Question 1

A patient who has been drinking heavily for 3 years seeks medical care. What should the nurse realize about alcohol withdrawal syndrome when caring for this patient?

Accepted Answer

A)   Alcohol is a stimulant that increases gamma-aminobutyric acid (GAB
A)  .
B)   The neurotransmitters inhibit impulses on the neurons.
C)   The CNS has become accustomed to the depressant effects of the alcohol, and CNS excitability develops when alcohol is no longer present.
D)   The neuroreceptors in the brain can begin to initiate a chemical reaction of normalcy. C

Question 2

The nurse suspects that a patient is dependent on alcohol rather than abusing alcohol when what is assessed?

Accepted Answer

A)   Alcohol is taken in larger amounts than planned, and there is proof of tolerance.
B)   Recurrent legal problems related to substance abuse are present.
C)   Despite social and interpersonal problems, the person continues to use alcohol.
D)   The person uses alcohol in physically hazardous situations. A

Question 3

A patient is recovering from an endoscopy with banding of esophageal varices. Which intervention should have the highest priority immediately following the procedure and until the patient is fully awake?

Accepted Answer

A)   Determining if the patient is able to swallow
B)   Irrigating the NG tube with saline to detect any additional bleeding
C)   Maintaining the patient in the left lateral decubitus position
D)   Monitoring the patient's vital signs every hour C

Question 4

An adolescent patient is admitted after ingesting 20 500-mg acetaminophen (Tylenol) tablets as a suicide attempt. The patient is currently nauseated, vomiting, and diaphoretic with a BP of 96/52 What should be the priority in this patient's care?

Accepted Answer

A)   Have a serum acetaminophen level drawn.
B)   Observe for possible urticaria and bronchospasms.
C)   Provide the first oral dose of N-acetylcysteine (Mucomyst)  in orange juice.
D)   Start an intravenous access line for rehydration.

Question 5

A patient comes into the emergency department after ingesting 50 650-mg tablets of arthritis-strength acetaminophen (Tylenol) 2 hours ago. What intervention should the nurse prepare to implement at this time? Select all that apply.

Accepted Answer

A)   Provide medication to induce vomiting.
B)   Prepare to insert a nasogastric tube for gastric lavage.
C)   Contact the pharmacy for activated charcoal.
D)   Draw a serum acetaminophen level.
E)   Administer N-acetylcysteine (NA
C)   (Mucomyst) .

Question 6

A patient with a history of alcohol dependency is demonstrating signs of a thiamine deficiency. What did the nurse assess in this patient? Select all that apply.

Accepted Answer

A)   Ataxia
B)   Nystagmus
C)   Peripheral neuropathy
D)   Fatigue
E)   Muscle wasting

Question 7

A patient with esophageal varices is treated with an esophageal tamponade (Sengstaken-Blakemore) tube. What should be the nurse's priority when caring for this patient?

Accepted Answer

A)   Ensuring that the gastric balloon remains inflated
B)   Keeping a pair of scissors at the bedside at all times
C)   Keeping the patient sedated and quiet
D)   Maintaining the esophageal balloon pressure between 15 and 20 mm Hg

Question 8

A patient with a history of alcohol misuse has been admitted for treatment. What should the nurse include in the assessment of this patient?

Accepted Answer

A)   The use of addiction standards to assess for drinking patterns
B)   The inclusion of objective and subjective input from the patient, including signs of anxiety and patterns of usage
C)   The amount of denial that the patient is exhibiting
D)   The amount of time spent obtaining, using, and recovering from alcohol

Question 9

The nurse plans care for a patient with alcohol withdrawal syndrome. Which criteria should the nurse use to determine the severity of the patient's symptoms from this syndrome? Select all that apply.

Accepted Answer

A)   Current blood alcohol level
B)   Concurrent illnesses
C)   History of previous withdrawals
D)   History of substance abuse
E)   Current vital signs

Question 10

During a focused assessment, the nurse learns that a patient consumes one 1,000-mL box of wine each day. If the patient is using a 5-ounce glass, how many drinks should the nurse document that this patient consumes daily? Round your number to the nearest whole number.

Accepted Answer

The answer of During a focused assessment, the nurse learns...

Question 11

A patient with bleeding esophageal varices is scheduled to receive a bolus followed by a continuous infusion of octreotide (Sandostatin). What care should the nurse expect when providing this medication?

