Unit P-Clients with Complex Liver Problems (Gastrointestinal)

Question 1

The nurse is interviewing a client who reports having abdominal cramping, bloating, and diarrhea after drinking milk or ingesting other dairy products. What health problem does the client most likely have?

a. Steatorrhea
b. Ulcerative colitis
c. Crohn disease
d. Lactose intolerance

Answer 1

ANS: D
The client is demonstrating signs and symptoms of lactose intolerance because they occur after the client eats or drinks dairy products which contain lactose.

Question 2

The primary health care provider documents that a client has a bruit over the abdominal aorta. What teaching will the nurse provide for assistive personnel (AP) based on this assessment finding?

a. “Use warm compresses on the client’s abdomen continuously.”
b. “Avoid washing the client’s abdomen too aggressively.”

c. “Apply ice to the client’s abdomen every 4 hours.”
d. “Massage the client’s abdomen to help reduce pain.”

Answer 2

ANS: B
A bruit heard over the abdominal aorta possible indicates stenosis or an aneurysm which should not be palpated or percussed. Therefore, the AP should wash the client’s abdomen very gently.

Question 3

A client is having an esophagogastroduodenoscopy (EGD) and has been given midazolam hydrochloride. The client’s respiratory rate is 8 breaths/min. What action by the nurse is appropriate?

a. Administer naloxone.
b. Call the Rapid Response Team.
c. Provide physical stimulation.
d. Ventilate with a bag-valve-mask.

Answer 3

ANS:C
For an EGD, clients are given mild sedation but would still be able to follow commands. For shallow or slow respirations after the sedation is given, the nurse’s most appropriate action is to provide a physical stimulation such as a sternal rub and directions to breathe deeply. Naloxone is not the antidote for midazolam HCl. The Rapid Response Team is not needed at this point. The client does not need manual ventilation.

Question 4

A client is scheduled for a colonoscopy and the nurse has provided instructions on the bowel cleansing regimen. What statement by the client indicates a need for further teaching?

a. “It’s a good thing I love orange and cherry gelatin.”
b. “My spouse will be here to drive me home.”
c. “I’ll avoid ibuprofen for several days before the test.”
d. “I’ll buy a case of clear Gatorade before the prep.”

Answer 4

ANS: A
The client would be advised to avoid beverages and gelatin that are red, orange, or purple in color as their residue can appear to be blood. The other statements show an understanding of the preparation for the procedure.

Question 5

A client had a colonoscopy and biopsy yesterday and calls the gastrointestinal clinic to report
a spot of bright red blood on the toilet paper today. What response by the nurse is appropriate?
a. Ask the client to call back if this happens again today.
b. Instruct the client to go to the emergency department.
c. Remind the client that a small amount of bleeding is possible.
d. Tell the client to come to the clinic this afternoon.

Answer 5

ANS: C
After a colonoscopy with biopsy, a small amount of bleeding is normal. The nurse would remind the client of this and instruct him or her to go to the emergency department for large amounts of bleeding, severe pain, or dizziness.

Question 6

An older adult has had an instance of drug toxicity and asks why this happens, since the client has been on this medication for years at the same dose. What response by the nurse is best?

a. “Changes in your liver cause drugs to be metabolized differently.”
b. “Perhaps you don’t need as high a dose of the drug as before.”
c. “Stomach muscles atrophy with age and you digest more slowly.”
d. “Your body probably can’t tolerate as much medication anymore.”

Answer 6

ANS:A
Decreased liver enzyme activity depresses drug metabolism, which leads to accumulation of drugs—possibly to toxic levels. The other options do not accurately explain this age-related change.

Question 7

To promote comfort and the passage of flatus after a colonoscopy, in what position does the nurse place the client?

a. Left lateral
b. Prone
c. Right lateral
d. Supine

Answer 7

ANS: A

After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.

