Chapter 39- Assessment and Management of Patients With Hepatic Disorders

1. The nurse is aware that a patient with liver failure often requires vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? A) Vitamin B12 B) Vitamin A C) Vitamin D D) Vitamin K Ans: D Difficulty: Moderate 2. What assessment finding will the nurse of an older adult with liver dysfunction expect to see? A) Liver function has changed dramatically. B) Metabolism of medications is delayed primarily by the liver. C) The liver is enlarged with hard edges. D) The liver has decreased in size and weight. Ans: D Difficulty: Moderate 3. A patient has a blocked bile duct from a tumor. The nurse can expect the patient's urine to be: A) Dark amber and concentrated C) Rust colored and concentrated B) Orange and foamy D) Pale yellow and dilute Ans: B Difficulty: Easy 4. What technique will the nurse use to palpate a patient's liver? Place the hand under the left lower rib cage 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 the right lower rib cage and press down lightly with the other hand D) Hold the hand 90 degrees to the abdomen and push down firmly Ans: C Difficulty: Moderate A) A) B) 5. The nurse caring for a patient with portal hypertension will assess for which finding? Bowel obstruction C) Ascites Vitamin A deficiency D) Hepatic encephalopathy Ans: C Difficulty: Moderate 6. A nurse practitioner teaching a class on hepatitis informs the participants that which of the following occupations provides the greatest risk for contracting hepatitis B? A) Flight attendants B) Health care workers C) Firefighters D) Educators Ans: B Difficulty: Easy 7. The critical care nurse caring for a patient with a liver tumor is aware that an early manifestation of liver malignancy, in addition to pain, is:
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A) B) C) D)

A continuous dull ache in the right upper quadrant, epigastrium, or back Weight gain An increase in appetite Jaundice Ans: A Difficulty: Moderate

8. A patient has cancer of the liver and has a percutaneous biliary drainage system. Which of the following assessments should the nurse record on the patient's data sheet? A) Amount and color of drainage C) Odor of drainage B) Temperature of drainage D) Consistency of drainage Ans: A Difficulty: Moderate 9. The nurse providing discharge teaching to a patient following a liver transplant will emphasize which topic? A) The patient will obtain measurement of drainage from the T-tube. B) The patient will exercise 3 times a week. C) The patient will take immunosuppressive agents as required. D) The patient will monitor for signs of liver dysfunction. Ans: C Difficulty: Difficult 10. The nurse who is assessing a patient in the emergency room with a history of chronic alcoholism is aware that the patient is at risk for which disease? A) Cirrhosis B) Renal failure C) Hepatitis D) Cardiovascular disease Ans: A Difficulty: Easy 11. The nurse practicing in a community health clinic provides care to patients with varying histories. Which of the following individuals would the nurse consider to be at the highest risk for developing hepatitis D? A) Someone who traveled to a country where this is endemic B) A person who had sexual intercourse with a person infected with hepatitis A C) A patient who has hepatitis B D) Someone who came in contact with a person with hepatitis E Ans: C Difficulty: Difficult 12. A patient has severe pruritus from hepatitis B. Which of the following nursing measures would provide the greatest level of patient comfort? A) Use hot water to increase vasodilation. B) Use cold water to decrease itching sensation. C) Give tepid water baths. D) Avoid lotions and creams. Ans: C

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Difficulty: Moderate 13. A nurse received an accidental needle stick while giving an IM injection. The greatest threat for the nurse is: A) Hepatitis B (HBV) C) Human immunodeficiency virus (HIV) B) Hepatitis C (HCV) D) Hepatitis A (HAV) Ans: A Difficulty: Easy 14. The nurse is teaching family members of a patient with hepatitis A virus (HAV). Family members were exposed to the patient and, therefore, should receive immunoglobulin. The nurse should tell the family members that immunoglobulin: A) Prevents hepatitis infection in all people B) Provides immunity for life C) Must be administered within 2 weeks of exposure D) Should be administered even if the person has anti-HAV antibodies Ans: C Difficulty: Moderate 15. The nurse is providing teaching to a patient with acute hepatitis about to be discharged to her home. Which activity guideline is most appropriate? A) Ambulate for increasing distances at least 3 times per day. B) Maintain bed rest except for trips to the bathroom. C) Perform active range-of-motion exercises 3 times per day. D) Perform mild housework as tolerated. Ans: B Difficulty: Moderate 16. The nurse caring for a patient with hepatic encephalopathy assesses that the patient exhibits episodes of confusion, is difficult to arouse from sleep, has rigid extremities, and EEG abnormalities. Based upon these clinical findings, what is the patient's stage of hepatic encephalopathy? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 Ans: C Difficulty: Moderate 17. The nurse assisting with a percutaneous liver biopsy assists the physician in positioning the patient at the completion of the procedure. The patient will be: A) Positioned on his right side with a pillow under the costal margin B) Placed in a supine position C) Positioned on his left side with a pillow under his knees D) Placed in a Trendelenburg position Ans: A Difficulty: Difficult

