Liver Disorders Flashcards
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient’s increased risk of bleeding. The nurse recognizes that this risk is related to the patient’s inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
A. Alterations in glucose metabolism
B. Retention of bile salts
C. Inadequate production of albumin by hepatocytes
D. Inability of the liver to use vitamin K
D. Inability of the liver to use vitamin K
Rationale: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin
A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient’s liver?
A. Place hand under the right lower abdominal quadrant and press down lightly with the other hand
B. Place the left hand over the abdomen and behind the left side at the 11th rib
C. Place hand under right lower rib cage and press down lightly with the other hand
D. Hold hand 90 degrees to right side of the abdomen and push down firmly
C. Place hand under right lower rib cage and press down lightly with the other hand
Rationale: to palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver isn’t on the left side or in the right lower abdominal quadrant
A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem?
A. Assessment of BP and assessment for headaches and visual changes
B. Assessments for signs and symptoms of venous thromboembolism
C. Daily weights and abdominal girth measurement
D. Blood glucose monitoring Q4H
C. Daily weights and abdominal girth measurement
Rationale: Obstruction to blood flow through the damaged liver results in increased BP (portal hypertension) throughout the portal venous system. This can result in varices and as it’s in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and doesn’t create a risk for unstable blood glucose or VTE
A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? SATA.
A. Immunization
B. Use of standard precautions
C. Consumption of a vitamin-rich diet
D. Annual vitamin K injections
E. Annual vitamin B12 injection
A. Immunization
B. Use of standard precautions
Rationale: People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. The consistent use of standard precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual’s risk of HBV
A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse’s most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse’s best response to this assessment finding?
A. Document the presence of normal bile output
B. Irritate the drainage system with NS as ordered
C. Aspirate a sample of the drainage for culture
D. Promptly report this assessment finding to the PCP
A. Document the presence of normal bile output
Rationale: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?
A. The patient will obtain measurement of drainage from the T-tube
B. The patient will exercise 3x a week
C. The patient will take immunosuppressive agents as required
D. The patient will monitor for signs of liver dysfunction
C. The patient will take immunosuppressive agents as required
Rationale: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn’t go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen
A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patient’s presentation?
A. How many alcoholic drinks do you typically consume in a week?
B. To the best of your knowledge, are your immunizations up to date
C. Have you ever worked in an occupation where you might have been exposed to toxins?
D. Has anyone in your family ever experienced symptoms similar to yours
A. How many alcoholic drinks do you typically consume in a week?
Rationale: Signs or symptoms of hepatic dysfunction indicate a need to assess for alcohol use. Immunization status, occupational risks, and family history are also relevant considerations, but alcohol use is a more common etiologic factor in liver disease
A nurse is participating in the emergency care of a patient who has just developed variceal bleeding. What intervention should the nurse anticipate?
A. Infusion of IV heparin
B. IV administration of albumin
C. STAT administration of vitamin K by the IM route
D. IV administration of octreotide (Sandostatin)
D. IV administration of octreotide (Sandostatin)
Rationale: Octreotide (Sandostatin) a synthetic analog of the hormone somatostatin is effective in decreasing bleeding from esophageal caprices, and lacks the vasoconstrictive effects of vasopressin. Because of this safety and efficacy profile, octreotide is considered the preferred treatment regimen for immediate control of variceal bleeding. Vitamin K and albumin aren’t administered and heparin would exacerbate, not alleviate, bleeding
A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the present of what sign of liver disease?
A. Asterixis
B. Constructional apraxia
C. Fetid hepaticus
D. Palmar erythema
A. Asterixis
Rationale: The nurse will document that a patient exhibiting a flapping tremor of the hands is demonstrating asterixis. While constructional apraxia is a motor disturbance, it is the inability to reproduce a simple figure. Fetid hepaticus is a sweet, slightly fecal odor to the breath and not associated with a motor disturbance. Skin changes associated with liver dysfunction may include palmar erythema, which is a reddening of the palms, but is not a flapping tremor.
A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
A. The hepatitis A vaccine
B. Albumin infusion
C. The hepatitis A and B vaccines
D. An immune globulin injection
D. An immune globulin injection
Rationale: For people who haven’t been previously vaccinated, hepatitis A can be prevented by the IM administration of immune globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Albumin confers no therapeutic benefit
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis?
A. Finish all prescribed courses of antibiotics, regardless of symptom resolution
B. Adhere to dosing recommendations of OTC analgesics
C. Ensure that expired medications are disposed of safely
D. Ensure that pharmacists regularly receive drug regimens for potential interactions
B. Adhere to dosing recommendations of OTC analgesics
Rationale: Although any medication can affect liver function, use of acetaminophen (found in many OTC medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease. Drug interactions are rarely the cause of drug induced hepatitis
Diagnostic testing has revealed that a patient’s hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patient’s plan of care will focus on what intervention?
A. Cryosurgery
B. Liver transplantation
C. Lobectomy
D. Laser hyperthermia
C. Lobectomy
Rationale: Surgical resection is there treatment of choose when HCC is confined to one lobe of the liver and the function of the remaining liver is considered adequate for postoperative recovery. Removal of a lobe of the liver (lobectomy) is the most common surgical procedure for excising a liver tumor. While cryosurgery and liver transplantation are other surgical options for management of liver cancer, these procedures aren’t performed at the same frequency as a lobectomy. Laser hyperthermia is a non-surgical treatment for liver cancer
A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?
A. Persistent fever and cognitive changes
B. Abdominal pain and hepatomegaly
C. Peripheral edema unresponsive to diuresis
D. Spontaneous bleeding and jaundice
B. Abdominal pain and hepatomegaly
Rationale: the early manifestations of malignancy of the liver include pain, continuous dull ache in the RUQ, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the sliver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs
A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patient’s continuing care, the nurse should prioritize which of the following risk diagnoses?
A. Risk for infection related to immunosuppressant use
B. Risk for injury related to decreased hemostasis
C. Risk for unstable blood glucose related to impaired gluconeogenesis
D. Risk for contamination related to accumulation of ammonia
A. Risk for infection related to immunosuppressant use
Rationale: Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of Risk for Contamination relates to environmental toxin exposure
A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?
A. Position the patient on the right side with a pillow under the costal margin after the procedure
B. Administer 1 unit of albumin 90 minutes before the procedure as ordered
C. Administer at least 1 unit of packed RBCs as ordered the day before the scheduled procedure
D. Confirm that the patient’s electrolyte levels have been assessed prior to the procedure
A. Position the patient on the right side with a pillow under the costal margin after the procedure
Rationale: immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation tests should be performed, but electrolyte analysis isn’t necessary
A nurse is caring for a patient with hepatic encephalopathy. The nurse’s assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
C. Stage 3
Rationale: Patients in the 3rd stage of hepatic encephalopathy exhibit the following symptoms: stuporous, difficult to arouse, sleeps most of the time, exhibits marked confusion, incoherent in speech, asterixis, increased DTRs, rigidity or extremities, marked EEG abnormalities. Patients in stage 1 and 2 exhibit clinical symptoms that aren’t as advanced as found in stage 3, and patients in stage 4 are comatose. In stage 4, there is an absence of asterixis, absence of DTRs, flaccidity of extremities, and EEG abnormalities
