Ignatavicius Ch 58: Care of Patients with Liver Problems Flashcards
A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to provide health teaching to this client?
a. I drink two glasses of red wine each week.
b. I take a lot of Tylenol for my arthritis pain.
c. I have a cousin who died of liver cancer.
d. I got a hepatitis vaccine before traveling.
b. I take a lot of Tylenol for my arthritis pain.
Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.
A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites?
a. Monitor intake and output.
b. Provide a low-sodium diet.
c. Increase oral fluid intake.
d. Weigh the client daily.
b. Provide a low-sodium diet.
A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.
A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse?
a. Urine output via indwelling urinary catheter is 20 mL/hr
b. Blood pressure increases from 110/58 to 120/62 mm Hg
c. Respiratory rate decreases from 18 to 14 breaths/min
d. A decrease in the clients weight by 6 kg
a. Urine output via indwelling urinary catheter is 20 mL/hr
Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the clients weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.
A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube. Which action should the nurse take first?
a. Sedate the client to prevent tube dislodgement.
b. Maintain balloon pressure at 15 and 20 mm Hg.
c. Irrigate the gastric lumen with normal saline.
d. Assess the client for airway patency.
d. Assess the client for airway patency.
Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.
A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices. Which clinical manifestation should alert the nurse to a serious adverse effect?
a. Nausea and vomiting
b. Frontal headache
c. Vertigo and syncope
d. Mid-sternal chest pain
d. Mid-sternal chest pain
Mid-sternal chest pain is indicative of acute angina or myocardial infarction, which can be precipitated by vasopressin. Nausea and vomiting, headache, and vertigo and syncope are not side effects of vasopressin.
A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance, and the family expresses distress that the client is receiving little dietary protein. How should the nurse respond?
a. A low-protein diet will help the liver rest and will restore liver function.
b. Less protein in the diet will help prevent confusion associated with liver failure.
c. Increasing dietary protein will help the client gain weight and muscle mass.
d. Low dietary protein is needed to prevent fluid from leaking into the abdomen.
b. Less protein in the diet will help prevent confusion associated with liver failure.
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. A low-protein diet has no impact on restoring liver function. Increasing the clients dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.
A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, I do not want to take this medication because it causes diarrhea. How should the nurse respond?
a. Diarrhea is expected; thats how your body gets rid of ammonia.
b. You may take Kaopectate liquid daily for loose stools.
c. Do not take any more of the medication until your stools firm up.
d. We will need to send a stool specimen to the laboratory.
a. Diarrhea is expected; thats how your body gets rid of ammonia.
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 nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.
After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the clients understanding. Which statement by the client indicates a correct understanding of the teaching?
a. Some medications have been known to cause hepatitis A.
b. I may have been exposed when we ate shrimp last weekend.
c. I was infected with hepatitis A through a recent blood transfusion.
d. My infection with Epstein-Barr virus can co-infect me with hepatitis A.
b. I may have been exposed when we ate shrimp last weekend.
The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.
A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B?
a. A 20-year-old college student who has had several sexual partners
b. A 46-year-old woman who takes acetaminophen daily for headaches
c. A 63-year-old businessman who travels frequently across the country
d. An 82-year-old woman who recently ate raw shellfish for dinner
a. A 20-year-old college student who has had several sexual partners
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. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.
A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this clients discharge education?
a. Use a pill organizer to ensure you take this medication as prescribed.
b. Transient muscle aching is a common side effect of this medication.
c. Follow up with your provider in 1 week to test your blood for toxicity.
d. Take your radial pulse for 1 minute prior to taking this medication.
a. Use a pill organizer to ensure you take this medication as prescribed.
Treatment of hepatitis C 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. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.
After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the clients understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching?
a. I should drink bottled water during my travels.
b. I will not eat off anothers plate or share utensils.
c. I should eat plenty of fresh fruits and vegetables.
d. I will wash my hands frequently and thoroughly.
c. I should eat plenty of fresh fruits and vegetables.
The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.
An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel mark across the clients chest. Which action should the nurse take?
a. Ask the client where in the car he or she was sitting during the crash.
b. Assess the client by gently palpating the abdomen for tenderness.
c. Notify the laboratory to draw blood for blood type and crossmatch.
d. Place the client on the stretcher in reverse Trendelenburg position.
b. Assess the client by gently palpating the abdomen for tenderness.
The liver is often injured by a steering wheel in a motor vehicle crash. Because the clients chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the clients 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.
A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver?
a. A 22-year-old with a history of blunt liver trauma
b. A 48-year-old with a history of diabetes mellitus
c. A 66-year-old who has a history of cirrhosis
d. An 82-year-old who has chronic malnutrition
c. A 66-year-old who has a history of cirrhosis
The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a persons risk for developing liver cancer.
A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, I am experiencing right flank pain and have a temperature of 101 F. How should the nurse respond?
a. The anti-rejection drugs you are taking make you susceptible to infection.
b. You should go to the hospital immediately to have your new liver checked out.
c. You should take an additional dose of cyclosporine today.
d. Take acetaminophen (Tylenol) every 4 hours until you feel better.
b. You should go to the hospital immediately to have your new liver checked out.
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. Anti-rejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse should not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.
After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the clients understanding. Which statement made by the client indicates a need for additional teaching?
a. I cannot drink any alcohol at all anymore.
b. I need to avoid protein in my diet.
c. I should not take over-the-counter medications.
d. I should eat small, frequent, balanced meals.
b. I need to avoid protein in my diet.
Based on the degree of liver involvement and decreased function, protein intake may have to be decreased. However, some protein is necessary for the synthesis of albumin and normal healing. The other statements indicate accurate understanding of self-care measures for this client.