Question 8

A nurse is assessing a client reporting right upper quadrant (RUQ) abdominal pain. What technique would the nurse use to assess this client’s abdomen?

a. Auscultate after palpating.
b. Avoid any type of palpation
c. Lightly palpate the RUQ first.
d. Lightly palpate the RUQ last

Answer 8

ANS: D
If pain is present in a certain area of the abdomen, that area would be palpated last to keep the client from tensing which could possibly affect the rest of the examination. Auscultation of the abdomen occurs prior to palpation.

Question 9

The nurse knows that a client with prolonged prothrombin time (PT) values (not related to medication) probably has dysfunction in which organ?

a. Kidneys
b. Liver
c. Spleen
d. Stomach

Answer 9

ANS: B
Severe acute or chronic liver damage leads to a prolonged PT secondary to impaired synthesis of clotting proteins. The other organs are not related to this issue.

Question 10

A client is recovering from an esophagogastroduodenoscopy (EGD) and requests something to drink. What action by the nurse is appropriate?

a. Allow the client cool liquids only.
b. Assess the client’s gag reflex.
c. Remind the client to remain NPO.
d. Tell the client to wait 4 hours.

Answer 10

ANS: B
The local anesthetic used during this procedure depresses the client’s gag reflex. After the procedure, the nurse would ensure that the gag reflex is intact before offering food or fluids. The client does not need to be restricted to cool beverages only and is not required to wait 4 hours before oral intake is allowed. Telling the client to remain NPO does not inform the client of when he or she can have fluids, nor does it reflect the client’s readiness for them.

Question 11

The assistive personnel note that a client had a dark stool. What stool test would the nurse obtain for this client?

a. Culture and sensitivity
b. Parasites and ova
c. Occult blood test
d. Total fat content

Answer 11

ANS: C
Dark stools are typical in clients who have lower GI bleeding. Therefore, an fecal occult blood test would be the most appropriate test as a follow-up.

Question 12

The nurse is aware of the most recent American Cancer Society Screening Guidelines for colon cancer, which include which accepted testing modalities for people over the age of 50? (Select all that apply.)

a. Colonoscopy every 10 years
b. Endoscopy every 5 years
c. Computed tomography (CT) colonography every 5 years
d. Double-contrast barium enema every 10 years
e. Flexible sigmoidoscopy every 5 years

Answer 12

ANS: A,C,E
The options for colon cancer screening for people over the age of 50 include colonoscopy every 10 years and CT colonography, double-contrast barium enema, or flexible sigmoidoscopy every 5 years.

Question 13

A client had an endoscopic retrograde cholangiopancreatography (ERCP). The nurse teaches the client and family about the signs of potential complications which include what problems? (Select all that apply.)

a. Cholangitis
b. Pancreatitis
c. Perforation
d. Renal lithiasis
e. Sepsis

Answer 13

ANS: A,B,C,E
Possible complications after an ERCP include cholangitis, pancreatitis, perforation, sepsis, and bleeding. Kidney stones are not a complication of ERCP.

Question 14

The nurse working with older clients understands age-related changes in the gastrointestinal system. Which changes does this include? (Select all that apply.)

a. Decreased hydrochloric acid production
b. Diminished sensation that can lead to constipation
c. Fat not digested as well in older adults
d. Increased peristalsis in the large intestine. Pancreatic vessels become calcified

Answer 14

ANS: A,B,C,E
Several age-related changes occur in the gastrointestinal system. These include decreased hydrochloric acid production, diminished nerve function that leads to decreased sensation of the need to pass stool, decreased fat digestion, decreased peristalsis in the large intestine, and calcification of pancreatic vessels.

Question 15

The nurse working with clients who have gastrointestinal problems knows that which laboratory values are related to which organ functions or dysfunctions? (Select all that apply.)

a. Alanine aminotransferase: biliary system
b. Ammonia: liver
c. Amylase: liver
d. Lipase: pancreas
e. Urine urobilinogen: stomach

Answer 15

ANS: B,D
Alanine aminotransferase and ammonia are related to the liver. Amylase and lipase are related to the pancreas. Urobilinogen evaluates both hepatic and biliary function.

