Liver Disorders Flashcards

1
Q

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

A

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

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2
Q

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

A

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

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3
Q

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

A

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

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4
Q

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

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

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5
Q

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

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

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6
Q

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

A

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

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7
Q

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

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

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8
Q

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)

A

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

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9
Q

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

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.

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

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

A

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

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13
Q

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

A

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

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14
Q

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

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

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15
Q

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

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

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16
Q

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

A

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

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17
Q

A patient has developed hepatic encephalopathy secondary to cirrhosis and is receiving care on the medical unit. The patient’s current medication regiment includes lactulose (Cephulac) four times daily. What desired outcome should the nurse relate to this pharmacologic intervention?

A. Two to 3 soft bowel movements daily
B. Significant increase in appetite and food intake
C. Absence of nausea and vomiting
D. Absence of blood or mucus in stool

A

A. Two to 3 soft bowel movements daily

Rationale: Lactulose is administered to reduce serum ammonia levels. Two or three soft stools per day are desirable; this indicates that lactulose is performing as intended. Lactulose doesn’t address the patient’s appetite, symptoms of NV, or the development of blood and mucus in the stool

18
Q

A nurse is performing an admission assessment for an 81-year old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

A. Similar liver size and texture as in younger adults
B. A nonpalpable liver
C. A slightly enlarged liver with palpably hard edges
D. A slightly decreased size of the liver

A

D. A slightly decreased size of the liver

Rationale: the most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges

19
Q

A nurse is caring for a patient with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

A. Watery, blood-streaked diarrhea
B. Orange and foamy urine
C. Increased abdominal girth
D. Decreased cognition

A

B. Orange and foamy urine

Rationale: If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Blood diarrhea, ascites, and cognitive changes aren’t associated with obstructive jaundice

20
Q

During a health education session, a participant has asked about the hepatitis E virus. What prevention measure should the nurse recommend for preventing infection with this virus?

A. Following proper hand-washing techniques
B. Avoiding chemicals that are toxic to the liver
C. Wearing a condom during sexual contact
D. Limiting alcohol intake

A

A. Following proper hand-washing techniques

Rationale: avoiding contact with the hepatitis E virus through good hygiene, including hand washing, is the major method of prevention. Hepatitis E is transmitted by the fecal-real route, principally through contaminated water in areas of poor sanitation. Consequently, none of the other listed preventative measures is indicated

21
Q

A patient’s physician has ordered a liver panel in response to the patient’s development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? SATA.

A. ALT
B. C-reactive protein
C. Gamma-glutamic transferase (GGT)
D. AST
E. B-type natriuretic peptide (BNP)

A

A. ALT
C. Gamma-glutamic transferase (GGT)
D. AST

Rationale: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel

22
Q

A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patient’s plan?

A. Increased potassium intake
B. Fluid restriction to 2-L per day
C. Reduction in sodium intake
D. High-protein, low-fat diet

A

C. Reduction in sodium intake

Rationale: Patients with ascites require a sharp reduction in sodium intake. Potassium intake shouldn’t be correspondingly increased. There is no need for fluid restriction or increased protein intake

23
Q

A nurse is amending a patient’s plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patient’s care plan?

A. Mobilization with assistance at least 4x daily
B. Administration of beta-adrenergic blockers as ordered
C. Vitamin B12 injections as ordered
D. Administration of diuretics as ordered

A

D. Administration of diuretics as ordered

Rationale: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers aren’t used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections aren’t necessary

24
Q

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patient’s plan of care?

A. Measurement of abdominal girth and body weight
B. Assessment for variceal bleeding
C. Assessment for signs and symptoms of jaundice
D. Monitoring of results of liver function testing

A

B. Assessment for variceal bleeding

Rationale: Esophageal variceal are a major cause of mortality in patients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse’s assessments and should be prioritized over the other listed assessments, even though each should be performed

25
Q

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patient’s treatment?

