Chapter 48: Focused Review of Cirrhosis, Liver Failure, and Hepatitis Flashcards
end-stage liver disease
cirrhosis
What is cirrhosis characterized by?
extensive degeneration and destruction of the liver cells
Overgrowth of fibrous connective tissue, resulting in impeded blood flow (portal system).
cirrhosis
Name this type of cirrhosis.
caused by viral hepatits, or some medications or toxins
a. postnecrotic
b. Laenne’s
c. biliary
a. postnecrotic
Name this type of cirrhosis.
caused by chronic alcohol use disorder
a. postnecrotic
b. Laenne’s
c. biliary
b. Laenne’s
Name this type of cirrhosis.
caused by chronic biliary obstruction or autoimmune disease
a. postnecrotic
b. Laenne’s
c. biliary
c. biliary
T/F
It is okay for your patient who has cirrhosis to engulf aspirin and NSAIDs.
false
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
b. hyponatremia
What steps should the nurse take when she witnesses that her cirrhosis patient has hematemesis?
asses the patient for bleeding and call the HCP
T/F
Cirrhosis is an acute disease.
false; chronic
T/F
Patients with liver issues should refrain from taking acetaminophen.
true
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
d. Albumin level
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
b. Avoiding all alcohol use
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.
d. Administer the spironolactone.
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.
b. Ask the patient to extend both arms forward.
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.
a. The patient is alert and oriented.
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.
b. Monitor the patient for shortness of breath.
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
b. Ammonia levels
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.
d. Place the patient on a pressure-relief mattress.
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
d. Fewer episodes of bleeding varices
What is another name for fulminant hepatic failure?
acute liver failure
rapid onset of severe liver dysfunction in someone with no history of liver disease
acute liver failure
What is acute liver failure often accompanied by?
hepatic encephalopathy
T/F
Herbal and dietary supplements will not cause acute liver failure.
false
What is most often the first clinical sign of acute liver failure?
changes in cognitive function
Does the acute liver failure patient have high or low serum bilirubin levels?
high
T/F
PT time is prolonged in acute liver failure.
true
T/F
Liver enzyme levels are often decreased in acute liver failure.
false; increased
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.
b. The patient‘s hands flap back and forth when the arms are extended.
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.
c. Stools test negative for occult blood.
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.
c. The medication will prevent irritation of the enlarged veins.
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
c. A patient with cirrhosis and ascites who has a temperature of 102F (38.8C)
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
a. Asterixis and lethargy
inflammation of the liver
hepatitis
What is the most common cause of hepatitis?
a. substances
b. viral
c. autoimmune diseases
d. metabolic problems
b. viral
Hepatitis A, B, C, D, or E?
incubation: 15-50 days; average 28 days
hep A
Hepatitis A, B, C, D, or E?
fecal contamination and oral ingestion
hep A
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
hep A
Hepatitis A, B, C, D, or E?
incubation: 115-180 days; average 56-96 days
hep B
Hepatitis A, B, C, D, or E?
percutaneous (parenteral) or mucosa exposure to blood or blood products; sexual contact perinatal transmission
hep B
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
hep B
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
hep A
Hepatitis A, B, C, D, or E?
infectivity
- before and after symptoms appear
- infectious for months
- carriers continue to be infectious for life
hep B
Hepatitis A, B, C, D, or E?
incubation: 14-180 days; average 56
hep C
Hepatitis A, B, C, D, or E?
-percutaneous or mucosal exposure to blood or blood products
- high-risk sexual contact
- perinatal contact
hep C
Hepatitis A, B, C, D, or E?
sources of infection
- blood and blood products
- needles and syringes
- sexual activity with infected partners, low-risk
hep C
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
hep C
Hepatitis A, B, C, D, or E?
incubation: 2-6 weeks
hep D
Hepatitis A, B, C, D, or E?
must come before hepatitis D
hep B
T/F
Chronic carriers of hepatitis B are always at risk for hepatitis E.
false; always at risk for hepatitis D
Hepatitis A, B, C, D, or E?
sources of infection
- same as hepatitis B
- can cause infection only when Hepatitis B is present
hep D
Hepatitis A, B, C, D, or E?
infectivity
- blood infectious at all stages of hepatits D infection
hep D
Hepatitis A, B, C, D, or E?
incubation: 15-64 days; average 26-42 days
hep E
transmission route of hepatitis E
fecal-oral route
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
hep E
Hepatitis A, B, C, D, or E?
infectivity
- not known
- may be similar to hepatitis A
hep E
Hepatitis A, B, C, D, or E?
can cause a mild flu-like illness and jaundice
hep A
T/F
Hepatitis A is an RNA virus.
true
The greatest risk for transmission of hepatitis A occurs _________ symptoms appear.
a. before
b. during
c. after
a. before
The presence of hepatitis A Ig_____ indicates acute hepatitis.
