Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon
and discovers that the client is difficult to arouse and has an elevated serum
ammonia level. The nurse should suspect which situation?
A. The client's hepatic function is decreasing.
B. The client didn't take his morning dose of lactulose (Cephulac).
C. The client is relaxed and not in pain.
D. The client is avoiding the nurse. - Correct answer- A
The decreased level of consciousness caused by an increased serum ammonia
level indicates hepatic disfunction. If the client didn't take his morning dose of
lactulose, he wouldn't have elevated ammonia levels and decreased level of
consciousness this soon. These assessment findings don't indicate that the client
is relaxed or avoiding the nurse.
A client has an elevated serum ammonia concentration and is exhibiting changes
in mental status. The nurse should suspect which condition?
A. Hepatic encephalopathy
B. Portal hypertension
C. Asterixis
D. Cirrhosis - Correct answer- A
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
Hepatic encephalopathy is a central nervous system dysfunction resulting from
liver disease. It is frequently associated with an elevated ammonia concentration
that produces changes in mental status, altered level of consciousness, and coma.
Portal hypertension is an elevated pressure in the portal circulation resulting from
obstruction of venous flow into and through the liver. Asterixis is an involuntary
flapping movement of the hands associated with metabolic liver dysfunction.
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock.
Which is a sign of potential hypovolemia?
A. Polyuria
B. Bradycardia
C. Hypotension
D. Warm moist skin - Correct answer- C
Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased
blood pressure; and decreased urine output.
Which of the following medications would the nurse expect the physician to order
for a client with cirrhosis who develops portal hypertension?
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
A. Spironolactone (Aldactone)
B. Kanamycin (Kantrex)
C. Lactulose (Cephulac)
D. Cyclosporine (Sandimmune) - Correct answer- A
For portal hypertension, a diuretic usually an aldosterone antagonist such as
spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to
treat hepatic encephalopathy to destroy intestinal microorganisms and decrease
ammonia production. Lactulose would be used to reduce serum ammonia
concentration in a client with hepatic encephalopathy. Cyclosporine
(Sandimmune) would be used to prevent graft rejection after a transplant.
A nurse is taking health history data from a client. Use of which of the following
medications would especially alert the nurse to an increased risk of hepatic
dysfunction and disease in this client? Select all that apply.
A. Acetaminophen
B. Ketoconazole
C. Valproic acid
D. Diazepam
E. Insulin - Correct answer- A, B, C
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
Many medications (including acetaminophen, ketoconazole, and valproic acid) are
responsible for hepatic dysfunction and disease. A thorough medication history
should address all current and past prescription medications, over-the-counter
medications, herbal remedies, and dietary supplements.
A client who was recently diagnosed with carcinoma of the pancreas and is having
a procedure in which the head of the pancreas is removed. In addition, the
surgeon will remove the duodenum and stomach, redirecting the flow of
secretions from the stomach, gallbladder, and pancreas into the middle section of
the small intestine. What procedure is this client having performed?
A. radical pancreatoduodenectomy
B. cholecystojejunostomy
C. total pancreatectomy
D. distal pancreatectomy - Correct answer- A
Radical pancreatoduodenectomy involves removing the head of the pancreas,
resecting the duodenum and stomach, and redirecting the flow of secretions from
the stomach, gallbladder, and pancreas into the jejunum. Cholecystojejunostomy
is a rerouting of the pancreatic and biliary drainage systems, which may be done
to relieve obstructive jaundice. This measure is considered palliative only. A
pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may
be total, in which case the entire organ is removed, usually along with the spleen,
gallbladder, common bile duct, and portions of the small intestine and stomach. A
Management of Patients With Hepatic
Disorders
A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon
and discovers that the client is difficult to arouse and has an elevated serum
ammonia level. The nurse should suspect which situation?
A. The client's hepatic function is decreasing.
B. The client didn't take his morning dose of lactulose (Cephulac).
C. The client is relaxed and not in pain.
D. The client is avoiding the nurse. - Correct answer- A
The decreased level of consciousness caused by an increased serum ammonia
level indicates hepatic disfunction. If the client didn't take his morning dose of
lactulose, he wouldn't have elevated ammonia levels and decreased level of
consciousness this soon. These assessment findings don't indicate that the client
is relaxed or avoiding the nurse.
A client has an elevated serum ammonia concentration and is exhibiting changes
in mental status. The nurse should suspect which condition?
A. Hepatic encephalopathy
B. Portal hypertension
C. Asterixis
D. Cirrhosis - Correct answer- A
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
Hepatic encephalopathy is a central nervous system dysfunction resulting from
liver disease. It is frequently associated with an elevated ammonia concentration
that produces changes in mental status, altered level of consciousness, and coma.
Portal hypertension is an elevated pressure in the portal circulation resulting from
obstruction of venous flow into and through the liver. Asterixis is an involuntary
flapping movement of the hands associated with metabolic liver dysfunction.
Clients diagnosed with esophageal varices are at risk for hemorrhagic shock.
Which is a sign of potential hypovolemia?
A. Polyuria
B. Bradycardia
C. Hypotension
D. Warm moist skin - Correct answer- C
Signs of potential hypovolemia include cool, clammy skin; tachycardia; decreased
blood pressure; and decreased urine output.
Which of the following medications would the nurse expect the physician to order
for a client with cirrhosis who develops portal hypertension?
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
A. Spironolactone (Aldactone)
B. Kanamycin (Kantrex)
C. Lactulose (Cephulac)
D. Cyclosporine (Sandimmune) - Correct answer- A
For portal hypertension, a diuretic usually an aldosterone antagonist such as
spironolactone (Aldactone) is ordered. Kanamycin (Kantrex) would be used to
treat hepatic encephalopathy to destroy intestinal microorganisms and decrease
ammonia production. Lactulose would be used to reduce serum ammonia
concentration in a client with hepatic encephalopathy. Cyclosporine
(Sandimmune) would be used to prevent graft rejection after a transplant.
A nurse is taking health history data from a client. Use of which of the following
medications would especially alert the nurse to an increased risk of hepatic
dysfunction and disease in this client? Select all that apply.
A. Acetaminophen
B. Ketoconazole
C. Valproic acid
D. Diazepam
E. Insulin - Correct answer- A, B, C
, Chapter 49: Assessment and
Management of Patients With Hepatic
Disorders
Many medications (including acetaminophen, ketoconazole, and valproic acid) are
responsible for hepatic dysfunction and disease. A thorough medication history
should address all current and past prescription medications, over-the-counter
medications, herbal remedies, and dietary supplements.
A client who was recently diagnosed with carcinoma of the pancreas and is having
a procedure in which the head of the pancreas is removed. In addition, the
surgeon will remove the duodenum and stomach, redirecting the flow of
secretions from the stomach, gallbladder, and pancreas into the middle section of
the small intestine. What procedure is this client having performed?
A. radical pancreatoduodenectomy
B. cholecystojejunostomy
C. total pancreatectomy
D. distal pancreatectomy - Correct answer- A
Radical pancreatoduodenectomy involves removing the head of the pancreas,
resecting the duodenum and stomach, and redirecting the flow of secretions from
the stomach, gallbladder, and pancreas into the jejunum. Cholecystojejunostomy
is a rerouting of the pancreatic and biliary drainage systems, which may be done
to relieve obstructive jaundice. This measure is considered palliative only. A
pancreatectomy is the surgical removal of the pancreas. A pancreatectomy may
be total, in which case the entire organ is removed, usually along with the spleen,
gallbladder, common bile duct, and portions of the small intestine and stomach. A
