Test
Exemplar 12.3: Liver Disease
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Preguntas del test (20)
1You 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.- A"Alcoholic cirrhosis is indirectly related to the amount of alcohol consumed, the number of years of excessive alcohol consumption, and blood alcohol levels."
- B"Men will develop cirrhosis faster than women, but that doesn't mean you aren't at risk."
- C"Cirrhosis at any stage cannot be reversed."
- D"Malnutrition commonly accompanies alcoholic cirrhosis."
2Select the EARLY clinical manifestations of cirrhosis.
- ADull, aching pain in the upper right quadrant
- BDull, aching pain in the upper left quadrant.
- CWeight loss
- DWeakness
- EAnorexia
- FDiarrhea or constiparion
- GPortal systemic encephalopathy.
- HEsophageal varices
3Early 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.- Aupper right quadrant
- Bupper left quadrant
- Clower right quadrant
- Dlower left quadrant
- EPortal hypertension
- FAscites
- Gvarices
- Hascites
- Ianeurysms
- Jbreaks
- Kthrombocytopenia
- Lleukopenia
- Manemia
- Nclotting factors
- Oplatelets
- Pspleen
- Qkidneys
- Rabdominal wall
- Sheart
- Tspleen
- Ukidneys
- Vlungs
- Wheart
- Xascites
- Yvarices
- Zspontaneous bacterial peritonitis
- AAspontaneous hyperthermia
- ABacute kidney failure
- ACammonia
- ADbilirubin
- AEportal systemic encephalopathy
- AFportal systemic neuropathy
- AGportal systemic peritonitis
- AHportal systemic meningitis
- AIasterixis
- AJParkinsonism
- AKTourette's
- ALaphasia
4Edema and ascites are manifestations of what issues caused by cirrhosis?
- AHypoalbuminemia
- BDisrupted hormone balance and fluid retention
- CIncreased pressure in portal venous system
- DDecreased clotting factor synthesis
- EImpaired vitamin K absorption
5Decreased clotting factor synthesis, increased platelet destruction by enlarged spleen, and impaired vitamin K absorption and storage cause what clinical manifestations of liver disease?
- ABleeding and bruising
- BEdema
- CAscites
- DEsophageal varices
6What are esophageal varices caused by?
- APortal hypertension causing collateral vessel development
- BImpaired vitamin K absorption and storage
- CThrombocytopenia
- DDecreased clotting factor synthesis
7Gastritis, anorexia, and diarrhea are caused by what?
- AEngorged veins in the gastrointestinal system
- BAlcohol ingestion
- CImpaired bile synthesis and fat absorption
- DImpaired bilirubin metabolism and secretion
- EAscites
8Jaundice is caused by impaired bilirubin metabolism and excretion
- AVerdadero
- BFalso
9Malnutrition and muscle wasting are caused by impaired nutrient metabolism, impaired fat absorption, and impaired hormone metabolism.
- AVerdadero
- BFalso
10Select the clinical manifestations of accumulated metabolic toxins and impaired ammonia metabolism and secretion.
- AAsterixis
- BEncephalopathy
- CJaundice
- DGastritis
- EHepatorenal syndrome
11Match 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.- AEsophagoscopy
- BColonoscopy
- CBilirubin
- DCalcium
- ELiver function studies
- FLiver biopsy
- GSerum electrolytes
- HSerum albumin
- ISerum bilirubin
- JSerum ammonia
- KSerum urea
- LCBC w/platelets
- MCoagulation studies
- NaPTT
- OINR
- PSerum glucose and cholesterol
- QSerum glucose and calcium
- RSerum cholesterol and albumin
- SAbdominal ultrasound:
- TPalpation
- UPercussion
12Which of the following medications might you give to a patient experiencing edema and ascites from hypoalbuminemia, hyperaldosteronism, and/or portal hypertension?
- ASipronolactone (Aldactone)
- BLactulose
- CNeomycin sulfate
- DOxazepam
13What two medications are commonly prescribed to treat the accumulation of metabolic toxins due to impaired ammonia metabolism and excretion?
- ALactulose
- BNeomycin sulfate
- CSpironolactone (Aldactone)
- DNadolol (Corgard)
- EFerrous sulfate
14What medication combination would you give to a patient with portal hypertension that is causing esophageal varices?
- ANadolol (Corgard) and isosorbide mononitrate (Ismo).
- BFerrous sulfate and folic acid
- CFerrous sulfate and vitamin K
- DFurosemide (Lasix) and spironolactone (Aldactone)
15What 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?
- AFerrous sulfate
- BFolic acid
- CVitamin K
- DOxazepam (Serax)
- ELactulose
16Diazepam (Valium) is the one benzodiazepine that is not metabolized by the liver, and is therefore safe to treat acute agitation.
- AVerdadero
- BFalso
17You 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?
- A"I need to restrict my sodium to less than 2 grams per day because sodium causes fluid retention."
- B"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."
- C"I must restrict my protein intake at all times."
- D"When I do eat protein, I should get most of it from plants."
- E"My diet should be high in calories and include about 66 grams of fat."
- F"I need to supplement my diet with B-complex and vitamins A, D, and E."
18Select appropriate interventions to enact for a patient with severe liver disease.
- AMonitor I & O and weigh daily
- BProvide a diet with a sodium intake of 2,000-3,000 mg/day and enact fluid restrictions.
- CControl pain with morphine.
- DDuring each interaction, observe for asterixis and changes in speech.
- EAssess vital signs every hour or so if the patient has had bleeding esophageal varices.
- FTurn the patient once every 4 hours.
- GUse hot water and alcohol-free soap when bathing, then apply an emollient or lubricant to the skin after.
- HProvide small meals and between-meal snacks
19What is the FIRST intervention to enact for a patient with active bleeding esophageal varices?
- AInsert a central line
- BAdminister blood and frozen plasma
- CAdminister IV somatostatin
- DPerform a gastric lavage
- EOrder an endotrachial tube for the patient
20Which of the following is NOT a potential complication for patients receiving a transjugular intrahepatic portosystemic shunt (TIPS)?
- AStenosis of shunt
- BOcclusion of shunt
- CHepatic encephalpathy
- DReduction in long-term survival
- EHypoalbuminemia
Información
- Descripción
- NCLEX (Medical-Surgical) Nursing Test sobre Exemplar 12.3: Liver Disease, creado por Olivia McRitchie el 10/12/2018.
- Autor
- Olivia McRitchie
- Idioma
- English
- Visitas
- 57
- Etiquetas
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