Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 922
Chapter 49: Assessment and Management of Patients with Hepatic Disorders
n n n n n n n n n
1. Annursenisncaringnfornanpatientnwithnlivernfailurenandnisnperformingnannassessmentninnthenknowledgenofnthe
npatientsnincreasednrisknofnbleeding.nThennursenrecognizesnthatnthisnrisknisnrelatedntonthenpatientsninability
ntonsynthesizenprothrombinninnthenliver.nWhatnfactornmostnlikelyncontributesntonthisnlossnofnfunction?
A) Alterationsninnglucosenmetabolism
B) Retentionnofnbilensalts
C) Inadequatenproductionnofnalbuminnbynhepatocytes
D) InabilitynofnthenliverntonusenvitaminnK
n Ans: D
Feedback:
Decreasednproductionnofnseveralnclottingnfactorsnmaynbenpartiallynduentondeficientnabsorptionnofnvitaminn
KnfromnthenGIntract.nThisnprobablynisncausednbyntheninabilitynofnliverncellsntonusenvitaminnKntonmakenpro
thrombin.nThisnbleedingnrisknisnunrelatedntonthenrolesnofnglucose,nbilensalts,nornalbumin.
2. Annursenisnperformingnannadmissionnassessmentnofnanpatientnwithnandiagnosisnofncirrhosis.nWhat
ntechniquenshouldnthennursenusentonpalpatenthenpatientsnliver?
A) Placenhandnundernthenrightnlowernabdominalnquadrantnandnpressndownnlightlynwithnthenothernhand.
B) Placenthenleftnhandnovernthenabdomennandnbehindnthenleftnsidenatnthen11thnrib.
C) Placenhandnundernrightnlowernribncagenandnpressndownnlightlynwithnthenothernhand.
D) Holdnhandn90ndegreesntonrightnsidenofnthenabdomennandnpushndownnfirmly.
Ans: C
Feedback:
Tonpalpatenthenliver,nthenexaminernplacesnonenhandnundernthenrightnlowernribncagenandnpressesndownwardn
withnlightnpressurenwithnthenothernhand.nThenlivernisnnotnonnthenleftnsidenorninnthenrightnlowernabdominaln
quadrant.
3. Anpatientnwithnportalnhypertensionnhasnbeennadmittedntonthenmedicalnfloor.nThennursenshouldnprioritize
,Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 923
whichnofnthenfollowingnassessmentsnrelatedntonthenmanifestationsnofnthisnhealthnproblem?
A) Assessmentnofnbloodnpressurenandnassessmentnfornheadachesnandnvisualnchanges
B) Assessmentsnfornsignsnandnsymptomsnofnvenousnthromboembolism
C) Dailynweightsnandnabdominalngirthnmeasurement
D) Bloodnglucosenmonitoringnq4h
Ans: C
Feedback:
Obstructionntonbloodnflownthroughnthendamagednlivernresultsninnincreasednbloodnpressuren(portalnhyperte
nsion)nthroughoutnthenportalnvenousnsystem.nThisncannresultninnvaricesnandnascitesninnthenabdominalncavit
y.nAssessmentsnrelatedntonascitesnarendailynweightsnandnabdominalngirths.nPortalnhypertensionnisnnotnsyno
nymousnwithncardiovascularnhypertensionnandndoesnnotncreatenanrisknfornunstablenbloodnglucosenornVTE.
4. Annurseneducatornisnteachingnangroupnofnrecentnnursingngraduatesnaboutntheirnoccupationalnrisksnforncon
tractingnhepatitisnB.nWhatnpreventativenmeasuresnshouldntheneducatornpromote?nSelectnallnthatnapply.
A) Immunization
B) Usenofnstandardnprecautions
C) Consumptionnofnanvitamin-richndiet
D) AnnualnvitaminnKninjections
E) AnnualnvitaminnB12ninjections
Ans: A,nB
Feedback:
Peoplenwhonarenatnhighnrisk,nincludingnnursesnandnothernhealthncarenpersonnelnexposedntonbloodnornblood
nproducts,nshouldnreceivenactivenimmunization.nThenconsistentnusenofnstandardnprecautionsnisnalsonhighl
ynbeneficial.nVitaminnsupplementationnisnunrelatedntonannindividualsnrisknofnHBV.
5. Annursenisncaringnfornanpatientnwithncancernofnthenlivernwhosenconditionnhasnrequiredntheninsertionnofnan
percutaneousnbiliaryndrainagensystem.nThennursesnmostnrecentnassessmentnrevealsnthenpresencenofndark
ngreennfluidninnthencollectionncontainer.nWhatnisnthennursesnbestnresponsentonthisnassessment nfinding?
,Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 924
A) Documentnthenpresencenofnnormalnbilenoutput.
B) Irrigatenthendrainagensystemnwithnnormalnsalinenasnordered.
C) Aspiratenansamplenofnthendrainagenfornculture.
D) Promptlynreportnthisnassessmentnfindingntonthenprimaryncarenprovider.
Ans: A
Feedback:
Bilenisnusuallynandarkngreennornbrownish-
yellowncolor,nsonthisnwouldnconstitutenannexpectednassessmentnfinding,nwithnnonothernactionnnecessary.
6. Anpatientnwhonhasnundergonenliverntransplantationnisnreadyntonbendischargednhome.nWhichnoutcomenof
nhealthneducationnshouldnthennursenprioritize?
A) ThenpatientnwillnobtainnmeasurementnofndrainagenfromnthenT-tube.
B) Thenpatientnwillnexercisenthreentimesnanweek.
C) Thenpatientnwillntakenimmunosuppressivenagentsnasnrequired.
D) Thenpatientnwillnmonitornfornsignsnofnliverndysfunction.
Ans: C
Feedback:
Thenpatientnisngivennwrittennandnverbalninstructionsnaboutnimmunosuppressivenagentndosesnandndosingnsc
hedules.nThenpatientnisnalsoninstructednonnstepsntonfollowntonensurenthatnannadequatensupplynofnmedicatio
nnisnavailablensonthatntherenisnnonchancenofnrunningnoutnofnthenmedicationnornskippingnandose.nFailurentonta
kenmedicationsnasninstructednmaynprecipitatenrejection.nThennursenwouldnnotnteachnthenpatientntonmeasuren
drainagenfromnanT-tubenasnthenpatientnwouldntngonhomenwithnanT-
tube.nThennursenmaynteachnthenpatientnaboutnthenneedntonexercisenornwhatnthensignsnofnliverndysfunctionna
re,nbutnthennursenwouldnnotnstressnthesentopicsnovernthenimmunosuppressivendrugnregimen.
7. Antriagennurseninnthenemergencyndepartmentnisnassessingnanpatientnwhonpresentednwithncomplaintsnof
ngeneralnmalaise.nAssessmentnrevealsnthenpresencenofnjaundicenandnincreasednabdominalngirth.nWha
tnassessmentnquestionnbestnaddressesnthenpossiblenetiologynofnthisnpatientsnpresentation?
A) Hownmanynalcoholicndrinksndonyountypicallynconsumeninnanweek?
B) Tonthenbestnofnyournknowledge,narenyournimmunizationsnupntondate?
C) Havenyounevernworkedninnannoccupationnwherenyounmightnhavenbeennexposedntontoxins?
, Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 925
D) Hasnanyoneninnyournfamilynevernexperiencednsymptomsnsimilarntonyours?
Ans: A
Feedback:
Signsnornsymptomsnofnhepaticndysfunctionnindicatenanneedntonassessnfornalcoholnuse.nImmunizationnstatus,n
occupationalnrisks,nandnfamilynhistorynarenalsonrelevantnconsiderations,nbutnalcoholnusenisnanmorencommo
nnetiologicnfactorninnliverndisease.
8. Annursenisnparticipatingninnthenemergencyncarenofnanpatientnwhonhasnjustndevelopednvaricealnbleeding.n
Whatninterventionnshouldnthennursenanticipate?
A) Infusionnofnintravenousnheparin
B) IVnadministrationnofnalbumin
C) STATnadministrationnofnvitaminnKnbynthenintramuscularnroute
D) IVnadministrationnofnoctreotiden(Sandostatin)
n Ans: D
Feedback:
Octreotiden(Sandostatin)ansyntheticnanalognofnthenhormonensomatostatinisneffectiveninndecreasingnbleedi
ngnfromnesophagealnvarices,nandnlacksnthenvasoconstrictiveneffectsnofnvasopressin.nBecausenofnthisnsafety
nandnefficacynprofile,noctreotidenisnconsiderednthenpreferredntreatmentnregimennfornimmediatencontrolnofn
varicealnbleeding.nVitaminnKnandnalbuminnarennotnadministerednandnheparinnwouldnexacerbate,nnotnallevi
ate,nbleeding.
9. Annursenisncaringnfornanpatientnwithnhepaticnencephalopathy.nWhilenmakingntheninitialnshiftnassessment,
nthennursennotesnthatnthenpatientnhasnanflappingntremornofnthenhands.nThennursenshouldndocumentnthenpr
esencenofnwhatnsignnofnliverndisease?