A. Decisional conflict
B. Deficient knowledge
C. Death anxiety
D. Disturbed thought process

A

C. Death anxiety

Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patient’s likely fear of death, which is a realistic possibility. For most patients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may not experience disturbances in thought processes

26
Q

A patient with a diagnosis of esophageal variceal has undergone endoscopy to gauge the progression of this complication of liver disease. Following the completion of this diagnostic test, what nursing intervention should the nurse perform?

A. Keep patient NPO until the results of test are known
B. Keep patient NPO until the patient’s gag reflex returns
C. Administer analgesia until post-procedure tenderness is relieved
D. Give the patient a cold beverage to promote swallowing ability

A

B. Keep patient NPO until the patient’s gag reflex returns

Rationale: After the exam, fluids aren’t given until the patient’s gag reflex returns. Lozenges and gargles may be used to relieve throat discomfort if the patient’s physical condition and mental status permit. The result of the test is known immediately. Food and fluids are contraindicated until the gag reflex returns

27
Q

A patient with esophageal variceal is being cared for in the ICU. The variceal have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringer’s lactate at 150 mL/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient?

A. Arterial line
B. Diuretics
C. Foley catheter
D. Volume expanders

A

D. Volume expanders

Rationale: Because patients with bleeding esophageal varies have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley catheter are likely to be ordered, but neither actively maintains the patient’s volume

28
Q

A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient’s treatment, the nurse should anticipate what intervention?

A. Administration of immune globulins
B. A regimen of antiviral medications
C. Rest and watchful waiting
D. Administration of fresh-frozen plasma (FFP)

A

B. A regimen of antiviral medications

Rationale: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP aren’t indicated

29
Q

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurse’s risk of acquiring hepatitis C in the workplace?

A. Disposing of sharps appropriately and not recapping needles
B. Performing meticulous hand hygiene at the appropriate moments in care
C. Adhering to the recommended schedule of immunizations
D. Wearing an N95 mask when providing care for patients on airborne precautions

A

A. Disposing of sharps appropriately and not recapping needles

Rationale: HCV is blood borne. Consequently, prevention of needle stick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions don’t directly mitigate the risk of HCV

30
Q

A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patient’s care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence.
1. Fever rises
2. Hematemesis
3. Clotting abnormalities
4. Vascular collapse
5. Coma

A. 1, 2, 5, 4, 3
B. 1, 2, 3, 4, 5
C. 2, 3, 1, 4, 5
D. 3, 1, 2, 5, 4

A

B. 1, 2, 3, 4, 5

Rationale: Recovery from acute toxic hepatitis is rapid if the hepatotoxic is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There aren’t effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant

31
Q

A previously health adult’s student and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the ICU. The nurse should be aware that the treatment of choice for this patient is what?

A. IV administration of immune globulins
B. Transfusion of packed RBCs and fresh-frozen plasma (FFP)
C. Liver transplantation
D. Lobectomy

A

C. Liver transplantation

Rationale: Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery

32
Q

A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurse’s most recent assessment reveals subtle changes in the patient’s cognition and behavior. What is the nurse’s most appropriate response?

A. Ensure that the patient’s sodium intake doesn’t exceed recommended levels
B. Report this finding to the PCP due to the possibility of hepatic encephalopathy
C. Inform the PCP that the patient should be assessed for alcoholic hepatitis
D. Implement interventions aimed at ensuring a calm and therapeutic care environment

A

B. Report this finding to the PCP due to the possibility of hepatic encephalopathy

Rationale: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patient’s mental status closely and reports changes to that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and wouldn’t signal the onset of hepatitis. A supportive care environment is beneficial, but doesn’t address the patient’s physiologic deterioration

33
Q

A patient with ESLD has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patient’s fluid volume excess? SATA.

A. Administering diuretics
B. Administering CCBs
C. Implementing fluid restrictions
D. Implementing a 1500 kcal/day restriction
E. Enhancing patient positioning

A

A. Administering diuretics
C. Implementing fluid restrictions
E. Enhancing patient positioning

Rationale: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. CCBs and calorie restriction don’t address this problem

34
Q

A patient with liver cancer is being discharged home with a biliary drainage system in place. The nurse should teach the patient’s family how to safely perform which of the following actions?

