Quiz #5 Liver Disease

Question 1

Chronic illness with broad hands, feet,and face

Answer 1

Acromegaly

B/c of the overproduction of growth hormones. The pt has a gradual enlargement of body tissues.

Question 2

Hypo parathyroidism what findings to monitor for select all that apply

Answer 2

-High phosphorus
- Low calcium

Question 3

NGN know the condition and finding
Encephalopathy
Ammonia

Answer 3

Answers:
Encephalopathy
Ammonia

Rationale: Hepatic encephalopathy: This is a condition that happens when your liver is too diseased or damaged to properly process ammonia, leading to a buildup of ammonia in your blood that travels to your brain

Question 4

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?

a. Patient with Hashimoto’s thyroiditis and a heart rate of 102
b. Patient with tetany who has a new order for IV calcium chloride
c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL
d. Patient with Addison’s disease who takes IV hydrocortisone twice daily

Answer 4

b. Patient with tetany who has a new order for IV calcium chloride

Emergency treatment of tetany requires IV administration of calcium; electrocardiographic monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

Question 5

A nurse is caring for a client who is 8 hr. postoperative following a subtotal thyroidectomy. In which of the following positions should the nurse keep the client?

A. High Fowler’s with neck extended
B. High Fowler’s with neck in a neutral position.
C. Semi-Fowler’s with neck extended
D. Semi-Fowler’s with neck in a neutral position

Answer 5

D. Semi-Fowler’s with neck in a neutral position

Semi-Fowler’s with neck in a neutral position
It is the most comfortable position for a pt who had thyroid surgery. Neck flexion could compromise the airway, and neck extension could place excessive tension on the operative area and the suture. A neutral position is essential.

Question 6

A nurse is assisting a client who has hypothyroidism with meal planning. Which of the following foods should the nurse recommend that the client add to her diet?

a. Ripe bananas
b. Poached eggs
c. Whole grains
d. Baked chicken

Answer 6

C. whole grains

Constipation is a classic manifestation of hypothyroidism; therefore, this client should increase her fluid and fiber intake. Whole grains provide ample amounts of fiber.

Question 7

NGN:
A nurse is caring for a client who has cirrhosis of the liver.

Medical History
Cirrhosis of the liver, hepatitis C, type 2 diabetes mellitus, hypertension, and coronary artery disease.
Surgical history: liver biopsy 2 years ago, paracentesis last done 4 months ago, and endoscopic variceal ligation 2 months ago.
Client reports feeling well until approximately 3 days ago. Client describes loss of appetite, fatigue, weight gain of approximately 3 kg (6.6 lb) in 4 days, and itching all over their body with increased abdominal distention and course tremor of both hands.

Diagnostic Results
Total bilirubin 8 mg/dL (0.3 to 1.0 mg/dL)
Alanine aminotransferase (ALT) 220 units/L (4 to 36 units/L)
Ammonia 95 mcg/dL (10 to 80 mcg/dL)
Platelets 90,000/mm3 (150,000 to 400,000/mm3)
Hematocrit 42% (37% to 47% female; 42% to 52% male)
Hemoglobin 14 g/dL (14 to 18 g/dL)
Albumin 2.1 g/dL (3.5 to 5 g/dL)

Vital Signs
Temperature 36° C (96.9° F)
Heart rate 101/min
Respiratory rate 24/min
Blood pressure 82/58 mm Hg
Oxygen saturation 92%

Which of the following assessment findings require immediate follow-up? Select all that apply.
Temperature
Ammonia level
Bilirubin
Abdominal girth
Pruritis
Asterixis
Scattered ecchymosis on the upper limbs
Blood pressure

Answer 7

• ammonia level
• blood pressure
• scattered ecchymosis
• abdominal girth

Question 8

A nurse is caring for a client who has cirrhosis and a new prescription for lactulose. Which of the following manifestations indicates an adverse effect of the medication?

A. Dry mouth
B. Vomiting
C. Headache
D. Peripheral edema

Answer 8

B. Vomiting

Question 9

A nurse is reviewing discharge instructions with a client who has rheumatoid arthritis and a new prescription for prednisone. Which of the following statements by the client indicates an understanding of the teaching?

A. “I should take my flu vaccine within one week of starting this medication.”
B. “I should eat more bananas while taking this medication.”
C. “I should take aspirin for minor aches and pains while taking this medication.”
D. “I can expect a sore throat for the first week after starting this medication.”

Answer 9

B. “I should eat more bananas while taking this medication.”

This is correct because prednisone can cause hypokalemia (low potassium levels) and bananas are a good source of potassium. The client should monitor their potassium levels and eat foods rich in potassium while taking prednisone.

