Chapter 48: Focused Review of Cirrhosis, Liver Failure, and Hepatitis

Question 1

end-stage liver disease

Answer 1

cirrhosis

Question 2

What is cirrhosis characterized by?

Answer 2

extensive degeneration and destruction of the liver cells

Question 3

Overgrowth of fibrous connective tissue, resulting in impeded blood flow (portal system).

Answer 3

cirrhosis

Question 4

Name this type of cirrhosis.

caused by viral hepatits, or some medications or toxins

a. postnecrotic
b. Laenne’s
c. biliary

Answer 4

a. postnecrotic

Question 5

Name this type of cirrhosis.

caused by chronic alcohol use disorder

a. postnecrotic
b. Laenne’s
c. biliary

Answer 5

b. Laenne’s

Question 6

Name this type of cirrhosis.

caused by chronic biliary obstruction or autoimmune disease

a. postnecrotic
b. Laenne’s
c. biliary

Answer 6

c. biliary

Question 7

T/F

It is okay for your patient who has cirrhosis to engulf aspirin and NSAIDs.

Answer 7

false

Question 8

Dysrhtymias, hypotension, tachycardia and generalized weakness may occur with __________ for the patient who has a diagnosis of cirrhosis.

a. hypernatremia
b. hyponatremia
c. hyperkalemia
d. hypokalemia

Answer 8

b. hyponatremia

Question 9

What steps should the nurse take when she witnesses that her cirrhosis patient has hematemesis?

Answer 9

asses the patient for bleeding and call the HCP

Question 10

T/F

Cirrhosis is an acute disease.

Answer 10

false; chronic

Question 11

T/F

Patients with liver issues should refrain from taking acetaminophen.

Answer 11

true

Question 12

A patient has cirrhosis and 4+ pitting edema. Which focused data would the nurse assess?

a. Hemoglobin

b. Temperature

c. Activity level

d. Albumin level

Answer 12

d. Albumin level

Question 13

Which topic is most important for the nurse to include in teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis?

a. Taking lactulose

b. Avoiding all alcohol use

c. Maintaining good nutrition

d. Using vitamin B supplements

Answer 13

b. Avoiding all alcohol use

Question 14

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action would the nurse take?

a. Withhold both drugs.

b. Administer both drugs.

c. Administer the furosemide.

d. Administer the spironolactone.

Answer 14

d. Administer the spironolactone.

Question 15

Which action would the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy?

a. Request that the patient stand on one foot.

b. Ask the patient to extend both arms forward.

c. Request that the patient walk with eyes closed.

d. Ask the patient to perform the Valsalva maneuver.

Answer 15

b. Ask the patient to extend both arms forward.

Question 16

Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis?

a. The patient is alert and oriented.

b. The patient denies nausea or anorexia.

c. The patient‘s bilirubin level decreases.

d. The patient has at least one stool daily.

Answer 16

a. The patient is alert and oriented.

Question 17

A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?

a. Instruct the patient to cough every hour.

b. Monitor the patient for shortness of breath.

c. Verify the position of the balloon every 4 hours.

d. Deflate the gastric balloon if the patient reports nausea.

Answer 17

b. Monitor the patient for shortness of breath.

Question 18

Which result is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

a. Bilirubin levels

b. Ammonia levels

c. Potassium levels

d. Prothrombin time

Answer 18

b. Ammonia levels

Question 19

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

a. Restrict daily dietary protein intake.

b. Reposition the patient every 4 hours.

c. Perform passive range of motion twice daily.

d. Place the patient on a pressure-relief mattress.

Answer 19

d. Place the patient on a pressure-relief mattress.

Question 20

Which finding indicates to the nurse that a patient‘s transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?

a. Increased serum albumin level

b. Decreased indirect bilirubin level

c. Improved alertness and orientation

d. Fewer episodes of bleeding varices

Answer 20

d. Fewer episodes of bleeding varices

Question 21

What is another name for fulminant hepatic failure?

