Question 1

A nurse cares for a client who is prescribed lactulose (Heptalac).The client states,"I do not want to take this medication because it causes diarrhea." How should the nurse respond?

Accepted Answer

A)   "Diarrhea is expected; that's how your body gets rid of ammonia."
B)   "You may take Kaopectate liquid daily for loose stools."
C)   "Do not take any more of the medication until your stools firm up."
D)   "We will need to send a stool specimen to the laboratory." A

Question 2

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin)for bleeding esophageal varices.Which clinical manifestation should alert the nurse to a serious adverse effect?

Accepted Answer

A)   Nausea and vomiting
B)   Frontal headache
C)   Vertigo and syncope
D)   Mid-sternal chest pain D

Question 3

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus).Which statement should the nurse include in this client's discharge education?

Accepted Answer

A)   "Use a pill organizer to ensure you take this medication as prescribed."
B)   "Transient muscle aching is a common side effect of this medication."
C)   "Follow up with your provider in 1 week to test your blood for toxicity."
D)   "Take your radial pulse for 1 minute prior to taking this medication." A

Question 4

A nurse cares for a client who is hemorrhaging from bleeding esophageal varices and has an esophagogastric tube.Which action should the nurse take first?

Accepted Answer

A)   Sedate the client to prevent tube dislodgement.
B)   Maintain balloon pressure at 15 and 20 mm Hg.
C)   Irrigate the gastric lumen with normal saline.
D)   Assess the client for airway patency.

Question 5

A nurse cares for a client who has cirrhosis of the liver.Which action should the nurse take to decrease the presence of ascites?

Accepted Answer

A)   Monitor intake and output.
B)   Provide a low-sodium diet.
C)   Increase oral fluid intake.
D)   Weigh the client daily.

Question 6

A telehealth nurse speaks with a client who is recovering from a liver transplant 2 weeks ago.The client states,"I am experiencing right flank pain and have a temperature of 101° F." How should the nurse respond?

Accepted Answer

A)   "The anti-rejection drugs you are taking make you susceptible to infection."
B)   "You should go to the hospital immediately to have your new liver checked out."
C)   "You should take an additional dose of cyclosporine today."
D)   "Take acetaminophen (Tylenol)  every 4 hours until you feel better."

Question 7

A nurse cares for a client with hepatitis C.The client's brother states,"I do not want to contract this infection,so I will not go into his hospital room." How should the nurse respond?

Accepted Answer

A)   "If you wear a gown and gloves, you will not get this virus."
B)   "Viral hepatitis is not spread through casual contact."
C)   "This virus is only transmitted through a fecal specimen."
D)   "I can give you an update on your brother's status from here."

Question 8

A nurse cares for a client with hepatopulmonary syndrome who is experiencing dyspnea with oxygen saturations at 92%.The client states,"I do not want to wear the oxygen because it causes my nose to bleed.Get out of my room and leave me alone!" Which action should the nurse take?

Accepted Answer

A)   Instruct the client to sit in as upright a position as possible.
B)   Add humidity to the oxygen and encourage the client to wear it.
C)   Document the client's refusal, and call the health care provider.
D)   Contact the provider to request an extra dose of the client's diuretic.

Question 9

After teaching a client who has been diagnosed with hepatitis A,the nurse assesses the client's understanding.Which statement by the client indicates a correct understanding of the teaching?

Accepted Answer

A)   "Some medications have been known to cause hepatitis A."
B)   "I may have been exposed when we ate shrimp last weekend."
C)   "I was infected with hepatitis A through a recent blood transfusion."
D)   "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

Question 10

A nurse cares for a client who is scheduled for a paracentesis.Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)?

Accepted Answer

A)   Have the client sign the informed consent form.
B)   Assist the client to void before the procedure.
C)   Help the client lie flat in bed on the right side.
D)   Get the client into a chair after the procedure.

Question 11

A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE).The client is thin and cachectic in appearance,and the family expresses distress that the client is receiving little dietary protein.How should the nurse respond?