Question 10

A nurse is teaching a client with a new diagnosis of hyperparathyroidism. The nurse should include in the teaching that which of the following is a complication?

a. Impaired skin integrity
b. Fluid retention
c. Pathophysiologic fractures
d. Dysphagia

Answer 10

c. Pathophysiologic fractures

Due to release of calcium and phosphate into the blood, which lower bone density and places client at risk for pathologic fractures. Hypercalcemia is too much calcium in the blood and weakened bones.

Question 11

A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism?

A. A client who has a phosphate of 5.7 mg/dL.
B. A client who has a calcium of 9.8 mg/dL.
C. A client who has a vitamin D of 25 ng/mL.
D. A client who has a magnesium of 1.8 mEq/L.

Answer 11

A. A client who has a phosphate of 5.7 mg/dL.

The client with a phosphate level of 5.7 mg/dL likely has a manifestation of hypoparathyroidism. Hypoparathyroidism leads to decreased parathyroid hormone (PTH) secretion, which causes increased renal phosphate reabsorption, leading to elevated phosphate levels in the blood.

Question 12

A nurse is collecting data from a client who has hypoparathyroidism. Which of the following findings should the nurse expect?

A. Negative Chvostek’s sign
B. Flaccid muscles
C. Numbness of the hands
D. Hypercalcemia

Answer 12

C. Numbness of the hands

Numbness of the hands is a common finding of hypoparathyroidism, as low levels of parathyroid hormone can cause hypocalcemia, which affects the nerve function and sensation. Numbness can also occur in the feet, lips, and tongue.

Question 13

A nurse is planning care for a client who has acromegaly and is postoperative following a transsphenoidal hypophysectomy. Which of the following interventions should the nurse include in the plan?

A. Maintain client in low-Fowlers positions
B. Encourage deep breathing and coughing
C. Encourage the client to brush their teeth when awake and alert
D. Observe dressing drainage for the presence of glucose

Answer 13

D. Observe dressing drainage for the presence of glucose

The nurse should monitor the drainage to the mustache dressing and observe for the presence of glucose, which would indicate presence of CSF

Question 14

A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. The nurse should recognize which of the following finding is a therapeutic response to the medication?

A. Decrease in appetite
B. Increase in weight
C. Increase in energy
D. Decrease in body temperature

Answer 14

C. Increase in energy.

Rationale: Depression, lethargy, and fatigue are manifestations of HYPOthyroidism and effective treatment will improve these manifestations.
Liothyronine is used to treat an underactive thyroid (hypothyroidism).

Question 15

A nurse is teaching about levothyroxine with a client who has primary hypothyroidism. Which of the following statements should the nurse use when teaching the client?

A. “Take this medication until your symptoms are gone and then discontinue”
B. “Tremors, nervousness, and insomnia may indicate your dose is too high”
C. “Symptoms improve immediately after starting the medication”
D. “The medication decreases the overproduction of the thyroid hormone thyroxine”

Answer 15

B. “Tremors, nervousness, and insomnia may indicate your dose is too high”

f the dose of levothyroxine is too high, it can lead to symptoms of hyperthyroidism or thyroid hormone excess. These symptoms include

Question 16

A nurse is assessing a client who has cirrhosis. Which of the following is an expected finding for this client?
A. Moist skin
B. Spider angiomas
C. Tarry stools
D. Blood in the urine

Answer 16

B. Spider angiomas

Spider angiomas (also known as spider nevi) are expected findings in clients with cirrhosis. They are small, dilated blood vessels near the surface of the skin that resemble a spider’s web. They can be found on the face, neck, upper trunk, and arms.

Question 17

The client diagnosed with Addison’s disease is admitted to the emergency departmentafter a day at the lake. The client is lethargic, forgetful, and weak. Which interventionshould be the emergency department nurse’s first action?

1. Start an IV with an 18-gauge needle and infuse NS rapidly.
2. Have the client wait in the waiting room until a bed is available.
3. Perform a complete head-to-toe assessment.
4. Collect urinalysis and blood samples for a CBC and calcium level.

Answer 17

1. Start an IV with an 18-gauge needle and infuse NS rapidly.

This client has been exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an Addisonian crisis. Rapid IV fluid replacement is necessary.

Question 18

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison’s disease. Which of the following findings should the nurse expect?

a. Hyperpigmentation
b. Intention tremors
c. Hirsutism
d. Purple striations

Answer 18

a. Hyperpigmentation

Addison’s disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.

Question 19

A nurse is reviewing the laboratory values of a client who has primary hypothyroidism. The nurse should anticipate an elevation of which of the following laboratory values?

a. Thyroid stimulating hormone (TSH)
b. Free T4
c. Serum T4
d. Serum T3

Answer 19

a. Thyroid stimulating hormone (TSH)

Question 20

A nurse is teaching a client about causes of biliary cirrhosis. Which of the following information should the nurse include in the teaching?

