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Liver Failure and Pancreatitis, NCLEX ScienceMedicineHepatology EmSay Save Hepatic Dysfunction NCLEX Style Q...181 terms marla_bellarPreview Pancreatitis NCLEX (ATI, Evolve, Lew...13 terms Jennster17Preview Exam 4- Cirrhosis NCLEX Teacher 26 terms RegisteredNurse22 Preview ICP Nc 120 term Ma the client is admitted with end stage liver failure and is prescribed the laxative lactulose (chronulac). which statement indicates the client needs more teaching concerning this med?

• i should have two to three soft stools a day
• i must check my ammonia level daily
• if i have diarrhea, i will call my dr
• i should check my stool for any blood

i must check my ammonia level daily: there is no instrument used at home to test daily ammonia levels. the ammonia level is a serum level requiring venipuncture and laboratory diagnostic equipment The nurse provides discharge instructions for a 64-year-old woman with ascites and peripheral edema related to cirrhosis. Which statement, if made by the patient, indicates teaching was effective?

• "It is safe to take acetaminophen up to four times a day for pain."
• "Lactulose (Cephulac) should be taken every day to prevent constipation."
• "Herbs and other spices should be used to season my foods instead of salt."
• "I will eat foods high in potassium while taking spironolactone (Aldactone)."
• "Herbs and other spices should be used to season my foods instead of salt."

A low-sodium diet is indicated for the patient with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided as these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs.Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.

The client dx with end stage liver failure is admitted with esophageal bleeding. the hcp inserts and inflates a triple lumen nasogastric tube (sengstaken-blakemore). which nursing intervention should the nurse implement for this treatment?

• assess the gag relex every shift
• stay with the client at all times
• administer the laxative lactulose (chronulac)
• monitor the clients ammonia level

stay with the client at all times: while the balloons are inflated, the client must not be left unattended in case they become dislodged and occlude the airway. this is a safety issue In a client admitted with cirrhosis of the liver, which serum levels would the nurse expect to be elevated?

• Serum amylase and lipase
• Serum ammonia
• Serum calcium
• Serum CEA

...ANS: B

Serum ammonia levels are elevated in conditions that incur hepatocellular injury, such as cirrhosis of the liver. Increased serum amylase and lipase levels are indicators of pancreatitis. CEA levels are useful in assessing the success of cancer therapy or the recurrence of cancer.The client has had a liver biopsy. which postprocedure intervention should the nurse implement?

• instruct the client to void immediatly
• keep the client NPO for 8 hours
• place the client on the right side
• monitor BUN and creatinine level

place the client on the right side: direct pressure is applied to the site, and then the client is placed on the right side to maintain site pressure the client dx with end stage liver failure is admitted with hepatic encephalopathy. which dietary restriction should be implemented by the nurse to address this complication?

• restrict sodium intake to 2g a day
• limit oral fluids to 1500ml a day
• decrease the daily fat intake
• reduce protein intake to 60 to 80g a day

reduced protein intake 60-80 g a day: ammonia is a by product of protein metabolism and contributes to hepatic encephalopathy. reducing protein intake should decrease ammonia levels Twenty-four hours after endoscopic retrograde cholangiopancreatography (ERCP), a client develops left upper quadrant abdominal pain and has a temperature of 101° F (38.3° C). What is the nurse's best action?

• Administer acetaminophen for control of fever and pain.
• Document the finding, because it is a normal postprocedure event.
• Notify the health care provider.
• Increase the IV fluid rate.

...ANS: C

The client who has undergone an ERCP may develop complications such as perforation or sepsis manifested by fever and abdominal pain. The nurse should report these symptoms to the health care provider immediately.

For the client with cirrhosis, what nursing intervention(s) would be most appropriate to control fluid accumulation in the abdominal cavity?

• Monitoring intake and output
• Providing a low-sodium diet
• Increasing PO fluid intake
• Weighing the client daily

ANS: B

A low-sodium diet is one means of controlling abdominal fluid collection. Sodium intake may be restricted to 500 mg to 1 g daily....After receiving lactulose the day before, the client reports having seven loose stools in the past 12 hours. Based on this data, what laboratory findings would the nurse expect?