Accepted Answer

A)   Anticipate that the medication will stop the bleeding immediately.
B)   Notify the physician if the patient has cardiac disease because the medication is contraindicated.
C)   Recognize that doses of 100 mcg/hour and higher are associated with better outcomes.
D)   Review serial hematocrit levels to determine if the patient is continuing to bleed.

Question 12

A patient is in the late stages of liver failure with cirrhosis and progressive, irreversible damage. What should the nurse explain to the family?

Accepted Answer

A)   Liver transplantation is the only feasible treatment.
B)   Abstinence from alcohol may decrease further liver cell injury and improve portal hypertension.
C)   The liver is the only organ affected so that the patient and family need not worry about other body systems.
D)   If the patient does not have any variceal hemorrhages, he will probably live for years.

Question 13

What should the nurse expect to assess in a patient with acute liver failure? Select all that apply.

Accepted Answer

A)   Jaundice
B)   Sudden severe nose bleed
C)   Ascites
D)   Peripheral edema
E)   Asterixis

Question 14

A patient with esophageal varices received octreotide (Sandostatin) 100 microgram intravenous bolus, and the nurse prepares to start a continuous infusion of the medication. The drug is diluted 500 micrograms in 250 mL of 0.9% normal saline to be administered at 50 mcg/hour. How many milliliters per hour should the intravenous infusion pump be set to in order to deliver the correct dose?

Accepted Answer

A)   100 mL
B)   50 mL
C)   12.5 mL
D)   25 mL

Question 15

A nurse cares for a patient during a transjugular intrahepatic portosystemic shunt (TIPS) procedure. For which complication should the nurse assess during the procedure?

Accepted Answer

A)   Alcohol withdrawal symptoms, because minimal sedation will be used
B)   Dysrhythmias as the catheter moves through the heart
C)   Hypotension as the liver is decompressed
D)   Vagal responses as the catheter is inserted

Question 16

The nurse prepares to administer the third dose of aldactone (Spironolactone) to a patient with cirrhosis and ascites. What should cause the nurse to question the administration of this medication?

Accepted Answer

A)   Serum creatinine of 1.6 mg/dL
B)   Serum sodium of 130 mEq/L
C)   Serum potassium of 5.7 mEq/L
D)   Weight gain of 0.2 kg

Question 17

A patient with a history of taking acetaminophen (Tylenol) for osteoarthritis pain is surprised to learn the diagnosis of liver failure. What should the nurse explain to the patient about this diagnosis? Select all that apply.

Accepted Answer

A)   "Liver damage can occur when the maximum daily dose of acetaminophen is taken repeatedly."
B)   "If your body cannot remove the toxins from acetaminophen, liver damage occurs."
C)   "Liver damage from acetaminophen can occur from taking as little as 4 grams of the medication a day."
D)   "Liver damage from acetaminophen only occurs when taking 10 grams or more of the medication per dose."
E)   "Liver damage from acetaminophen only occurs when it is taken with alcoholic beverages."

Question 18

In anticipation of a patient's alcohol withdrawal symptoms, the nurse should perform which action? Select all that apply.

Accepted Answer

A)   Recognize that hallucinations are common, and reorient the patient.
B)   Prepare for seizures that might occur within the first 12 hours of admission.
C)   Frequently assess vital signs.
D)   Have a sitter present to monitor any attempt by the patient to escape.
E)   Prevent, recognize, and treat symptoms while providing a safe environment.

Question 19

What should the nurse include when planning care for a patient experiencing pruritus associated with decompensated liver disease? Select all that apply.

Accepted Answer

A)   Provide cholestyramine as prescribed.
B)   Provide colestipol as prescribed.
C)   Provide diphenhydramine at hour of sleep.
D)   Encourage the patient to keep the nails short.
E)   Restrict fluids.

Question 20

A patient with ascites is recovering from a paracentesis where 8 liters of fluid have been removed. What should the nurse monitor in order to detect a common complication after this procedure?

Accepted Answer

A)   Blood pressure at least every half hour until the patient is stable
B)   Serum ammonia every 4 hours for the next 24 hours
C)   Chest film for evidence of a pneumothorax
D)   Temperature every 2 hours to detect bacterial peritonitis

Exam 12: Care of the Critically Ill Patient Experiencing Alcohol Withdrawal Andor Liver Failure