A. Aspirating bile from the catheter using a syringe
B. Removing the catheter when output is </= 15 mL in 24 hours
C. Instilling antibiotics into the catheter
D. Assessing the latency of the drainage catheter

A

D. Assessing the latency of the drainage catheter

Rationale: Families should be taught to provide basic catheter care, including assessment of latency. Antibiotics aren’t instilled into the catheter and aspiration using a syringe is contraindicated. The family wouldn’t independently remove the Cather; this would be done by a member of the care team when deemed necessary

35
Q

A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patient’s prioritization for receiving a donor liver be determined?

A. By considering the patient’s age and prognosis
B. By objectively determining the patient’s medical need
C. By objectively assessing the patient’s willingness to adhere to post-transplantation care
D. By systematically ruling out alternative treatment options

A

B. By objectively determining the patient’s medical need

Rationale: The patient would undergo a classification of the degree of medical need through an objective determination known as the MELD classification, which stratifies the level of illness of those awaiting a liver transplant. This algorithm considers multiple variables, not solely age, prognosis, potential for adherence, and the rejection of alternative options

36
Q

A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patient’s vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurse’s most appropriate action?

A. Remove the patient’s commode and supply a bedpan
B. Complete an incident report and submit it to the unit supervisor
C. Have the patient assessed by the physician due to the risk of internal bleeding
D. Perform a focused abdominal assessment in order to rule out injury

A

C. Have the patient assessed by the physician due to the risk of internal bleeding

Rationale: a fall would necessitate thorough medical assessment due to the patient’s risk of bleeding. The nurse’s abdominal assessment is an appropriate action, but isn’t wholly sufficient to rule out internal injury. Medical assessment is a priority over removing the commode or filling out an incident report, even though these actions are appropriate

37
Q

A patient with liver cancer is being discharged home with a hepatic artery catheter in place. The nurse should be aware that this catheter will facilitate which of the following?

A. Continuous monitoring for portal hypertension
B. Administration of immunosuppressive drugs during the first weeks after transplantation
C. Real-time monitoring of vascular changes in the hepatic system
D. Delivery of a continuous chemotherapeutic dose

A

D. Delivery of a continuous chemotherapeutic dose

Rationale: In most cases, the hepatic artery catheter has been inserted surgically and has a prefilled infusion pump that delivers a continuous chemotherapeutic dose until completed. The hepatic artery catheter doesn’t monitor portal hypertension, deliver immunosuppressive drugs, or monitor vascular changes in the hepatic system

38
Q

A nurse on a solid organ transplant unit is planning the care of a patient who will soon be admitted upon immediate recovery following liver transplantation. What aspect of nursing care is the nurse’s priority?

A. Implementation of infection-control measures
B. Close monitoring of skin integrity and color
C. Frequent assessment of the patient’s psychosocial status
D. Administration of antiretroviral medications

A

A. Implementation of infection-control measures

Rationale: Infection control is paramount following liver transplantation. This is a priority over skin integrity and psychosis status, even though these are valid areas of assessment and intervention. Antiretrovirals aren’t indicated

39
Q

A 55-year old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

A. Destruction of the patient’s liver tumor
B. Restoration of portal vein latency
C. Destruction of a liver abscess
D. Reversal of metastasis

A

A. Destruction of the patient’s liver tumor

Rationale: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique doesn’t address circulatory function or abscess formation. It doesn’t allow for the reversal of metastasis

40
Q

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory test show free bilirubin to be 24 mg/dL. For what complication is this patient at risk?

A. Chronic jaundice
B. Pigment stones in portal circulation
C. Central nervous system damage
D. Hepatomegaly

A

C. Central nervous system damage

Rationale: Prolonged jaundice, even if mild, predisposes to the formation of pigment stones in the gallbladder, and extremely severe jaundice (levels of free bilirubin exceeding 20 to 25 mg/dL) poses a risk for CNS damage. There aren’t specific risks of hepatomegaly or chronic jaundice resulting from high bilirubin