Answer 21

acute liver failure

Question 22

rapid onset of severe liver dysfunction in someone with no history of liver disease

Answer 22

acute liver failure

Question 23

What is acute liver failure often accompanied by?

Answer 23

hepatic encephalopathy

Question 24

T/F

Herbal and dietary supplements will not cause acute liver failure.

Answer 24

false

Question 25

What is most often the first clinical sign of acute liver failure?

Answer 25

changes in cognitive function

Question 26

Does the acute liver failure patient have high or low serum bilirubin levels?

Answer 26

high

Question 27

T/F PT time is prolonged in acute liver failure.

Answer 27

true

Question 28

T/F Liver enzyme levels are often decreased in acute liver failure.

Answer 28

false; increased

Question 29

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern? a. The patient reports right upper-quadrant pain with palpation. b. The patient‘s hands flap back and forth when the arms are extended. c. The patient has ascites and a 2-kg weight gain from the previous day. d. The patient‘s abdominal skin has multiple spider-shaped blood vessels.

Answer 29

b. The patient‘s hands flap back and forth when the arms are extended.

Question 30

A patient who has cirrhosis and esophageal varices is being treated with propranolol. Which finding is the best indicator to the nurse that the medication has been effective? a. The patient reports no chest pain. b. Blood pressure is 130/80 mm Hg. c. Stools test negative for occult blood. d. The apical pulse rate is 68 beats/min.

Answer 30

c. Stools test negative for occult blood.

Question 31

Which response by the nurse best explains the purpose of propranolol for a patient who was admitted with bleeding esophageal varices? a. The medication will reduce the risk for aspiration. b. The medication will inhibit development of gastric ulcers. c. The medication will prevent irritation of the enlarged veins. d. The medication will decrease nausea and improve the appetite.

Answer 31

c. The medication will prevent irritation of the enlarged veins.

Question 32

During change-of-shift report, the nurse learns about the following four patients. Which patient would the nurse assess first? a. A patient who has compensated cirrhosis and reports anorexia b. A patient with chronic pancreatitis who has gnawing abdominal pain c. A patient with cirrhosis and ascites who has a temperature of 102F (38.8C) d. A patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain

Answer 32

c. A patient with cirrhosis and ascites who has a temperature of 102F (38.8C)

Question 33

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider? a. Asterixis and lethargy b. Jaundiced sclera and skin c. Elevated total bilirubin level d. Liver 3 cm below costal margin

Answer 33

a. Asterixis and lethargy

Question 34

inflammation of the liver

Answer 34

hepatitis

Question 35

What is the most common cause of hepatitis? a. substances b. viral c. autoimmune diseases d. metabolic problems

Answer 35

b. viral

Question 36

Hepatitis A, B, C, D, or E? incubation: 15-50 days; average 28 days

Answer 36

hep A

Question 37

Hepatitis A, B, C, D, or E? fecal contamination and oral ingestion

Answer 37

hep A

Question 38

Hepatitis A, B, C, D, or E? sources of infection include: - contained food, milk, water, shellfish - crowded areas - persons with subclinical infections - poor personal hygiene - poor sanitation

Answer 38

hep A

Question 39

Hepatitis A, B, C, D, or E? incubation: 115-180 days; average 56-96 days

Answer 39

hep B

Question 40

Hepatitis A, B, C, D, or E? percutaneous (parenteral) or mucosa exposure to blood or blood products; sexual contact perinatal transmission

Answer 40

hep B

Question 41

Hepatitis A, B, C, D, or E? sources of infection - contaminated needles, syringes, and blood products - HBV-infected mother - sexual activity with infected partners; asymptomatic carriers - tattoos or body piercings with contaminated needles

Answer 41

hep B

Question 42

Hepatitis A, B, C, D, or E? infectivity - most infectious during 2 weeks before onset of symptoms - infectious until 1-2 weeks after the start of symptoms

