0A Ex2 Class27&28 Hepatic Fall07 Nursing

Front 1

The various functions of the liver are caried out by?

Back 1

hepatocytes

Front 2

The liver produces & excretes?

Back 2

bile

Front 3

The liver produces and excretes bile (a greenish liquid) required for?

Back 3

emulsifying fats

Front 4

Some of the bile drains directly into the?

Back 4

duodenum, and some is stored in the gallbladder

Front 5

The liver also performs several roles in _____ & _______metabolism.

Back 5

lipids & carbohydrates

Front 6

The liver also performs several roles in lipid metabolism. Name them.

Back 6

1- Cholesterol synthesis

2- The production of triglycerides (fats)

Front 7

The liver performs several roles in carbohydrate metabolism. Name 3.

Back 7

1- Gluconeogenesis (the synthesis of glucose from certain amino acids, lactate or glycerol)

2- Glycogenolysis (the breakdown of glycogen into glucose) (muscle tissues can also do this)
3- Glycogenesis (the formation of glycogen from glucose)

Front 8

The synthesis of glucose from certain amino acids, lactate or glycerol?

Back 8

Gluconeogenesis

Front 9

The breakdown of glycogen into glucose) (muscle tissues can also do this?

Back 9

Glycogenolysis:

The breakdown of glycogen into glucose. (muscle tissues can also do this)

Front 10

The formation of glycogen from glucose?

a) Gluconeogenesis

b) Glycogenesis

c) Glycogenolysis

Back 10

Glycogenesis

The formation of glycogen from glucose

Front 11

The liver performs several roles in carbohydrate metabolism which include
Gluconeogenesis, Gycogenolysis, & Glycogenesis in addition to the breakdown of ______ & other _____.

Back 11

insulin & other hormones

Front 12

The liver is responsible for the mainstay of _____ metabolism.

Back 12

protein

Front 13

The liver produces what coagulation factors?

Back 13

I (fibrinogen), II (prothrombin), V, VII, IX, X and XI, as well as protein C, protein S and antithrombin.

Front 14

Creates metabolites that are added to bile as pigment (bilirubin and biliverdin).

Back 14

haemoglobin

broken down by the liver

Front 15

This sometimes results in toxication, when the metabolite is more toxic than its precursor

Back 15

drug metabolism

The liver breaks down toxic substances and most medicinal products in a process called drug metabolism. This sometimes results in toxication, when the metabolite is more toxic than its precursor

Front 16

The liver converts ammonia to ____?

Back 16

urea

Front 17

The liver stores glucose in the form of glycogen, ____, ____, and copper.

Back 17

vitamin B12

iron

Front 18

In the first trimester fetus, the main site of red blood cell production is?

Back 18

liver

Front 19

The liver is responsible for ______ effects.

Back 19

immunological

Front 20

The liver is responsible for immunological effects. The reticuloendothelial system of the liver contains many immunologically active cells, acting as a 'sieve' for ____ carried to it via the portal system.

Back 20

antigens

Front 21

Patients with liver dysfunction may exhibit . . .

Name 6.

Back 21

1- Altered lipid & protein digestion

2- Altered Detoxification of blood

3- Altered Drug Metabolism

4- Altered Digestion as a whole (remember the bile)
= altered vitamin synthesis

5- Lack of energy (remember glycogen)

6- Irritation of other organs (think gallbladder/pancreas/brain)

Front 22

Disorders of the liver.

NAME 6.

Back 22

1- Viral Hepatitis (A,B,C,D,E,G)

2- Hepatitis 2nd to toxins (drugs, chemicals, alcohol

3- Autoimmune Hepatitis

4- Bacterial Hepatitis (steptococci, Ecoli, salmonella)

5- Jaundice Conditions

6- Cirrhosis Conditions

Front 23

Complications from disorders of the liver.
Name 6.

Back 23

1- Esophageal Varices

2- Portal Hypertension

3- Edema

4- Ascites

5- Encephalopathy

6- Hepatorenal syndrome

Front 24

The primary manifestation from disorders of the liver is/are? jaundice

Back 24

jaundice

Front 25

Jaundice results from an alteration in normal _____ _____ or flow of bile into heptic or biliary duct systems.

Back 25

bilirubin metabolism

Front 26

Juandice is a symptom rather than disease.

true/false?

Back 26

true

Front 27

Bilirubin is formed by?

Back 27

the breakdown of hemoglobin

Front 28

Due to increased RBC breakdown 2nd to blood transfusion reaction, sickle cell crisis, hemolytic anemia?

Back 28

Hemolytic jaundice

Front 29

Altered ability of the liver to take up bilirubin or conjugate or excrete it. Causes include hepatitis, cirrhosis and carcinoma.

Back 29

Hepaticellular hepatitis

Front 30

Impeded or obstructed flow of bile, caused by stone obstructions, pancreas carcinomas, stool and urine changes noted with complete obstruction.

Back 30

Obstructive jaundice

Front 31

Hemolytic jaundice is due to _____ RBC breakdown 2nd to blood transfusion reaction, sickle cell crisis, hemolytic anemia.

Back 31

increased

Front 32

Hepaticellular hepatitis is the altered ability of the liver to take up bilirubin or conjugate or excrete it. Causes include _____, cirrhosis and carcinoma.

Back 32

hepatitis

Front 33

Obstructive jaundice is from impeded or obstructed flow of ____, caused by stone obstructions, pancreas carcinomas, stool and urine changes noted with complete obstruction.

Back 33

bile

Front 34

The only way to distinguish between what type of viral hepatitis is through ____ specific labs (table 42-4)

Back 34

antigen

Front 35

Infection by each type of hepatitis virus provides immunity to that virus only.

