Chapter 39: Assessment and Management of Patients With Hepatic Disorders

Chapter 39: Assessment and Management of Patients With Hepatic Disorders

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Multiple Choice

1. The nurse is caring for a patient with liver failure. The nurse understands that patients in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin?
2. A) Vitamin B₁₂
3. B) Vitamin A
4. C) Vitamin D
5. D) Vitamin K

Ans:  D

Chapter:  39

Client Needs:  D-2

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  1

Page and Header:  1118, Anatomic and Physiologic Overview

Feedback:  The liver requires vitamin K for the synthesis of prothrombin and some of the other clotting factors. Breakdown of fatty acids into ketone bodies occurs primarily when the availability of metabolism is limited, as during starvation or in uncontrolled diabetes. Vitamins stored in the liver include A, B₁₂, D, and several of the B-complex vitamins.

2. The nursing instructor is teaching the beginning nursing students how to palpate a liver. What technique will the student nurse use to palpate a patient’s liver?
3. A) Place hand under left lower rib cage and press down lightly with the other hand.
4. B) Place the left hand over the abdomen and behind the left side at the 11th rib.
5. C) Place hand under right lower rib cage and press down lightly with the other hand.
6. D) Hold hand 90 degrees to abdomen and push down firmly.

Ans:  C

Chapter:  39

Client Needs:  D-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  2

Page and Header:  1120, Assessment

Feedback:  To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. Therefore options A, B, and D are incorrect.

3. A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension?
4. A) Bowel obstruction
5. B) Vitamin A deficiency
6. C) Ascites
7. D) Hepatic encephalopathy

Ans:  C

Chapter:  39

Client Needs:  D-4

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  3

Page and Header:  1124, Portal Hypertension

Feedback:  Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Portal hypertension does not generally cause bowel obstruction. Vitamin A deficiency is not something the nurse assesses for. Hepatic encephalopathy is a complication of cirrohsis.

4. A nurse practitioner is teaching a health class in the local high school. The nurse practitioner informs the class about hepatitis B. What occupation does the nurse practitioner inform the class is at the greatest risk for contracting hepatitis B?
5. A) Flight attendants
6. B) Health care workers
7. C) Fire fighters
8. D) Educators

Ans:  B

Chapter:  39

Client Needs:  D-3

Cognitive Level:  Application

Difficulty:  Easy

Integrated Process:  Nursing Process

Objective:  5

Page and Header:  1142, Hepatitis B Virus

Feedback:  People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. Health care workers who have had frequent contact with blood are screened for anti-HBs to determine whether immunity is already present from previous exposure. Flight attendants, fire fighters and educators are not at high risk for hepatitis B.

5. The nurse is caring for a patient with cancer of the liver. The patient has a percutaneous biliary drainage system. What assessments should the nurse record in the patient’s chart?
6. A) Amount and color of drainage
7. B) Temperature of drainage
8. C) Odor of drainage
9. D) Consistency of drainage

Ans:  A

Chapter:  39

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  7

Page and Header:  1159, Liver Metastases

Feedback:  The percutaneous biliary system is open to external drainage.  The bile is observed closely for the amount, color, and presence of blood and debris. The nurse would not record the temperature, odor, and consistency of the drainage.