Answer 42

hep A

Question 43

Hepatitis A, B, C, D, or E? infectivity - before and after symptoms appear - infectious for months - carriers continue to be infectious for life

Answer 43

hep B

Question 44

Hepatitis A, B, C, D, or E? incubation: 14-180 days; average 56

Answer 44

hep C

Question 45

Hepatitis A, B, C, D, or E? -percutaneous or mucosal exposure to blood or blood products - high-risk sexual contact - perinatal contact

Answer 45

hep C

Question 46

Hepatitis A, B, C, D, or E? sources of infection - blood and blood products - needles and syringes - sexual activity with infected partners, low-risk

Answer 46

hep C

Question 47

Hepatitis A, B, C, D, or E? infectivity - 1-2 weeks before symptoms appear - continues during clinical course - 75%-85% go on to develop chronic hepatitis C and remain infectious

Answer 47

hep C

Question 48

Hepatitis A, B, C, D, or E? incubation: 2-6 weeks

Answer 48

hep D

Question 49

Hepatitis A, B, C, D, or E? must come before hepatitis D

Answer 49

hep B

Question 50

T/F Chronic carriers of hepatitis B are always at risk for hepatitis E.

Answer 50

false; always at risk for hepatitis D

Question 51

Hepatitis A, B, C, D, or E? sources of infection - same as hepatitis B - can cause infection only when Hepatitis B is present

Answer 51

hep D

Question 52

Hepatitis A, B, C, D, or E? infectivity - blood infectious at all stages of hepatits D infection

Answer 52

hep D

Question 53

Hepatitis A, B, C, D, or E? incubation: 15-64 days; average 26-42 days

Answer 53

hep E

Question 54

transmission route of hepatitis E

Answer 54

fecal-oral route

Question 55

Hepatitis A, B, C, D, or E? sources of infection - contaminated water, poor sanitation - found in Asia, Africa, and Mexico - not common in the US but it is increasing

Answer 55

hep E

Question 56

Hepatitis A, B, C, D, or E? infectivity - not known - may be similar to hepatitis A

Answer 56

hep E

Question 57

Hepatitis A, B, C, D, or E? can cause a mild flu-like illness and jaundice

Answer 57

hep A

Question 58

T/F Hepatitis A is an RNA virus.

Answer 58

true

Question 59

The greatest risk for transmission of hepatitis A occurs _________ symptoms appear. a. before b. during c. after

Answer 59

a. before

Question 60

The presence of hepatitis A Ig_____ indicates acute hepatitis.

Answer 60

IgM

Question 61

What are the best ways to prevent hepatitis A?

Answer 61

vaccination and handwashing

Question 62

T/F Hepatitis B is an RNA virus.

Answer 62

false; DNA

Question 63

What is the most common mode of hepatitis B transmission?

Answer 63

sexual transmission

Question 64

T/F In most people who acquire a hepatitis B infection as an adult, the infection completely resolves without any long-term complications.

Answer 64

true

Question 65

T/F Hepatitis C is a DNA virus.

Answer 65

false; RNA

Question 66

What is the most common mode of hepatitis C transmission?

Answer 66

sharing contaminated needles and equipment among IV drug users

Question 67

T/F Many people affected with hepatitis C develop chronic infections.

Answer 67

true

Question 68

T/F There is no cure for hepatitis C.

Answer 68

false

Question 69

delta virus

Answer 69

hep D

Question 70

T/F Hepatitis D is an RNA virus.

Answer 70

true

Question 71

Only those infected with hepatitis B can be infected with hepatitis _____.

Answer 71

hep D

Question 72

T/F There is a vaccine for hepatitis D.

Answer 72

false

Question 73

T/F Hepatitis E is an RNA virus.

Answer 73

true

Question 74

What is the usual mode of transmission for hepatitis E?