A) Asterixis
B) Constructionaln apraxia
C) Fetornhepaticus
D) Palmarnerythema
Ans: A
Chapter 49: Assessment and Management of Patients with Hepatic Disorders
n n n n n n n n n
1. Annursenisncaringnfornanpatientnwithnlivernfailurenandnisnperformingnannassessmentninnthenknowledgenofnthe
npatientsnincreasednrisknofnbleeding.nThennursenrecognizesnthatnthisnrisknisnrelatedntonthenpatientsninability
ntonsynthesizenprothrombinninnthenliver.nWhatnfactornmostnlikelyncontributesntonthisnlossnofnfunction?
A) Alterationsninnglucosenmetabolism
B) Retentionnofnbilensalts
C) Inadequatenproductionnofnalbuminnbynhepatocytes
D) InabilitynofnthenliverntonusenvitaminnK
n Ans: D
Feedback:
Decreasednproductionnofnseveralnclottingnfactorsnmaynbenpartiallynduentondeficientnabsorptionnofnvitaminn
KnfromnthenGIntract.nThisnprobablynisncausednbyntheninabilitynofnliverncellsntonusenvitaminnKntonmakenpro
thrombin.nThisnbleedingnrisknisnunrelatedntonthenrolesnofnglucose,nbilensalts,nornalbumin.
2. Annursenisnperformingnannadmissionnassessmentnofnanpatientnwithnandiagnosisnofncirrhosis.nWhat
ntechniquenshouldnthennursenusentonpalpatenthenpatientsnliver?
A) Placenhandnundernthenrightnlowernabdominalnquadrantnandnpressndownnlightlynwithnthenothernhand.
B) Placenthenleftnhandnovernthenabdomennandnbehindnthenleftnsidenatnthen11thnrib.
C) Placenhandnundernrightnlowernribncagenandnpressndownnlightlynwithnthenothernhand.
D) Holdnhandn90ndegreesntonrightnsidenofnthenabdomennandnpushndownnfirmly.
Ans: C
Feedback:
Tonpalpatenthenliver,nthenexaminernplacesnonenhandnundernthenrightnlowernribncagenandnpressesndownwardn
withnlightnpressurenwithnthenothernhand.nThenlivernisnnotnonnthenleftnsidenorninnthenrightnlowernabdominaln
quadrant.
3. Anpatientnwithnportalnhypertensionnhasnbeennadmittedntonthenmedicalnfloor.nThennursenshouldnprioritize
,Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 923
whichnofnthenfollowingnassessmentsnrelatedntonthenmanifestationsnofnthisnhealthnproblem?
A) Assessmentnofnbloodnpressurenandnassessmentnfornheadachesnandnvisualnchanges
B) Assessmentsnfornsignsnandnsymptomsnofnvenousnthromboembolism
C) Dailynweightsnandnabdominalngirthnmeasurement
D) Bloodnglucosenmonitoringnq4h
Ans: C
Feedback:
Obstructionntonbloodnflownthroughnthendamagednlivernresultsninnincreasednbloodnpressuren(portalnhyperte
nsion)nthroughoutnthenportalnvenousnsystem.nThisncannresultninnvaricesnandnascitesninnthenabdominalncavit
y.nAssessmentsnrelatedntonascitesnarendailynweightsnandnabdominalngirths.nPortalnhypertensionnisnnotnsyno
nymousnwithncardiovascularnhypertensionnandndoesnnotncreatenanrisknfornunstablenbloodnglucosenornVTE.
4. Annurseneducatornisnteachingnangroupnofnrecentnnursingngraduatesnaboutntheirnoccupationalnrisksnforncon
tractingnhepatitisnB.nWhatnpreventativenmeasuresnshouldntheneducatornpromote?nSelectnallnthatnapply.
A) Immunization
B) Usenofnstandardnprecautions
C) Consumptionnofnanvitamin-richndiet
D) AnnualnvitaminnKninjections
E) AnnualnvitaminnB12ninjections
Ans: A,nB
Feedback:
Peoplenwhonarenatnhighnrisk,nincludingnnursesnandnothernhealthncarenpersonnelnexposedntonbloodnornblood
nproducts,nshouldnreceivenactivenimmunization.nThenconsistentnusenofnstandardnprecautionsnisnalsonhighl
ynbeneficial.nVitaminnsupplementationnisnunrelatedntonannindividualsnrisknofnHBV.
5. Annursenisncaringnfornanpatientnwithncancernofnthenlivernwhosenconditionnhasnrequiredntheninsertionnofnan
percutaneousnbiliaryndrainagensystem.nThennursesnmostnrecentnassessmentnrevealsnthenpresencenofndark
ngreennfluidninnthencollectionncontainer.nWhatnisnthennursesnbestnresponsentonthisnassessment nfinding?
,Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 924
A) Documentnthenpresencenofnnormalnbilenoutput.
