Chapter 58: Care of Patients with Liver Problems

Chapter 58: Care of Patients with Liver Problems

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. 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?
   1. “I drink two glasses of red wine each week.”
   2. “I take a lot of Tylenol for my arthritis pain.”
   3. “I have a cousin who died of liver cancer.”
   4. “I got a hepatitis vaccine before traveling.”

ANS:   B

Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explore other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.

DIF:     Applying/Application                         REF: 1202                   KEY: Cirrhosis| acetaminophen| medication safety                                            MSC:                         Integrated Process: Nursing Process: Analysis                                            NOT:                          Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A nurse cares for a client who has cirrhosis of the liver. Which action should the nurse take to decrease the presence of ascites?
   1. Monitor intake and output.
   2. Provide a low-sodium diet.
   3. Increase oral fluid intake.
   4. Weigh the client daily.

ANS:   B

A low-sodium diet is one means of controlling abdominal fluid collection. Monitoring intake and output does not control fluid accumulation, nor does weighing the client. These interventions merely assess or monitor the situation. Increasing fluid intake would not be helpful.

DIF:     Applying/Application                         REF: 1202

KEY:   Cirrhosis| nutritional requirements

MSC:   Integrated Process: Nursing Process: Implementation           NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

3. A nurse assesses a client who is recovering from a paracentesis 1 hour ago. Which assessment finding requires action by the nurse?
   1. Urine output via indwelling urinary catheter is 20 mL/hr
   2. Blood pressure increases from 110/58 to 120/62 mm Hg
   3. Respiratory rate decreases from 18 to 14 breaths/min
   4. A decrease in the client’s weight by 6 kg

ANS:           A

Rapid removal of ascetic fluid causes decreased abdominal pressure, which can contribute to hypovolemia. This can be manifested by a decrease in urine output to below 30 mL/hr. A slight increase in systolic blood pressure is insignificant. A decrease in respiratory rate indicates that breathing has been made easier by the procedure. The nurse would expect the client’s weight to drop as fluid is removed. Six kilograms is less than 3 pounds and is expected.

DIF:            Applying/Application                         REF:    1199                 KEY: Hydration| hemodynamics| cirrhosis                                                                  MSC: Integrated Process: Nursing Process: Analysis                      NOT:                                                 Client Needs Category: Physiological Integrity: Reduction of Risk Potential

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?
   1. Sedate the client to prevent tube dislodgement.
   2. Maintain balloon pressure at 15 and 20 mm Hg.
   3. Irrigate the gastric lumen with normal saline.
   4. Assess the client for airway patency.

ANS:           D

Maintaining airway patency is the primary nursing intervention for this client. The nurse suctions oral secretions to prevent aspiration and occlusion of the airway. The client usually is intubated and mechanically ventilated during this treatment. The client should be sedated, balloon pressure should be maintained between 15 and 20 mm Hg, and the lumen can be irrigated with saline or tap water. However, these are not a higher priority than airway patency.

DIF:            Applying/Application                         REF:    1193                 KEY: Hemorrhaging| respiratory distress/failure| cirrhosis                                         MSC: Integrated Process: Nursing Process: Implementation                                                      NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential