Question 1

A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

Accepted Answer

A)   The patient will obtain measurement of drainage from the T-tube.
B)   The patient will exercise three times a week.
C)   The patient will take immunosuppressive agents as required.
D)   The patient will monitor for signs of liver dysfunction. C

Question 2

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

Accepted Answer

A)   Similar liver size and texture as in younger adults
B)   A nonpalpable liver
C)   A slightly enlarged liver with palpably hard edges
D)   A slightly decreased size of the liver D

Question 3

A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor liver be determined?

Accepted Answer

A)   By considering the patients age and prognosis
B)   By objectively determining the patients medical need
C)   By objectively assessing the patients willingness to adhere to post-transplantation care
D)   By systematically ruling out alternative treatment options B

Question 4

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

Accepted Answer

A)   Destruction of the patients liver tumor
B)   Restoration of portal vein patency
C)   Destruction of a liver abscess
D)   Reversal of metastasis

Question 5

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be $24 \mathrm{mg} / \mathrm{dL}$. For what complication is this patient at risk?

Accepted Answer

A)   Chronic jaundice
B)   Pigment stones in portal circulation
C)   Central nervous system damage
D)   Hepatomegaly

Question 6

A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

Accepted Answer

A)   The hepatitis A vaccine
B)   Albumin infusion
C)   The hepatitis A and B vaccines
D)   An immune globulin injection

Question 7

A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Accepted Answer

A)   Alterations in glucose metabolism
B)   Retention of bile salts
C)   Inadequate production of albumin by hepatocytes
D)   Inability of the liver to use vitamin  K\mathrm{K}K

Question 8

A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringers lactate at $150 \mathrm{cc} / \mathrm{hr}$ infusing. What else might the nurse expect to have ordered to maintain volume for this patient?

Accepted Answer

A)   Arterial line
B)   Diuretics
C)   Foley catheter
D)   Volume expanders

Question 9

A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patients care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence
1)Fever rises.
2) Hematemesis.
3) Clotting abnormalities.
4) Vascular collapse.
5) Coma.

Accepted Answer

A)   1,2,5,4,3
B)   1,2,3,4,5
C)   2,3,1,4,5
D)   3,1,2,5,4

Question 10

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis $\mathrm{C}$ in the workplace?

Accepted Answer

A)   Disposing of sharps appropriately and not recapping needles
B)   Performing meticulous hand hygiene at the appropriate moments in care
C)   Adhering to the recommended schedule of immunizations
D)   Wearing an N95 mask when providing care for patients on airborne precautions

Question 11

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.

Accepted Answer

A)   Administering diuretics
B)   Administering calcium channel blockers
C)   Implementing fluid restrictions
D)   Implementing a 1500 kcal/day restriction
E)   Enhancing patient positioning

Question 12

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patients plan of care?

Accepted Answer

A)   Measurement of abdominal girth and body weight
B)   Assessment for variceal bleeding
C)   Assessment for signs and symptoms of jaundice
D)   Monitoring of results of liver function testing

Question 13

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?

Accepted Answer

A)   Decisional Conflict
B)   Deficient Knowledge
C)   Death Anxiety
D)   Disturbed Thought Processes

Question 14

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver?

Accepted Answer

A)   Place hand under the right lower abdominal quadrant and press down lightly with the other hand.
B)   Place the left hand over the abdomen and behind the left side at the 11th rib.
C)   Place hand under right lower rib cage and press down lightly with the other hand.
D)   Hold hand 90 degrees to right side of the abdomen and push down firmly.

Question 15

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

Accepted Answer

A)   Position the patient on the right side with a pillow under the costal margin after the procedure.
B)   Administer 1 unit of albumin 90 minutes before the procedure as ordered.
C)   Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure.
D)   Confirm that the patients electrolyte levels have been assessed prior to the procedure.

Question 16

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?

Accepted Answer

A)   Persistent fever and cognitive changes
B)   Abdominal pain and hepatomegaly
C)   Peripheral edema unresponsive to diuresis
D)   Spontaneous bleeding and jaundice

Question 17

A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurses most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurses best response to this assessment finding?

Accepted Answer

A)   Document the presence of normal bile output.
B)   Irrigate the drainage system with normal saline as ordered.
C)   Aspirate a sample of the drainage for culture.
D)   Promptly report this assessment finding to the primary care provider.

Question 18

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patients presentation?

Accepted Answer

A)   How many alcoholic drinks do you typically consume in a week?
B)   To the best of your knowledge, are your immunizations up to date?
C)   Have you ever worked in an occupation where you might have been exposed to toxins?
D)   Has anyone in your family ever experienced symptoms similar to yours?

Question 19

Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention?

Accepted Answer

A)   Cryosurgery
B)   Liver transplantation
C)   Lobectomy
D)   Laser hyperthermia

Question 20

A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?

Accepted Answer

A)   Risk for Infection Related to Immunosuppressant Use
B)   Risk for Injury Related to Decreased Hemostasis
C)   Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
D)   Risk for Contamination Related to Accumulation of Ammonia

Exam 48: Assessment and Management of Patients With Hepatic Disorders

A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor liver be determined?

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be $24 \mathrm{mg} / \mathrm{dL}$ . For what complication is this patient at risk?

A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis $\mathrm{C}$ in the workplace?

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patients plan of care?

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver?

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patients presentation?

Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention?

A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?

Exam 48: Assessment and Management of Patients With Hepatic Disorders

A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?

A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor liver be determined?

A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be 24mg/dL24 \mathrm{mg} / \mathrm{dL}24mg/dL . For what complication is this patient at risk?

A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis C\mathrm{C}C in the workplace?

A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.

A nurse is caring for a patient who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this patients plan of care?

A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?

A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patients liver?

A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?

A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?

A triage nurse in the emergency department is assessing a patient who presented with complaints of general malaise. Assessment reveals the presence of jaundice and increased abdominal girth. What assessment question best addresses the possible etiology of this patients presentation?

Diagnostic testing has revealed that a patients hepatocellular carcinoma (HCC) is limited to one lobe. The nurse should anticipate that this patients plan of care will focus on what intervention?

A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?

A nurse is caring for a patient with severe hemolytic jaundice. Laboratory tests show free bilirubin to be $24 \mathrm{mg} / \mathrm{dL}$ . For what complication is this patient at risk?

A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis $\mathrm{C}$ in the workplace?