IgM
What are the best ways to prevent hepatitis A?
vaccination and handwashing
T/F
Hepatitis B is an RNA virus.
false; DNA
What is the most common mode of hepatitis B transmission?
sexual transmission
T/F
In most people who acquire a hepatitis B infection as an adult, the infection completely resolves without any long-term complications.
true
T/F
Hepatitis C is a DNA virus.
false; RNA
What is the most common mode of hepatitis C transmission?
sharing contaminated needles and equipment among IV drug users
T/F
Many people affected with hepatitis C develop chronic infections.
true
T/F
There is no cure for hepatitis C.
false
delta virus
hep D
T/F
Hepatitis D is an RNA virus.
true
Only those infected with hepatitis B can be infected with hepatitis _____.
hep D
T/F
There is a vaccine for hepatitis D.
false
T/F
Hepatitis E is an RNA virus.
true
What is the usual mode of transmission for hepatitis E?
water
The following preventative measures belong to which hepatitis… A, B, or C?
- hand washing
- proper personal hygiene
- environmental sanitation
hep A
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
hep D
The following preventative measures belong to which hepatitis… A, B, or C?
- hand washing
- avoid sharing toothbrushes and razors
- one-time needlesticks
- vaccines
hep B and C
T/F
Isolation is needed for hepatitis A.
false
T/F
There is a vaccine for hepatitis A.
true
How old should children be when they receive the hepatitis A vaccine?
a. 3 months
b. 6 months
c. 1 year
d. 2 years
c. 1 year
T/F
There is no vaccine for hepatitis B.
false
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
d. 0 months, 1 month, 6 months
T/F
A pregnant woman can receive the hepatitis B vaccine.
true
T/F
There is a vaccine available for hepatitis C.
false
Which drug therapies are used to treat acute hepatitis A?
there are no drug therapies for treating acute hep A
first-line therapies for chronic hepatitis B
nucleoside and nucleotide analogs, and sometimes interferon therapy
What inhibits viral DNA replication?
nucleoside and nucleotide analogs
T/F
Nucleoside and nucleotide analogs do not prevent all viral hepatitis reproduction.
true
A naturally occurring immune protein made by the body during an infection to recognize and respond to pathogens.
interferon
T/F
Treatment for chronic hepatitis C is patient-specific.
true
What is the treatment of hepatitis C based on?
- genotype
- severity of liver disease
- other health problems
What is the main treatment for hepatitis C?
the use of DAAs (direct-acting antivirals)
blocks proteins needed for hepatitis C replication
DAA (direct-acting antivirals)
diet for viral hepatitis
no specific diet
Will the viral hepatitis patient have increased or decreased ALT and AST (liver enzymes) lab values?
increased
Will the viral hepatitis patient have increased or decreased ammonia and bilirubin lab values?
increased
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)
d. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
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.
b. anti-HBs.
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.
a. Schedule the patient for HCV genotype testing.
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
b. Measures for improving appetite
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.
b. The patient used IV drugs about 30 years ago.
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?”
c. “Do you use any over-the-counter drugs?”
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)
d. Pegylated a-interferon (Pegasys)
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.
b. Maintain adequate nutrition.
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.
b. Schedule for liver cancer screening every 6 months.
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).
c. Ask whether the patient has been screened for hepatitis C.
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
c. Report of severe depression
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.
a. Administer hepatitis B vaccine.
b. Test for antibodies to hepatitis B.
d. Give hepatitis B immune globulin.
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
b. supportive care
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
a. within 24 hours
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
a. ascites
b. esophageal varices
supplements recommended for osteoporosis
calcium and vitamin D
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
b. broccoli
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
d. Oatmeal with skim milk and fruit yogurt