A. Excessive alcohol consumption
B. Hepatitis C
C. Hepatotoxic medications
D. Obstruction of the bile duct

Answer 20

D. Obstruction of the bile duct

Question 21

A nurse is planning care for a client who is postoperative following a thyroidectomy. Which of the following interventions should the nurse include in the plan?

A. Place the head of the client’s bed in the flat position.
B. Instruct the client to deep breathe every 4 hr.
C. Hyperextend the client’s neck.
D. Check the client’s voice every 2 hr.

Answer 21

D. Check the client’s voice every 2 hrs

The nurse should assess the client’s voice every 2 hr to monitor for hoarseness, which is a manifestation of laryngeal nerve damage.

Question 22

A nurse is teaching a community education course about the physical complications related to substance use disorder. Which of the following findings should the nurse identify as the primary cause of liver cirrhosis?

A. Alcohol
B. Caffeine
C. Cocaine
D. Inhalants

Answer 22

A. Alcohol

Chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver.

Question 23

A nursing is reviewing nutrition therapy with a client who has Cushing’s disease. Which of the following dietary modifications should the nurse include in this discussion?

A. Limit potassium rich foods in the diet.
B. Decrease sodium intake.
C. Increase calorie intake.
D. Consume more calories from carbohydrates than protein.

Answer 23

B. Decrease sodium intake.

This is the correct choice. Decreasing sodium intake is a dietary modification relevant to individuals with Cushing’s disease. Excessive cortisol production can lead to sodium and water retention, and reducing sodium intake helps manage fluid balance.

Question 24

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance?

a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome.

b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.
d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

Answer 24

d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.

The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient’s physiological changes are caused by the high hormone levels, not by the patient’s diet or exercise choices

Question 25

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to

A. cough and deep breathe every 2 hours postoperatively.
B. remain on bed rest for the first 48 hours after the
surgery.
C. be positioned flat with sandbags at the head
postoperatively.
D. avoid brushing the teeth for at least 10 days after the surgery.

Answer 25

D. avoid brushing the teeth for at least 10 days after the surgery.

To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.

Question 26

A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first?

1) Encourage range-of-motion exercises.
2) Document the finding and monitor the client.
3) Take vital signs, including temperature.
4) Assess pain and administer pain medication.

Answer 26

3) Take vital signs, including temperature.

Question 27

The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new prescription for methimazole (Tapazole). Which patient statement indicates understanding of instructions about this medication?

A. “This medication will increase my metabolism.”
B. “As long as I take this medication daily, the time of the dose is not important.”
C. “This medication will cure my thyroid problem.”
D. “I will need regular blood tests while taking this medication.”

Answer 27

D. “I will need regular blood tests while taking this medication.”

Question 28

A nurse is planning care for a client who has end-stage cirrhosis of the liver with encephalopathy. Which of the following interventions should the nurse plan to implement to decrease the client’s ammonia level?

A. Administer diuretics.
B. Restrict the client’s intake of fluids.
C. Reduce the client’s intake of protein.
D. Administer vitamin K.

Answer 28

C. Reduce the client’s intake of protein.

Intake of protein is broken down into amino acids. Left over amino acids gets produced into ammonia.

Question 29

Delegation instructions for collecting urine sample?
- “Note the time of the client’s first void and collect urine for 24 hours

Question 30

a nurse is caring for a client who is in myxedema coma. which of the following actions should the nurse take?

a. turn the client every 4 hour
b. check the client’s blood pressure every 2 hours
c. initiate measures to cool the client
d. place the client on aspiration precautions

Answer 30

d. place the client on aspiration precautions

Question 31

A nurse is caring for a client who has Cushing’s syndrome. The nurse should recognize that which of the following are manifestations of Cushing’s syndrome? (Select all that apply.)

A. Alopecia
B. Tremors
C. Moon face
D. Purple striations
E. Buffalo hump

Answer 31

C. Moon face
D. Purple striations
E. Buffalo hump

Alopecia, Moon face, Purple striations, Buffalo hump Rationale: Alopecia is correct. Clients who have Cushing’s syndrome can develop hirsutism, which is excessive body hair. Women can also develop alopecia, in the form of male pattern baldness.Tremors is incorrect. Tremors are not a common manifestation of Cushing’s syndrome.Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing’s syndrome.Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing’s syndrome.Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing’s syndrome.

Question 32

A nurse is assessing a client who is admitted with hyperthyroidism. The client reports weight loss of 5.4 kg (12 lbs) in the last 2 months, increased appetite, increase perspiration, fatigue, menstural irregularity, and restlessness. Which of the following should the nurse take to prevent thyroid crisis?

a. Provide a quiet, low-stimulus environment
b. Administer aspirin as prescribed for any sign of hyperthermia.
c. Keep the client NPO.
d. Observe the client carefully for signs of hypocalcemia.

Answer 32

A. Provide a quiet, low-stimulus environment

Thyroid crisis can occur in response to a stressor, so the nurse should minimize stressful stimuli in the client’s environment.