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18. When assessing the patient with liver dysfunction for jaundice, the nurse will assess the patient's: A) Skin, nail beds, and body C) Mucosa, hair, and nail beds temperature B) Skin, mucosa, and sclera D) Sclera, lips, and hair Ans: B Difficulty: Moderate 19. While instructing a patient with ascites on dietary modification, the nurse will discuss the patient's need to restrict: A) Potassium B) Sodium C) Calcium D) Glucose Ans: B Difficulty: Moderate 20. Upon review of the history a patient ordered to receive vasopressin for bleeding esophageal varices, the nurse calls the physician to question the use of this medication when she reads that the patient has a history of: A) Diabetes mellitus C) Arthritis B) Chronic kidney disease D) Coronary artery disease Ans: D Difficulty: Moderate 21. The nurse assessing that the patient with hepatic encephalopathy who has a flapping tremor of the hands will document this condition in the patient's chart as: A) Asterixis C) Fetor hepaticus B) Constructional apraxia D) Palmar erythema Ans: A Difficulty: Moderate 22. The nurse working in a local department of health has been informed that a cook in a local restaurant has been diagnosed with hepatitis A. Individuals who ate at this restaurant and have never received the hepatitis A vaccine should be advised to receive: A) The hepatitis A vaccine C) The hepatitis A and B vaccines B) The hepatitis B vaccine D) An immune globulin injection Ans: D Difficulty: Moderate 23. The nurse is preparing to give a patient on hemodialysis his first dose of the hepatitis B vaccine. When will the nurse administer the second and third doses of this vaccine? A) 1 and 2 months after the first dose B) 2 months and 4 months after the first dose C) 1 and 6 months after the first dose D) 6 months and one year after the first dose Ans: C Difficulty: Moderate

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24. The nurse caring for a patient admitted with hepatitis C is developing the patient's care plan. The nurse is aware that the best treatment for hepatitis C includes: A) Bed rest B) Vitamin therapy C) Antiviral therapy D) Dietary modifications Ans: C Difficulty: Difficult 25. The nurse is reviewing the patient's history and notes that the patient has a history of postnecrotic cirrhosis. This type of cirrhosis is often the result of: A) A previous bout of acute viral C) Biliary obstruction hepatitis B) Chronic alcoholism D) Cholangitis Ans: A Difficulty: Moderate 26. In planning the care for a patient exhibiting symptoms associated with hepatitis B, the nurse anticipates that the patient will be maintained on bed rest until: A) The patient is able to tolerate the intake of solid food. B) The hepatic enlargement and elevated levels of bilirubin and enzymes have disappeared. C) The serum BUN and creatinine values return to normal levels. D) Physical therapy has been completed. Ans: B Difficulty: Difficult 27. The nurse informs the patient with hepatitis E preparing for discharge to the home that the best method for prevention of transmission is: A) Following proper handwashing techniques B) Avoiding chemicals that are toxic to the liver C) Wearing a condom during sexual relations D) Isolating yourself from your family members Ans: A Difficulty: Moderate 28. The nurse working in the PACU recognizes that the most common surgical procedure for liver cancer is: A) Cryosurgery C) Lobectomy B) Liver transplantation D) Laser hyperthermia Ans: C Difficulty: Moderate 29. While surgical resection of the liver tumor is possible in some patients, the risks associated with this procedure increase when the patient has a history of: A) Oral contraceptive use C) Hypertension B) Cirrhosis D) Prior abdominal surgery Ans: B Difficulty: Moderate

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30. A patient who is being discharged after a liver transplant asks the nurse when she will be able to try to become pregnant. The nurse appropriately responds by stating: A) You will never have a period after a liver transplant and you will never be able to get pregnant. B) You can consider trying to get pregnant now. Let's start you on prenatal vitamins today. C) You should see a fertility specialist to discuss this topic. D) Pregnancy can be considered after one year of transplantation, but it is considered a high-risk pregnancy and you will need to discuss this with your doctor. Ans: D Difficulty: Moderate

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