Question 16

A nurse cares for a client who is recovering from a colonoscopy. Which actions would the nurse take? (Select all that apply.)

a. Obtain vital signs every 15 to 30 minutes until alert.
b. Assess the client for rectal bleeding and severe pain.
c. Administer prescribed pain medications as needed.
d. Monitor the client’s serum and urine glucose levels.
e. Confirm the client has a ride home and plans to rest.

Answer 16

ANS: A,B,E
During the recovery phase after a colonoscopy, the nurse would obtain vital signs
every 15 to 30 minutes until the client is alert, assess for rectal bleeding or severe pain, and confirm the client has arranged for another person to drive home to get rest. Pain medications are not necessary after the procedure, and neither is glucose monitoring

Question 17

The nurse is caring for a client who has cirrhosis of the liver. Which risk factor is the leading cause of cirrhosis?

a. Metabolic syndrome
b. Liver cancer
c. Nonalcoholic fatty liver disease
d. Hepatitis C

Answer 17

ANS: D
Hepatitis C is the leading cause of cirrhosis and an also cause liver cancer. Clients with nonalcoholic fatty liver disease often have metabolic syndrome and can also develop cirrhosis

Question 18

The nurse is caring for a client who has cirrhosis of the liver. What nursing action is appropriate to help control ascites?

a. Monitor intake and output.
b. Provide a low-sodium diet.
c. Increase oral fluid intake.
d. Weigh the patient daily.

Answer 18

ANS: B
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.

Question 19

The nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding would require immediate 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 22 to 16 breaths/min
d. A decrease in the client’s weight by 3 lb (1.4 kg)

Answer 19

ANS:ARapid removal of ascitic 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 client’s weight to drop as fluid is removed. To prevent hypovolemic shock, no more than 2000 mL are usually removed from the abdomen at one time. The patient’s weight typically only decreases by less than 2 kg or 4.4 lb.

Question 20

The nurse is caring for a client who has a risk gene for developing cirrhosis. Which racial/ethnic group has this gene most often?

a. Blacks
b. Asian/Pacific Islanders
c. Latinos
d. French

Answer 20

ANS: C
The Patatin-like phospholipase domain containing 3 gene (PNPLA3) has been identified as a risk gene for cirrhosis, which occurs most often in Latinos when compared to other populations.

Question 21

The nurse is caring for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic, and the family expresses distress that the patient is receiving little dietary protein. How would 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 patient gain weight and muscle mass.”
d. “Low dietary protein is needed to prevent fluid from leaking into the abdomen.”

Answer 21

ANS: B
A low-protein diet is prescribed 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 patient’s dietary protein will cause complications of liver failure and would not be suggested. Increased intravascular protein will help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.

Question 22

The nurse is caring for a client who is prescribed lactulose. The client states, “I do not want to take this medication because it causes diarrhea.” How would the nurse respond?

a. “Diarrhea is expected; that’s how your body gets rid of ammonia.”
b. “You may take antidiarrheal medication to prevent 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 as soon as possible.”

Answer 22

ANS: A
The purpose of administering lactulose to this patient 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 patient must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse would 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.

Question 23

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client’s understanding. Which statement by the client indicates 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.”

Answer 23

ANS: B
The route of transmission for hGepRaAtitDisEASLinAfeBct.ioCnOisMthrough 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.

Question 24

The nurse is caring for a client scheduled to have a transjugular intrahepatic portal-systemic shunt (TIPS) procedure. What client assessment would the nurse perform prior to this procedure?

a. Musculoskeletal assessment
b. Neurologic assessment
c. Mental health assessment
d. Cardiovascular assessment

Answer 24

ANS: D
A postprocedure complication of a TIPS procedure is right-sided heart failure. Therefore, the nurse would perform a cardiovascular assessment before the procedure to determine if the client has signs and symptoms of heart failure.

Question 25

The nurse is preparing to teach a client with chronic hepatitis B about lamivudine therapy. What health teaching would the nurse include?

a. “Follow up on all appointments to monitor your lab values.”
b. “Do not take amiodorone at any time while on this drug.”
c. “Monitor for jaundice, rash, and itchy skin while on this drug.”
d. “Report any changes in urinary elimination while on this drug.”