• Hypokalemia
• Hyponatremia
• Hypercalcemia
• Hyperglycemia

...ANS: A

Because lactulose can cause the client to have several loose stools daily, the nurse should monitor serum electrolyte levels, particularly the serum potassium level for hypokalemia.Which client is most at risk for the development of gallstones?

• 22-year-old woman who is 1 month postpartum
• 65-year-old woman after a liquid protein diet
• 70-year-old man with peptic ulcer disease
• 33-year-old man with type 2 diabetes

...ANS: B

Liquid protein diets increase susceptibility to gallstones by releasing cholesterol from tissues, which is then excreted as crystals in the bile.A client had a transhepatic biliary catheter placed 3 days ago. Which clinical manifestation would indicate that the procedure was successful?

• The client's sclera remains icteric.
• The client's stools are brown in color.
• The client's urine is a dark amber color.
• The client's catheter has blood return on aspiration.

...ANS: B

A transhepatic biliary catheter decompresses extrahepatic ducts to promote the flow of bile. When bile flows normally, it reaches the large intestine where bile is converted to urobilinogen, coloring the stools brown.the client dx with liver failure is experiencing pruritus secondary to severe jaundice. which action by the unlicensed assistive personnel warrants intervention by the nurse?

• the UAP is assisting the client to take a hot soapy shower
• the UAP applies an emollient to the clients legs and back
• the UAP puts mittens on both hands of the client
• the cUAP pats the clients skin dry with a clean towel

the UAP is assisting the client to take a hot soapy shower: hot water increases pruritus and soap will cause dry skin, which increases pruritus, therefore, the nurse should discuss this with the UAP

the nurse identifies the client problem "excess fluid volume" for the client in liver failure. which short term goal would be most appropriate for this problem?

• the client will not gain more than 2kg a day
• the client will have no increase in abdominal girth
• the clients v/s will remain WNL
• the client will receive a low sodium diet

the client will have no increase in abdominal girth: excess fluid volume could be secondary to portal hypertension. therefore, no increase in abdominal girth would be an appropriate short term goal, indicating no excess of fluid volume the client in end stage liver failure has vitamin K deficiency. which interventions should the nurse implement? select all that apply

• avoid rectal temperatures
• use only a soft toothbrush
• monitor the platelet count
• use small gauge needles
• assess for asterixis

avoid rectal temps, use only a soft toothbrush, monitor platelet count, use small gauge needles: vitamin k deficiency causes impaired coagulation, therefore, rectal thermometers should be avoided to prevent bleeding. Soft bristle toothbrushes will help prevent bleeding of the gums. platelet count, ptt/pt, and INR should be monitored to assess coagulation status. Injections should be avoided, if at all possible, bc the client is unable to clot, but if they are absolutely necessarily, the nurse should use small gauge needles which gastrointestinal assessment data should the nurse expect to find when assessing the client in end stage liver failure?

• hypoalbuminemia and muscle wasting
• oligomenorrhea and decreased body hair
• clay colored stools and hemorrhoids
• dyspnea and caput medusae

clay colored stools and hemorrhoids: clay colored stools and hemorrhoids are gastrointestinal effects of liver failure which assessment question is priority for the nurse to ask the client dx with end stage liver failure secondary to alcoholic cirrhosis?

• how many yrs have you been drinking alcohol
• have you completed an advance directive
• when did you have your last alcoholic drink
• what foods did you eat at your last meal

when did you have your last alcoholic drink?: the nurse must know when the client had the last alcoholic drink to be able to determine when and if the client will experience delirium tremens, the physical withdrawal from alcohol the client has end stage liver failure secondary to alcoholic cirrhosis. which complication indicates the client is at risk for developing hepatic encephalopathy?

• gastrointestinal bleeding
• hypoalbuminemia
• splenomegaly
• hyperaldosteronism

gastrointestinal bleeding: blood in the intestinal tract is digested as a protein, which increases serum ammonia levels and increases the risk of developing hepatic encephalopathy