Answer 74

water

Question 75

The following preventative measures belong to which hepatitis... A, B, or C? - hand washing - proper personal hygiene - environmental sanitation

Answer 75

hep A

Question 76

The following preventative measures belong to which hepatitis... A, B, or C? - control and screening of food handlers - serologic screening for those carrying virus - active immunization

Answer 76

hep D

Question 77

The following preventative measures belong to which hepatitis... A, B, or C? - hand washing - avoid sharing toothbrushes and razors - one-time needlesticks - vaccines

Answer 77

hep B and C

Question 78

T/F Isolation is needed for hepatitis A.

Answer 78

false

Question 79

T/F There is a vaccine for hepatitis A.

Answer 79

true

Question 80

How old should children be when they receive the hepatitis A vaccine? a. 3 months b. 6 months c. 1 year d. 2 years

Answer 80

c. 1 year

Question 81

T/F There is no vaccine for hepatitis B.

Answer 81

false

Question 82

What ages do children get the hepatitis B vaccine series? a. 3 months, 6 months, 9 months b. 0 months, 6 months, 1 year c. 1 year, 2 years, 3 years d. 0 months, 1 month, 6 months

Answer 82

d. 0 months, 1 month, 6 months

Question 83

T/F A pregnant woman can receive the hepatitis B vaccine.

Answer 83

true

Question 84

T/F There is a vaccine available for hepatitis C.

Answer 84

false

Question 85

Which drug therapies are used to treat acute hepatitis A?

Answer 85

there are no drug therapies for treating acute hep A

Question 86

first-line therapies for chronic hepatitis B

Answer 86

nucleoside and nucleotide analogs, and sometimes interferon therapy

Question 87

What inhibits viral DNA replication?

Answer 87

nucleoside and nucleotide analogs

Question 88

T/F Nucleoside and nucleotide analogs do not prevent all viral hepatitis reproduction.

Answer 88

true

Question 88

A naturally occurring immune protein made by the body during an infection to recognize and respond to pathogens.

Answer 88

interferon

Question 89

T/F Treatment for chronic hepatitis C is patient-specific.

Answer 89

true

Question 90

What is the treatment of hepatitis C based on?

Answer 90

- genotype - severity of liver disease - other health problems

Question 91

What is the main treatment for hepatitis C?

Answer 91

the use of DAAs (direct-acting antivirals)

Question 92

blocks proteins needed for hepatitis C replication

Answer 92

DAA (direct-acting antivirals)

Question 93

diet for viral hepatitis

Answer 93

no specific diet

Question 94

Will the viral hepatitis patient have increased or decreased ALT and AST (liver enzymes) lab values?

Answer 94

increased

Question 95

Will the viral hepatitis patient have increased or decreased ammonia and bilirubin lab values?

Answer 95

increased

Question 96

A young adult contracts hepatitis from contaminated food. Which result would the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient‘s illness? a. Antibody to hepatitis D (anti-HDV) b. Hepatitis B surface antigen (HBsAg) c. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG) d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

Answer 96

d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)

Question 97

The nurse evaluates that administration of hepatitis B vaccine to a healthy patient was effective when the patient‘s later blood specimen reveals the presence of a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.

Answer 97

b. anti-HBs.

Question 98

A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action would the nurse take? a. Schedule the patient for HCV genotype testing. b. Administer the HCV vaccine and immune globulin. c. Teach the patient about direct-acting antiviral treatment. d. Explain that the infection will resolve over a few months.

Answer 98

a. Schedule the patient for HCV genotype testing.

Question 99

Which topic would the nurse plan to teach the patient diagnosed with acute hepatitis B? a. Administering a-interferon b. Measures for improving appetite c. Side effects of nucleotide analogs d. Ways to increase activity and exercise

Answer 99

b. Measures for improving appetite

Question 100

Which information from a 70-year-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C? a. The patient had a blood transfusion in 2005. b. The patient used IV drugs about 30 years ago. c. The patient frequently eats in fast-food restaurants. d. The patient traveled to a country with poor sanitation.