Accepted Answer

A)   "A low-protein diet will help the liver rest and will restore liver function."
B)   "Less protein in the diet will help prevent confusion associated with liver failure."
C)   "Increasing dietary protein will help the client gain weight and muscle mass."
D)   "Low dietary protein is needed to prevent fluid from leaking into the abdomen."

Question 12

An emergency room nurse assesses a client with potential liver trauma.Which clinical manifestations should alert the nurse to internal bleeding and hypovolemic shock? (Select all that apply.)

Accepted Answer

A)   Hypertension
B)   Tachycardia
C)   Flushed skin
D)   Confusion
E)   Shallow respirations

Question 13

A nurse assesses a client who is recovering from a paracentesis 1 hour ago.Which assessment finding requires action by the nurse?

Accepted Answer

A)   Urine output via indwelling urinary catheter is 20 mL/hr
B)   Blood pressure increases from 110/58 to 120/62 mm Hg
C)   Respiratory rate decreases from 18 to 14 breaths/min
D)   A decrease in the client's weight by 6 kg

Question 14

A nurse assesses clients on the medical-surgical unit.Which client is at greatest risk for the development of carcinoma of the liver?

Accepted Answer

A)   A 22-year-old with a history of blunt liver trauma
B)   A 48-year-old with a history of diabetes mellitus
C)   A 66-year-old who has a history of cirrhosis
D)   An 82-year-old who has chronic malnutrition

Question 15

After teaching a client who has alcohol-induced cirrhosis,a nurse assesses the client's understanding.Which statement made by the client indicates a need for additional teaching?

Accepted Answer

A)   "I cannot drink any alcohol at all anymore."
B)   "I need to avoid protein in my diet."
C)   "I should not take over-the-counter medications."
D)   "I should eat small, frequent, balanced meals."

Question 16

A nurse assesses clients at a community health fair.Which client is at greatest risk for the development of hepatitis B?

Accepted Answer

A)   A 20-year-old college student who has had several sexual partners
B)   A 46-year-old woman who takes acetaminophen daily for headaches
C)   A 63-year-old businessman who travels frequently across the country
D)   An 82-year-old woman who recently ate raw shellfish for dinner

Question 17

A nurse obtains a client's health history at a community health clinic.Which statement alerts the nurse to provide health teaching to this client?

Accepted Answer

A)   "I drink two glasses of red wine each week."
B)   "I take a lot of Tylenol for my arthritis pain."
C)   "I have a cousin who died of liver cancer."
D)   "I got a hepatitis vaccine before traveling."

Question 18

A nurse cares for a client who has chronic cirrhosis from substance abuse.The client states,"All of my family hates me." How should the nurse respond?

Accepted Answer

A)   "You should make peace with your family."
B)   "This is not unusual.My family hates me too."
C)   "I will help you identify a support system."
D)   "You must attend Alcoholics Anonymous."

Question 19

A nurse assesses a male client who has symptoms of cirrhosis.Which questions should the nurse ask to identify potential factors contributing to this laboratory result? (Select all that apply.)

Accepted Answer

A)   "How frequently do you drink alcohol?"
B)   "Have you ever had sex with a man?"
C)   "Do you have a family history of cancer?"
D)   "Have you ever worked as a plumber?"
E)   "Were you previously incarcerated?"

Question 20

An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work.Which ideas should the nurse include in this plan? (Select all that apply.)

Accepted Answer

A)   Policies related to consistent use of Standard Precautions
B)   Hepatitis vaccination mandate for workers in high-risk areas
C)   Implementation of a needleless system for intravenous therapy
D)   Number of sharps used in client care reduced where possible
E)   Postexposure prophylaxis provided in a timely manner

Exam 58: Care of Patients with Liver Problems

A nurse cares for a client who is prescribed lactulose (Heptalac) .The client states,"I do not want to take this medication because it causes diarrhea." How should the nurse respond?

A nurse assesses a client who is prescribed an infusion of vasopressin (Pitressin) for bleeding esophageal varices.Which clinical manifestation should alert the nurse to a serious adverse effect?

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus) .Which statement should the nurse include in this client's discharge education?