Disorders of the Liver NCLEX style questions

Disorders of the Liver NCLEX style questions ScienceMedicineHepatology Krysta0123 Save Hepatic Dysfunction NCLEX Style Q...181 terms marla_bellarPreview Exam 4- Cirrhosis NCLEX Teacher 26 terms RegisteredNurse22 Preview

NCLEX Questions: Liver, Pancreas, a...

Teacher 31 terms rebecca_bowman2 Preview NCLEX 15 terms bet The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching?

• "If I notice a fast heart rate or irregular beats, it is normal for cirrhosis."
• "I need to take good care of my belly and ankle skin where it is swollen."
• "A scrotal support may be more comfortable when I have scrotal edema."
• "I can use pillows to support my head to help me breathe when I am in bed."

A If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider, because this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. A scrotal support may improve comfort if there is scrotal edema. Pillows and a semi-Fowler's or Fowler's position will increase respiratory efficiency.Text Reference - p. 1024

When teaching the male patient with acute hepatitis C (HCV), the patient demonstrates understanding when the patient makes which statement?

• "I will use care when kissing my wife to prevent giving it to her."
• "I will need to take adofevir to prevent chronic HCV."
• "Now that I have had HCV, I will have immunity and not get it again."
• "I will need to be checked for chronic HCV and other liver problems."

D The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva, but percutaneously and via high-risk sexual activity exposure. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adofevir is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with hepatitis A virus (HAV) and HBV, so the patient may be reinfected with another type of HCV.Text Reference - p. 1015 A female patient expresses her concern about becoming pregnant while her partner is on ribavirin therapy for chronic hepatitis C. What should the nurse advise the patient?

• She can plan pregnancy now.
• She should avoid getting pregnant now.
• She should not get pregnant with this partner ever.
• She should avoid any sexual intercourse after conception.

B Any woman who is on ribavirin or whose male partner is on is on ribavirin should avoid pregnancy during treatment. The pregnancy can be planned after the treatment is complete. She can get pregnant with this partner, but not while on treatment. Avoiding intercourse after conception is not necessary.Text Reference - p. 1013 A patient with cancer that has metastasized to the liver manifests symptoms of fluid retention, including edema and ascites. To determine the effectiveness of the diuretic therapy that has been prescribed, what should the nurse assess?

• Breath sounds
• Bowel sounds
• Abdominal girth
• Recent blood work

C.Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease. Breath and bowel sounds are usually not affected by liver metastasis until the late stages, when fluid overload and multisystem organ involvement occur. Reviewing the results of the most recent blood work will not show direct measurement of the effectiveness of diuretic therapy.Text Reference - p. 1019

A patient with hepatitis A asks whether other family members are at risk for "catching" the disease. The nurse's response will be based on the

knowledge that hepatitis A is transmitted primarily:

• During sexual intercourse
• By contact with infected body secretions
• Through fecal contamination of food or water
• Through kissing that involves contact with mucous membranes

C.Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water, as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important in preventing the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important in decreasing the risk of transmission. Sexual intercourse, contact with infected body secretions, and contact through mucous membranes all present higher risk for hepatitis B and C than for hepatitis A.Text Reference - p. 1007 A patient with hepatitis A infection is being discharged from the hospital. What is the most important instruction that the nurse should include in the discharge teaching?

• Do not share razors or toothbrushes.
• Isolate the patient from other family members.
• Take acetaminophen every four hours if fever persists.
• Wash hands carefully after bowel movements

D The mode of transmission of hepatitis A infection is the fecal-oral route. Therefore, it is very important to maintain personal and environmental hygiene. The nurse should teach the patient and the family members about careful hand washing immediately after bowel movements and before eating to prevent outbreaks of hepatitis A viral infection. Not sharing toothbrushes and razors is a concern for the prevention of hepatitis B and C, because they are transferred through blood contact. There is no need to isolate the patient with hepatitis A unless he or she is incontinent or maintains poor personal hygiene. Acetaminophen may cause liver damage and should be avoided in hepatic viral infection.Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.Text Reference - p. 1014 The nurse provides discharge instructions to a patient with newly diagnosed cirrhosis. Which statement made by the patient indicates the need for further teaching?

• "I should take frequent rest periods."
• "I can eat anything that appeals to me."
• "I can do without my glass of wine with dinner."
• "I should take only medications that have been prescribed."

B.Even though a low-protein diet has been questioned in the treatment of patients with cirrhosis, it remains in use. In light of this, it is incorrect for the patient to say that he may eat anything. Patients with cirrhosis must also avoid alcohol. Frequent rest and limitation of medications to those that have been prescribed are appropriate resolutions in a newly diagnosed case of cirrhosis and therefore do not indicate the need for further teaching.Text Reference - p. 1022

A patient has been admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse. Laboratory results are significant for an alanine aminotransferase (ALT) of 198 IU/L and aspartate transaminase (AST) of 224 IU/L. Which diagnosis does the nurse attribute these findings to?

• Diabetes mellitus
• Alcohol abuse
• Malnutrition
• Osteomyelitis

B.In the patient with alcohol abuse, liver disease could develop as a complication, increasing the liver function tests above the normal levels. The normal ALT range is 7 to 56 IU/L and the normal AST range is 5 to 40 IU/L. Diabetes would result in elevated blood sugar levels. Malnutrition would be evidenced by low protein levels. Osteomyelitis is an infection of the bone, which would result in an elevated white blood cell count.Text Reference - p. 1015 The nurse recalls that hepatic coma results primarily from accumulation of which substance in the blood?

• Sodium
• Calcium
• Ammonia
• Potassium

C.A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage. Sodium, calcium, and potassium are not directly affected by liver dysfunction or hepatic coma.Text Reference - p. 1021 A patient has an increased ammonia level associated with hepatic encephalopathy. What assessment finding does the nurse expect?

• Aphasia
• Asterixis
• Hyperactivity
• Acute dementia

B.Asterixis is a twitching spasm of the hands and wrists seen in patients with increased ammonia levels in conditions such as hepatic encephalopathy. Aphasia, hyperactivity, and acute dementia are manifestations not associated with hepatic encephalopathy. Besides asterixis, an increased serum ammonia level causes sedation and confusion that progress to a comatose state.Text Reference - p. 1021