Exemplar 12.3: Liver Disease

Beschreibung

NCLEX Nursing (Medical-Surgical) Quiz am Exemplar 12.3: Liver Disease, erstellt von Olivia McRitchie am 10/12/2018.
Olivia McRitchie
Quiz von Olivia McRitchie, aktualisiert more than 1 year ago
Olivia McRitchie
Erstellt von Olivia McRitchie vor fast 6 Jahre
31
0

Zusammenfassung der Ressource

Frage 1

Frage
You have a patient who is an alcoholic and doesn't quite understand why she should quit drinking. She asks you "what exactly is going to happen if I don't stop?" Select the correct statement you can give to her about cirrhosis.
Antworten
  • "Alcoholic cirrhosis is indirectly related to the amount of alcohol consumed, the number of years of excessive alcohol consumption, and blood alcohol levels."
  • "Men will develop cirrhosis faster than women, but that doesn't mean you aren't at risk."
  • "Cirrhosis at any stage cannot be reversed."
  • "Malnutrition commonly accompanies alcoholic cirrhosis."

Frage 2

Frage
Select the EARLY clinical manifestations of cirrhosis.
Antworten
  • Dull, aching pain in the upper right quadrant
  • Dull, aching pain in the upper left quadrant.
  • Weight loss
  • Weakness
  • Anorexia
  • Diarrhea or constiparion
  • Portal systemic encephalopathy.
  • Esophageal varices

Frage 3

Frage
Early in the course of cirrhosis, few manifestations are present. The liver may be palpable and tender. A dull aching pain may be present in the [blank_start]upper right quadrant[blank_end] of the abdomen. Weight loss, weakness, anorexia, and bowel disruption may occur. As cirrhosis progresses, however, manifestations relate to liver cell failure and portal hypertension. [blank_start]Portal hypertension[blank_end] is the shunting of blood to lower-pressure vessels. Some of the collateral veins that are affected are located in the esophagus, causing large, thin-walled, esophageal [blank_start]varices[blank_end]. These vessels can rupture and cause massive hemorrhaging, especially if the liver damage causes [blank_start]thrombocytopenia[blank_end] and impaired production of [blank_start]clotting factors[blank_end]. In addition to being shunted to the esophagus, blood can be shunted to the [blank_start]spleen[blank_end], causing it to enlarge. Enlargement of the [blank_start]spleen[blank_end] can lead to anemia, leukopenia, and thombocytopenia due to increased destruction of blood cells. Because portal hypertension increases hydrostatic pressure, it can also cause [blank_start]ascites[blank_end], which is the accumulation of plasma-rich fluid in the abdominal cavity. In relation to this is the ability to develop [blank_start]spontaneous bacterial peritonitis[blank_end]. Cirrhosis can even cause psychological manifestations. Without functioning liver tissue, [blank_start]ammonia[blank_end] is not converted to uera, causing it to build up in the blood and cause [blank_start]portal systemic encephalopathy[blank_end]. The primary manifestation of this is [blank_start]asterixis[blank_end], which is a muscle tremor that interferes with the ability to maintain a fixed position of the extremities.
Antworten
  • upper right quadrant
  • upper left quadrant
  • lower right quadrant
  • lower left quadrant
  • Portal hypertension
  • Ascites
  • varices
  • ascites
  • aneurysms
  • breaks
  • thrombocytopenia
  • leukopenia
  • anemia
  • clotting factors
  • platelets
  • spleen
  • kidneys
  • abdominal wall
  • heart
  • spleen
  • kidneys
  • lungs
  • heart
  • ascites
  • varices
  • spontaneous bacterial peritonitis
  • spontaneous hyperthermia
  • acute kidney failure
  • ammonia
  • bilirubin
  • portal systemic encephalopathy
  • portal systemic neuropathy
  • portal systemic peritonitis
  • portal systemic meningitis
  • asterixis
  • Parkinsonism
  • Tourette's
  • aphasia