Answer 100

b. The patient used IV drugs about 30 years ago.

Question 101

A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies, but serologic testing is negative for viral causes of hepatitis. Which question would the nurse ask? a. “Have you taken corticosteroids?” b. “Do you have a history of IV drug use?” c. “Do you use any over-the-counter drugs?” d. “Have you recently traveled to another country?”

Answer 101

c. “Do you use any over-the-counter drugs?”

Question 102

A patient with chronic hepatitis B infection declines to take any medication that requires an injection. Which medication, if prescribed, requires further discussion with the health care provider? a. Tenofovir (Viread) b. Adefovir (Hepsera) c. Lamivudine (Epivir) d. Pegylated a-interferon (Pegasys)

Answer 102

d. Pegylated a-interferon (Pegasys)

Question 103

A 26-year-old patient who was admitted with viral hepatitis has severe anorexia and fatigue, and is homeless. Which goal has the highest priority in the plan of care? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable place of residence. d. Identify source of hepatitis exposure.

Answer 103

b. Maintain adequate nutrition.

Question 104

Which action would the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B? a. Advise limiting alcohol intake to 1 drink daily. b. Schedule for liver cancer screening every 6 months. c. Initiate administration of the hepatitis C vaccine series. d. Monitor anti-hepatitis B surface antigen (anti-HBs) levels.

Answer 104

b. Schedule for liver cancer screening every 6 months.

Question 105

A patient born in 1955 had hepatitis A infection 1 year ago. Which action would the nurse include in care when the patient is seen for a routine annual physical examination? a. Start the hepatitis B immunization series. b. Teach the patient about hepatitis A immune globulin. c. Ask whether the patient has been screened for hepatitis C. d. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

Answer 105

c. Ask whether the patient has been screened for hepatitis C.

Question 106

A 36-year-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy? a. Nausea and anorexia b. Weight loss of 2 lb (1 kg) c. Report of severe depression d. Hemoglobin level of 10.4 g/dL

Answer 106

c. Report of severe depression

Question 107

After an unimmunized person is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take? (Select all that apply.) a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about a-interferon therapy. d. Give hepatitis B immune globulin. e. Explain options for oral antiviral therapy.

Answer 107

a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. d. Give hepatitis B immune globulin.

Question 108

The nurse anticipates the preferred treatment for a patient with acute hepatitis A infection will include: a. interferon b. supportive care c. hepatitis A vaccine d. direct-acting antivirals

Answer 108

b. supportive care

Question 109

A person needs postexposure prophylaxis for hepatitis B with hepatitis B immune globulin (HBIG). When should HBIG be given after exposure? a. within 24 hours b. between 1 and 2 weeks c. at 1 month and 6 months d. at 1 month, 4 months, and 6 months

Answer 109

a. within 24 hours

Question 110

A patient with late-stage cirrhosis develops portal hypertension. Which complications can develop from this condition? (SATA) a. ascites b. esophageal varices c. decreased bilirubin d. decreased spleen size e. increased albumin levels

Answer 110

a. ascites b. esophageal varices

Question 111

supplements recommended for osteoporosis

Answer 111

calcium and vitamin D

Question 112

A nurse is providing dietary teaching about calcium-rich foods with a client who has osteoporosis. Which of the following foods should the nurse include in the instructions? a. white bread b. broccoli c. apples d. brown rice

Answer 112

b. broccoli

Question 113

Which menu choice by a patient with osteoporosis indicates the nurse‘s teaching about appropriate diet has been effective? a. Pancakes with syrup and bacon b. Whole wheat toast and fresh fruit c. Egg-white omelet and a half grapefruit d. Oatmeal with skim milk and fruit yogurt

Answer 113

d. Oatmeal with skim milk and fruit yogurt