Answer 25

ANS: D

Lamivudine can cause renal impairment and the nurse would remind the client of changes that may indicate kidney damage

Question 26

The nurse is teaching a client a client about taking elbasvir for hepatitis C. What information in the client’s history would the nurse need prior to drug administration?

a. History of hepatitis B
b. History of kidney disease
c. History of cardiac disease
d. History of rectal bleeding

Answer 26

ANS: A
Elbasvir can cause liver toxicity and therefore the nurse would assess for a history of or
current hepatitis B.

Question 27

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago. The client states, “I’m having right belly pain and have a temperature of 101° F (38.3° C).” How would 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 get checked out.”
c. “You should take an additional dose of cyclosporine today.”
d. “Take acetaminophen every 4 hours until you feel better soon.”

Answer 27

ANS: B
Fever, right abdominal quadrant pain, and jaundice are signs of possible liver transplant rejection; the client would be admitted to the hospital as soon as possible for intervention. Antirejection drugs do make a client more susceptible to infection, but this client has signs of rejection, not infection. The nurse would not advise the client to take an additional dose of cyclosporine or acetaminophen as these medications will not treat the acute rejection.

Question 28

After teaching a client who has alcohol-induced cirrhosis, a nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching?

a. “I cannot drink any alcohol at all anymore.”
b. “I should not take over-the-counter medications.”
c. “I need to avoid protein in my diet.”
d. “I should eat small, frequent, balanced meals.”

Answer 28

ANS: C
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.

Question 29

The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take?

a. Have the client sign the informed consent form.
b. Get the patient into a chair before the procedure.
c. Help the client lie flat in bed on the right side.
d. Assist the client to void before the procedure.

Answer 29

ANS: D
For safety, the patient would void just before a paracentesis to prevent bladder damage to the procedure. The primary health care provider would have the client sign the consent form. The proper position for a paracentesGisRiAsDsiEttiSnLgAupBri.gChtOinMbed or, alternatively, sitting on the side of the bed and leaning over the bedside table.

Question 30

The nurse is caring for a client who has cirrhosis from substance abuse. The client states, “All of my family hates me.” How would the nurse respond?

a. “You should make peace with your family.”
b. “This is not unusual. My family hates me too.”
c. “I will help you identify a support system.”
d. “You must attend Alcoholics Anonymous.”

Answer 30

ANS: C
Clients who have cirrhosis due to addiction may have alienated relatives over the years because of substance abuse. The nurse would assist the client to identify a friend, neighbor, clergy/spiritual leader, or group for support. The nurse would not minimize the patient’s concerns. Attending AA may be appropriate, but this response doesn’t address the client’s concern. “Making peace” with the client’s family may not be possible. This statement is not client-centered.

Question 31

The nurse is caring for a client with hepatitis C. The client’s brother states, “I do not want to get this infection, so I’m not going into his hospital room.” How would the nurse respond?

a. “Hepatitis C is not spread through casual contact.”
b. “If you wear a gown and gloves, you will not get this virus.”
c. “This virus is only transmitted through a fecal specimen.”
d. “I can give you an update on your brother’s status from here.”

Answer 31

ANS: A
Although family members may be afraid that they will contract hepatitis C, the nurse would educate them about how the virus is spread. Hepatitis C is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needlesticks, unsanitary tattoo equipment, and sharing of intranasal drug paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client’s status with the brother

Question 32

The nurse is caring for a client with early encephalopathy due to cirrhosis of the liver. Which factors may contribute to increased encephalopathy for which the nurse would assess? (Select all that apply.)

a. Infection
b. GI bleeding
c. Irritable bowel syndrome
d. Constipation
e. Anemia
f. Hypovolemia

Answer 32

ANS: A,B,D,F
Anemia and irritable bowel syndrome are unrelated to developing or worsening encephalopathy, which is caused by increased protein which breaks down into ammonia. Infection can cause hypovolemia which would increase serum protein concentration. Constipation and GI bleeding causes a large protein load in the intestines.