Frage 4

Frage
Edema and ascites are manifestations of what issues caused by cirrhosis?
Antworten
  • Hypoalbuminemia
  • Disrupted hormone balance and fluid retention
  • Increased pressure in portal venous system
  • Decreased clotting factor synthesis
  • Impaired vitamin K absorption

Frage 5

Frage
Decreased clotting factor synthesis, increased platelet destruction by enlarged spleen, and impaired vitamin K absorption and storage cause what clinical manifestations of liver disease?
Antworten
  • Bleeding and bruising
  • Edema
  • Ascites
  • Esophageal varices

Frage 6

Frage
What are esophageal varices caused by?
Antworten
  • Portal hypertension causing collateral vessel development
  • Impaired vitamin K absorption and storage
  • Thrombocytopenia
  • Decreased clotting factor synthesis

Frage 7

Frage
Gastritis, anorexia, and diarrhea are caused by what?
Antworten
  • Engorged veins in the gastrointestinal system
  • Alcohol ingestion
  • Impaired bile synthesis and fat absorption
  • Impaired bilirubin metabolism and secretion
  • Ascites

Frage 8

Frage
Jaundice is caused by impaired bilirubin metabolism and excretion
Antworten
  • True
  • False

Frage 9

Frage
Malnutrition and muscle wasting are caused by impaired nutrient metabolism, impaired fat absorption, and impaired hormone metabolism.
Antworten
  • True
  • False

Frage 10

Frage
Select the clinical manifestations of accumulated metabolic toxins and impaired ammonia metabolism and secretion.
Antworten
  • Asterixis
  • Encephalopathy
  • Jaundice
  • Gastritis
  • Hepatorenal syndrome

Frage 11

Frage
Match each diagnostic test with its description. [blank_start]Esophagoscopy[blank_end]: Used to determine the presence of upper esophageal varices. [blank_start]Bilirubin[blank_end]: Both conjugated and unconjugated versions of this are elevated with severe cirrhosis. [blank_start]Liver function studies[blank_end]: Includes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase. These will be elevated in patients with cirrhosis, but will not be as severely in patients with severe hepatitis. [blank_start]Liver biopsy[blank_end]: May be done to distinguish cirrhosis from other forms of liver disease. May be deferred if bleeding is prolonged. [blank_start]Serum electrolytes[blank_end]: Hyponatremia is common, resulting in hemodilution. Hypokalemia, hypophosphatemia, and hypomagnesemia are also frequently seen, r/t malnutrition and altered renal excretion. [blank_start]Serum albumin[blank_end]: This value decreases due to impaired liver production of the protein. [blank_start]Serum ammonia[blank_end]: This value elevates because the liver cannot convert ammonia into urea. [blank_start]CBC w/platelets[blank_end]: Low RBC, hemoglobin, and hematocrit demonstrate anemia r/t bone marrow suppression, increased RBC destruction, bleeding, and deficiencies of folic acid and vitamin B12. Thrombocytopenia and leukopenia occurs because platelets are destroyed by the spleen. [blank_start]Coagulation studies[blank_end]: Prolonged prothrombin time results from impaired production of coagulation proteins and lack of vitamin K. [blank_start]Serum glucose and cholesterol[blank_end]: These 2 values are frequently abnormal in patients with cirrhosis. [blank_start]Abdominal ultrasound:[blank_end] Used to evaluate liver size, detect ascites, and identify liver nodules. It may be used with Doppler studies to evaluate blood flow through the liver and spleen.
Antworten
  • Esophagoscopy
  • Colonoscopy
  • Bilirubin
  • Calcium
  • Liver function studies
  • Liver biopsy
  • Serum electrolytes
  • Serum albumin
  • Serum bilirubin
  • Serum ammonia
  • Serum urea
  • CBC w/platelets
  • Coagulation studies
  • aPTT
  • INR
  • Serum glucose and cholesterol
  • Serum glucose and calcium
  • Serum cholesterol and albumin
  • Abdominal ultrasound:
  • Palpation
  • Percussion