B) Irrigatenthendrainagensystemnwithnnormalnsalinenasnordered.
C) Aspiratenansamplenofnthendrainagenfornculture.
D) Promptlynreportnthisnassessmentnfindingntonthenprimaryncarenprovider.
Ans: A
Feedback:
Bilenisnusuallynandarkngreennornbrownish-
yellowncolor,nsonthisnwouldnconstitutenannexpectednassessmentnfinding,nwithnnonothernactionnnecessary.
6. Anpatientnwhonhasnundergonenliverntransplantationnisnreadyntonbendischargednhome.nWhichnoutcomenof
nhealthneducationnshouldnthennursenprioritize?
A) ThenpatientnwillnobtainnmeasurementnofndrainagenfromnthenT-tube.
B) Thenpatientnwillnexercisenthreentimesnanweek.
C) Thenpatientnwillntakenimmunosuppressivenagentsnasnrequired.
D) Thenpatientnwillnmonitornfornsignsnofnliverndysfunction.
Ans: C
Feedback:
Thenpatientnisngivennwrittennandnverbalninstructionsnaboutnimmunosuppressivenagentndosesnandndosingnsc
hedules.nThenpatientnisnalsoninstructednonnstepsntonfollowntonensurenthatnannadequatensupplynofnmedicatio
nnisnavailablensonthatntherenisnnonchancenofnrunningnoutnofnthenmedicationnornskippingnandose.nFailurentonta
kenmedicationsnasninstructednmaynprecipitatenrejection.nThennursenwouldnnotnteachnthenpatientntonmeasuren
drainagenfromnanT-tubenasnthenpatientnwouldntngonhomenwithnanT-
tube.nThennursenmaynteachnthenpatientnaboutnthenneedntonexercisenornwhatnthensignsnofnliverndysfunctionna
re,nbutnthennursenwouldnnotnstressnthesentopicsnovernthenimmunosuppressivendrugnregimen.
7. Antriagennurseninnthenemergencyndepartmentnisnassessingnanpatientnwhonpresentednwithncomplaintsnof
ngeneralnmalaise.nAssessmentnrevealsnthenpresencenofnjaundicenandnincreasednabdominalngirth.nWha
tnassessmentnquestionnbestnaddressesnthenpossiblenetiologynofnthisnpatientsnpresentation?
A) Hownmanynalcoholicndrinksndonyountypicallynconsumeninnanweek?
B) Tonthenbestnofnyournknowledge,narenyournimmunizationsnupntondate?
C) Havenyounevernworkedninnannoccupationnwherenyounmightnhavenbeennexposedntontoxins?
, Testn Bankn -n Brunnern &n Suddarth'snTextbookn ofn Medical-Surgicaln Nursingn 14en (Hinklen 2017) 925
D) Hasnanyoneninnyournfamilynevernexperiencednsymptomsnsimilarntonyours?
Ans: A
Feedback:
Signsnornsymptomsnofnhepaticndysfunctionnindicatenanneedntonassessnfornalcoholnuse.nImmunizationnstatus,n
occupationalnrisks,nandnfamilynhistorynarenalsonrelevantnconsiderations,nbutnalcoholnusenisnanmorencommo
nnetiologicnfactorninnliverndisease.
8. Annursenisnparticipatingninnthenemergencyncarenofnanpatientnwhonhasnjustndevelopednvaricealnbleeding.n
Whatninterventionnshouldnthennursenanticipate?
A) Infusionnofnintravenousnheparin
B) IVnadministrationnofnalbumin
C) STATnadministrationnofnvitaminnKnbynthenintramuscularnroute
D) IVnadministrationnofnoctreotiden(Sandostatin)
n Ans: D
Feedback:
Octreotiden(Sandostatin)ansyntheticnanalognofnthenhormonensomatostatinisneffectiveninndecreasingnbleedi
ngnfromnesophagealnvarices,nandnlacksnthenvasoconstrictiveneffectsnofnvasopressin.nBecausenofnthisnsafety
nandnefficacynprofile,noctreotidenisnconsiderednthenpreferredntreatmentnregimennfornimmediatencontrolnofn
varicealnbleeding.nVitaminnKnandnalbuminnarennotnadministerednandnheparinnwouldnexacerbate,nnotnallevi
ate,nbleeding.
9. Annursenisncaringnfornanpatientnwithnhepaticnencephalopathy.nWhilenmakingntheninitialnshiftnassessment,
nthennursennotesnthatnthenpatientnhasnanflappingntremornofnthenhands.nThennursenshouldndocumentnthenpr
esencenofnwhatnsignnofnliverndisease?
A) Asterixis
B) Constructionaln apraxia
C) Fetornhepaticus
D) Palmarnerythema
Ans: A
