.
Measure abdominal girth according to a set routine.

Explanation: If the abdomen appears enlarged, the nurse measures it according to a set routine. The nurse reports any change in mental status or signs of gastrointestinal bleeding immediately. It is not essential for the client to take laxatives unless prescribed. The client's food intake does not affect the size of the abdomen in case of cirrhosis.
An 87-year-old client is in the ICU where you practice nursing. He was admitted for critical care due to his esophageal varices and his precarious physical condition. Which of the following could result in causing his varices to hemorrhage?

a) All options are correct
b) Little protective tissue to protect fragile veins
c) Chemical irritation
d) Rough food
All options are correct

Explanation: Esophageal varices overfill as a result of portal hypertension. They are especially vulnerable to bleeding because they lie superficially in the mucosa, contain little protective elastic tissue, and are easily traumatized by rough food or chemical irritation.