Frage 12

Frage
Which of the following medications might you give to a patient experiencing edema and ascites from hypoalbuminemia, hyperaldosteronism, and/or portal hypertension?
Antworten
  • Sipronolactone (Aldactone)
  • Lactulose
  • Neomycin sulfate
  • Oxazepam

Frage 13

Frage
What two medications are commonly prescribed to treat the accumulation of metabolic toxins due to impaired ammonia metabolism and excretion?
Antworten
  • Lactulose
  • Neomycin sulfate
  • Spironolactone (Aldactone)
  • Nadolol (Corgard)
  • Ferrous sulfate

Frage 14

Frage
What medication combination would you give to a patient with portal hypertension that is causing esophageal varices?
Antworten
  • Nadolol (Corgard) and isosorbide mononitrate (Ismo).
  • Ferrous sulfate and folic acid
  • Ferrous sulfate and vitamin K
  • Furosemide (Lasix) and spironolactone (Aldactone)

Frage 15

Frage
What medications would you give to a patient suffering from bleeding and bruising due to decreased clotting factor synthesis, thrombocytopenia, and impaired vitamin K absorption and storage?
Antworten
  • Ferrous sulfate
  • Folic acid
  • Vitamin K
  • Oxazepam (Serax)
  • Lactulose

Frage 16

Frage
Diazepam (Valium) is the one benzodiazepine that is not metabolized by the liver, and is therefore safe to treat acute agitation.
Antworten
  • True
  • False

Frage 17

Frage
You are teaching a cirrhosis patient and his wife about diet and liver failure. Which of the following statements, made by the patient, shows that more teaching is needed?
Antworten
  • "I need to restrict my sodium to less than 2 grams per day because sodium causes fluid retention."
  • "As a general rule, I need to restrict my fluid intake to about 1,500 mL a day to reduce the risk of ascites and edema."
  • "I must restrict my protein intake at all times."
  • "When I do eat protein, I should get most of it from plants."
  • "My diet should be high in calories and include about 66 grams of fat."
  • "I need to supplement my diet with B-complex and vitamins A, D, and E."

Frage 18

Frage
Select appropriate interventions to enact for a patient with severe liver disease.
Antworten
  • Monitor I & O and weigh daily
  • Provide a diet with a sodium intake of 2,000-3,000 mg/day and enact fluid restrictions.
  • Control pain with morphine.
  • During each interaction, observe for asterixis and changes in speech.
  • Assess vital signs every hour or so if the patient has had bleeding esophageal varices.
  • Turn the patient once every 4 hours.
  • Use hot water and alcohol-free soap when bathing, then apply an emollient or lubricant to the skin after.
  • Provide small meals and between-meal snacks

Frage 19

Frage
What is the FIRST intervention to enact for a patient with active bleeding esophageal varices?
Antworten
  • Insert a central line
  • Administer blood and frozen plasma
  • Administer IV somatostatin
  • Perform a gastric lavage
  • Order an endotrachial tube for the patient

Frage 20

Frage
Which of the following is NOT a potential complication for patients receiving a transjugular intrahepatic portosystemic shunt (TIPS)?
Antworten
  • Stenosis of shunt
  • Occlusion of shunt
  • Hepatic encephalpathy
  • Reduction in long-term survival
  • Hypoalbuminemia
Zusammenfassung anzeigen Zusammenfassung ausblenden

ähnlicher Inhalt

Nervous System
4everlakena
Diabetes Mellitus
Kirsty Jayne Buckley
Renal System A&P
Kirsty Jayne Buckley
Oxygenation
Jessdwill
Clostridium Difficile
Kirsty Jayne Buckley
Definitions
katherinethelma
Clinical Governance
Kirsty Jayne Buckley
CMS Interpretive Guidelines for Complaint/Grievances
Lydia Elliott, Ed.D
NCLEX RN SAMPLE TEST
MrPRCA
NURS 310 EXAM 1 PRACTIC EXAM
harlacherha
Skin Integrity and Wound Care
cpeters