Question 33

A nurse assesses a client who has cirrhosis of the liver. Which laboratory findings would the nurse expect in clients with this disorder? (Select all that apply.)

a. Elevated aspartate transaminase
b. Elevated international normalized ratio (INR)
c. Decreased serum globulin levels
d. Decreased serum alkaline phosphatase
e. Elevated serum ammonia
f. Elevated prothrombin time (PT)

Answer 33

ANS: B,E,F
Elevated INR and PT are indications of clotting disturbances and alert the nurse to the increased possibility of hemorrhage. Elevated ammonia levels increase the client’s confusion. The other values are abnormal and associated with liver disease but do not necessarily place the client at increased risk for complications.

Question 34

The nurse is teaching assistive personnel (AP) about care of a client who has advanced cirrhosis. Which statements would the nurse include in the staff teaching? (Select all that apply.)

a. “Apply lotion to the client’s dry skin areas.”
b. “Use a basin with warm water to bathe the patient.”
c. “For the patient’s oral care, use a soft toothbrush.”
d. “Provide clippers so the patient can trim the fingernails.”
e. “Bathe with antibacterial and water-based soaps.”

Answer 34

ANS: A,C,D
Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush would be used to prevent gum bleeding, and the client’s nails would need to be trimmed short to prevent the patient from scratching himself or herself. These clients should use cool, not warm, water on their skin, and should not use excessive amounts of soap

Question 35

The nurse is caring for a client who has late-stage (advanced) cirrhosis. What assessment findings would the nurse expect? (Select all that apply.)

a. Jaundice
b. Clay-colored stools
c. Icterus
d. Ascites
e. Petechiae
f. Dark urine

Answer 35

ANS: A,B,C,D,E,F
All of these assessment findings are very common for a client who has late-stage cirrhosis due to biliary obstruction and poor liver function. The client has vascular lesions and excess fluid from portal hypertension

Question 36

The nurse plans care for a patient who has hepatopulmonary syndrome. Which interventions would the nurse include in this client’s plan of care? (Select all that apply.)

a. Oxygen therapy
b. Prone position
c. Feet elevated on pillows
d. Daily weights
e. Physical therapy
f. Respiratory therapy

Answer 36

ANS: A,C,D,F
Care for a client who has hepatopulmonary syndrome would include oxygen therapy, the head of bed elevated at least 30 degrees or as high as the client wants to improve breathing, elevated feet to decrease dependent edema, and daily weights. There is no need to place the patient in a prone position, on the patient’s stomach. Although physical therapy may be helpful to a patient who has been hospitalized for several days, physical therapy is not an intervention specifically for hepatopulmonary syndrome. However, respiratory support from a specialized therapist may be needed.

Question 37

The nurse is assessing a client with hepatitis C. The client asks the nurse how it was possible to have this disease. What questions might the nurse ask to help the client determine how the disease was contracted? (Select all that apply.)

a. “How old are you?”
b. “Do you work in health care?
c. “Are you receiving hemodialysis?”
d. “Do you use IV drugs?”
e. “Did you receive blood before 1992?”
f. “Have you even been in prison or jail?”

Answer 37

ANS: A,B,C,D,E,F
The nurse would ask all of these questions because “baby boomers,” people who use illicit drugs, people on hemodialysis, health workers, and prisoners are at a very high risk for hepatitis C. Additionally, individuals who received blood, blood products, or an organ transplant prior to 1992 before bloodborne disease screening of these products was mandated are at risk for hepatitis C.

Question 38

The nurse is assessing a client who has hepatitis C. What extrahepatic complications would the nurse anticipate? (Select all that apply.)

a. Pancreatitis
b. Polyarthritis
c. Heart disease
d. Myalgia
e. Peptic ulcer disease
f. Ulcerative colitis

Answer 38

ANS: B,C,D
The client who has hepatitis C has complications that do not relate to the liver, including polyarthritis, myalgia, heart disease and vasculitis, renal disease, and cognitive impairment.