Olivia McRitchie
Quiz by , created more than 1 year ago

NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 12.3: Liver Disease, created by Olivia McRitchie on 10/12/2018.

30
0
0
Olivia McRitchie
Created by Olivia McRitchie over 5 years ago
Close

Exemplar 12.3: Liver Disease

Question 1 of 20

1

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.

Select one of the following:

  • "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."

Explanation

Question 2 of 20

1

Select the EARLY clinical manifestations of cirrhosis.

Select one or more of the following:

  • 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

Explanation

Question 3 of 20

1

Select from the dropdown lists to complete the text.

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 ( upper right quadrant, upper left quadrant, lower right quadrant, lower left quadrant ) 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.

( Portal hypertension, Ascites ) 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 ( varices, ascites, aneurysms, breaks ). These vessels can rupture and cause massive hemorrhaging, especially if the liver damage causes ( thrombocytopenia, leukopenia, anemia ) and impaired production of ( clotting factors, platelets ).

In addition to being shunted to the esophagus, blood can be shunted to the ( spleen, kidneys, abdominal wall, heart ), causing it to enlarge. Enlargement of the ( spleen, kidneys, lungs, heart ) can lead to anemia, leukopenia, and thombocytopenia due to increased destruction of blood cells.

Because portal hypertension increases hydrostatic pressure, it can also cause ( ascites, varices ), which is the accumulation of plasma-rich fluid in the abdominal cavity. In relation to this is the ability to develop ( spontaneous bacterial peritonitis, spontaneous hyperthermia, acute kidney failure ).

Cirrhosis can even cause psychological manifestations. Without functioning liver tissue, ( ammonia, bilirubin ) is not converted to uera, causing it to build up in the blood and cause ( portal systemic encephalopathy, portal systemic neuropathy, portal systemic peritonitis, portal systemic meningitis ). The primary manifestation of this is ( asterixis, Parkinsonism, Tourette's, aphasia ), which is a muscle tremor that interferes with the ability to maintain a fixed position of the extremities.

Explanation

Question 4 of 20

1

Edema and ascites are manifestations of what issues caused by cirrhosis?

Select one or more of the following:

  • Hypoalbuminemia

  • Disrupted hormone balance and fluid retention

  • Increased pressure in portal venous system

  • Decreased clotting factor synthesis

  • Impaired vitamin K absorption

Explanation

Question 5 of 20

1

Decreased clotting factor synthesis, increased platelet destruction by enlarged spleen, and impaired vitamin K absorption and storage cause what clinical manifestations of liver disease?

Select one of the following:

  • Bleeding and bruising

  • Edema

  • Ascites

  • Esophageal varices

Explanation

Question 6 of 20

1

What are esophageal varices caused by?

Select one of the following:

  • Portal hypertension causing collateral vessel development

  • Impaired vitamin K absorption and storage

  • Thrombocytopenia

  • Decreased clotting factor synthesis

Explanation

Question 7 of 20

1

Gastritis, anorexia, and diarrhea are caused by what?

Select one or more of the following:

  • Engorged veins in the gastrointestinal system

  • Alcohol ingestion

  • Impaired bile synthesis and fat absorption

  • Impaired bilirubin metabolism and secretion

  • Ascites

Explanation

Question 8 of 20

1

Jaundice is caused by impaired bilirubin metabolism and excretion

Select one of the following:

  • True
  • False

Explanation

Question 9 of 20

1

Malnutrition and muscle wasting are caused by impaired nutrient metabolism, impaired fat absorption, and impaired hormone metabolism.

Select one of the following:

  • True
  • False

Explanation

Question 10 of 20

1

Select the clinical manifestations of accumulated metabolic toxins and impaired ammonia metabolism and secretion.

Select one or more of the following:

  • Asterixis

  • Encephalopathy

  • Jaundice

  • Gastritis

  • Hepatorenal syndrome

Explanation

Question 11 of 20

1

Match each diagnostic test with its description.

: Used to determine the presence of upper esophageal varices.

: Both conjugated and unconjugated versions of this are elevated with severe cirrhosis.

: 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.

: May be done to distinguish cirrhosis from other forms of liver disease. May be deferred if bleeding is prolonged.

: Hyponatremia is common, resulting in hemodilution. Hypokalemia, hypophosphatemia, and hypomagnesemia are also frequently seen, r/t malnutrition and altered renal excretion.

: This value decreases due to impaired liver production of the protein.

: This value elevates because the liver cannot convert ammonia into urea.

: 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.

: Prolonged prothrombin time results from impaired production of coagulation proteins and lack of vitamin K.

: These 2 values are frequently abnormal in patients with cirrhosis.

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.

Drag and drop to complete the text.

    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

Explanation

Question 12 of 20

1

Which of the following medications might you give to a patient experiencing edema and ascites from hypoalbuminemia, hyperaldosteronism, and/or portal hypertension?

Select one of the following:

  • Sipronolactone (Aldactone)

  • Lactulose

  • Neomycin sulfate

  • Oxazepam

Explanation

Question 13 of 20

1

What two medications are commonly prescribed to treat the accumulation of metabolic toxins due to impaired ammonia metabolism and excretion?

Select one or more of the following:

  • Lactulose

  • Neomycin sulfate

  • Spironolactone (Aldactone)

  • Nadolol (Corgard)

  • Ferrous sulfate

Explanation

Question 14 of 20

1

What medication combination would you give to a patient with portal hypertension that is causing esophageal varices?

Select one of the following:

  • Nadolol (Corgard) and isosorbide mononitrate (Ismo).

  • Ferrous sulfate and folic acid

  • Ferrous sulfate and vitamin K

  • Furosemide (Lasix) and spironolactone (Aldactone)

Explanation

Question 15 of 20

1

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?

Select one or more of the following:

  • Ferrous sulfate

  • Folic acid

  • Vitamin K

  • Oxazepam (Serax)

  • Lactulose

Explanation

Question 16 of 20

1

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

Select one of the following:

  • True
  • False

Explanation

Question 17 of 20

1

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?

Select one of the following:

  • "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."

Explanation

Question 18 of 20

1

Select appropriate interventions to enact for a patient with severe liver disease.

Select one or more of the following:

  • 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

Explanation

Question 19 of 20

1

What is the FIRST intervention to enact for a patient with active bleeding esophageal varices?

Select one of the following:

  • Insert a central line

  • Administer blood and frozen plasma

  • Administer IV somatostatin

  • Perform a gastric lavage

  • Order an endotrachial tube for the patient

Explanation

Question 20 of 20

1

Which of the following is NOT a potential complication for patients receiving a transjugular intrahepatic portosystemic shunt (TIPS)?

Select one of the following:

  • Stenosis of shunt

  • Occlusion of shunt

  • Hepatic encephalpathy

  • Reduction in long-term survival

  • Hypoalbuminemia

Explanation

Previous
Check answer
Next