Med. surg. practice questions LIVER

Med. surg. practice questions (LIVER) ScienceMedicineNursing jhowie44 Save Med Surg Gastrointestinal NCLEX Q...86 terms Jasmine_Lawson4 Preview Hepatic Dysfunction NCLEX Style Q...181 terms marla_bellarPreview Exam 4- Cirrhosis NCLEX Teacher 26 terms RegisteredNurse22 Preview Pancre 59 terms me For a client in hepatic coma, which outcome would be the most appropriate?

• The client is oriented to time, place, and person.
• The client exhibits no ecchymotic areas.
• The client increases oral intake to 2,000 calories/day.
• The client exhibits increased serum albumin level.
• The client is oriented to time, place, and person.

Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves, improvement in the client's level of consciousness occurs. The client should be able to express orientation to time, place, and person When planning home care for a client with hepatitis A, which preventive measure should be emphasized to protect the client's family?

• Keeping the client in complete isolation
• Using good sanitation with dishes and shared bathrooms
• Avoiding contact with blood-soiled clothing or dressing
• Forbidding the sharing of needles or syringes
• Using good sanitation with dishes and shared bathrooms

Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing, personal hygiene and sanitation, and use of standard precautions.

For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important?

• Allowing complete independence of mobility
• Applying pressure to injection sites
• Administering antibiotics as prescribed
• Increasing nutritional intake
• Applying pressure to injection sites

The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important.A client with advanced cirrhosis has been diagnosed with hepatic encephalopathy. The nurse expects to assess for:

• Malaise
• Stomatitis
• Hand tremors
• Weight loss
• Hand tremors

Hepatic encephalopathy results from the accumulation of neurotoxins in the blood, therefore the nurse wants to assess for signs of neurological involvement. Flapping of the hands (asterixis), changes in mentation, agitation, and confusion are common.A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? (Select all that apply.)

• Range of motion every 4 hours
• Turn and reposition every 2 hours
• Abdominal and foot massages every 2 hours
• Alternating air pressure mattress
• Sit in chair for 30 minutes each shift
• Turn and reposition every 2 hours
• Alternating air pressure mattress

Edematous tissue must receive meticulous care to prevent tissue breakdown. Range of motion exercises preserve joint function but do not prevent skin breakdown.Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis?

• Increase fluid intake to 3000 ml per day
• Adequate bed rest
• Bland diet
• Administer antibiotics as ordered
• Adequate bed rest

Treatment of hepatitis consists of bed rest during the acute phase to reduce metabolic demands on the liver, thus increasing blood supply and cell regeneration.

Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. The nurse should monitor the client for which of the following medication-related side effects?

• Jaundice
• Hyperkalemia
• Tachycardia
• Constipation
• Hyperkalemia

This is a potassium-sparing diuretic so clients should be monitored closely for hyperkalemia. Diarrhea, dizziness, and headaches are other more common side effects.Mr. Hasakusa is in end-stage liver failure. Which interventions should the nurse implement when addressing hepatic encephalopathy? (Select all that apply.)

• Assessing the client's neurologic status every 2 hours
• Monitoring the client's hemoglobin and hematocrit levels
• Evaluating the client's serum ammonia level
• Monitoring the client's handwriting daily
• Preparing to insert an esophageal tamponade tube
• Making sure the client's fingernails are short
• Assessing the client's neurologic status every 2 hours
• Evaluating the client's serum ammonia level
• Monitoring the client's handwriting daily

Hepatic encephalopathy results from an increased ammonia level due to the liver's inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client's neurologic status, serum ammonia level, and handwriting.A patient with chronic alcohol abuse is admitted with liver failure. You closely monitor the patient's blood pressure because of which change that is associated with the liver failure?

• Hypoalbuminemia
• Increased capillary permeability
• Abnormal peripheral vasodilation
• Excess rennin release from the kidneys
• Hypoalbuminemia

Blood pressure decreases as the body is unable to maintain normal oncotic pressure with liver failure, so patients with liver failure require close blood pressure monitoring.

You're caring for Lewis, a 67 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Relief of which symptom indicated that the paracentesis was effective?

• Pruritus
• Dyspnea
• Jaundice
• Peripheral Neuropathy
• Dyspnea

Ascites puts pressure on the diaphragm. Paracentesis is done to remove fluid and reducing pressure on the diaphragm. The goal is to improve the patient's breathing.You're caring for Jane, a 57 y.o. patient with liver cirrhosis who developed ascites and requires paracentesis. Before her paracentesis, you instruct

her to:

• Empty her bladder
• Lie supine in bed
• Remain NPO for 4 hours
• Clean her bowels with an enema
• Empty her bladder

A full bladder can interfere with paracentesis and be punctured inadvertently.You're caring for Betty with liver cirrhosis. Which of the following assessment findings leads you to suspect hepatic encephalopathy in her?

• Asterixis
• Chvostek's sign
• Trousseau's sign
• Hepatojugular reflex
• Asterixis

Asterixis is an early neurologic sign of hepatic encephalopathy elicited by asking the patient to hold her arms stretched out. Asterixis is present if the hands rapidly extend and flex.You are developing a care plan on Sally, a 67 y.o. patient with hepatic encephalopathy. Which of the following do you include?

• Administering a lactulose enema as ordered
• Encouraging a protein-rich diet
• Administering sedatives, as necessary
• Encouraging ambulation at least four times a day
• Administering a lactulose enema as ordered

You may administer the laxative lactulose to reduce ammonia levels in the colon.