Unit P-Clients with Complex Liver Problems (Gastrointestinal) Flashcards
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
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.
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.”
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.
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.
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.
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.”
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.
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.
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.
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.”
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.
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
ANS: A
After colonoscopy, clients have less discomfort and quicker passage of flatus when placed in the left lateral position.
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
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.
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
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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.
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
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
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
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.
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.
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)
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.
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
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.
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.”
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.
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.”
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.
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.”
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.
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
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.