True/False

Back 35

True

Front 36

Vaccinations are available for Hep B but not Hep A.

True/False

Back 36

False

Vaccinations are available for both Hep A & B

Front 37

Available for Hep A exposure.

Back 37

Immunoglobulin

Front 38

Hepatic tenderness, hepatomegaly and splenomegaly may be revealed by?

Back 38

Physical exam

Front 39

Fecal-Oral hepatitis:

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
f) Hep G

Back 39

a) Hep A

Front 40

Infection only with Hep B/Same routes:

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
f) Hep G

Back 40

d) Hep D

Front 41

Parental/Per-mucosal/Sexual/Perinatal

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
f) Hep G

Back 41

b) Hep B
and . . .
Hep C

Front 42

Fecal – Oral/contaminated water

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
f) Hep G

Back 42

e) Hep E

Front 43

Parental/Sexual

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E
f) Hep G

Back 43

f) Hep G

Front 44

Hep A, B, C, D, E, & G all have similar pathophysiologic effects which are widespread _____ of liver tissue

Back 44

inflammation

Front 45

Acute damage from hepatitis causes cell _____ & ____

Back 45

necrosis & cholestasis

Front 46

Systemic damage from hepatitis includes angioedema, arthritis, fever and malaise, ____ & ____ damage

Back 46

kidney and vascular

Front 47

Damage from hepatitis occurs in _____ phases.

Back 47

Three

Front 48

Name the 3 phases of damge caused by hepatitis.

Back 48

1- Preicteric/prodromal phase

2- Icteric phase

3- Posticteric/convalescent phase

Front 49

Complications from hepatitis are are most recover completely unless comorbidities exist. 10% of HBV will have ____ ____chronic infection & 75% of HCV

Back 49

chronic infection

Front 50

A syndrome with severe impairment or necrosis with potential liver failure

Back 50

Fulminant

Front 51

Precedes jaundice & lasts from 1-21 days.

Back 51

preicteric phase of viral hepatitis

Front 52

Period of maximal infectivity for Hep A.

Back 52

preiteric phase

Front 53

Hep B positive & hep c patients can be infective for?

Back 53

years

Front 54

GI symptoms in patients w/hepatitis include anorexia, nausea, abdominal discomfort (r-upper quadrant) & sometimes vomiting, constipation, or diarrhea. The anorexia is often severe & may be due to _____ or other chemicals produced by the infectied liver.

Back 54

cytokines

Front 55

Phase of hepatitis characterized by jaundice.

Back 55

icteric phase

Front 56

The icteric phase of hepatitis is characterized by jaundice which generally last from ____ weeks.

Back 56

2-4

Front 57

Phase of hepatitis in which the urine may darken because of excess bilirubin excreted by the kidneys.

Back 57

icteric phase

Front 58

During the icteric phase of hepatitis, the urine may darken because of excess bilirubin excreted by the kidneys & if conjugated bilirubin cannot flow out of the liver because of an abstruction or inflammation of the bile ducts the stools will be?

Back 58

light or clay colored

Front 59

Pruritus sometimes accompanies jaundice especialaly if ____ is present.

Back 59

cholestasis

Front 60

Pruritus with jaundice occurs as a result of?

Back 60

accumulation of bile salts beneath the skin

Front 61

When jaundice occurs the fever usually rises.

true/false

Back 61

false

once jaundice appears the fever usually subsides.

Gi symptoms generally remain & fatigue continues. Liver is usually enlarged & tender.

Front 62

The posticteric phase of of hepatitis begins when?

Back 62

jaundice is disappearing

Front 63

How long will the posticteric phase last?

Back 63

weeks to months with an average of 2-4 months

Front 64

The patients jaundice has begun to disappear & the major complaint is malaise & easy fatigability. What phase is this?

Back 64

posticteric phase

Front 65

Phase when splenomegally subsides but hepatomegaly remains for several weeks.

Back 65

posticteric phase

Front 66

The disappearance of jaundice indicates that the patient is totally recovered.

true/false

Back 66

false


does not mean patient has yet fully recovered & relapses may occur

Front 67

All patients with viral hepatitis experience jaundice.

true/false

Back 67

false

Front 68

Anicteric hepatitis means?

Back 68

hepatitis infection without occurance of jaundice & common in Hep A

Front 69

You are caring for a patient who is in the preicteric phase of acute viral hepatitis. Your patient asks “am I going to turn yellow”? Which response is most appropriate?
“As your liver copes with the viral infection it can’t get rid of bilirubin which may cause your skin, urine or stool to turn yellow”
“Jaundice is scary, everything gets yellow”
“No, very few people turn yellow”

Back 69

I am in question about this hypothetical presented.

The first response listed by instructor is a true response & "may" indeed cause skin to turn yellow.

However, the book states that "a high % of persons" w/HAV are anicteric & w/out symptoms in addition to stating 30% of all patients w/acute HBV & 80% with acute HCV are asymptomatic.

Front 70

Hepatitis from an unknown cause which often includes systemic problems, s/s mimic viral hepatitis, elevated LFT without + viral lab & of which 70-80% of cases are female.

Back 70

Autoimmune (Idiopathic) Hepatitis

Front 71

Autoimmune (Idiopathic) Hepatitis is more common in men or women?

Back 71

70-80% of cases are female

Front 72

Autoimmune (Idiopathic) Hepatitis is of an unknown cause & often includes systemic problems. S/S mimic viral hepatitis, elevated LFT without + viral lab. This form of hepatitis is TX with?

Back 72

corticosteroids and immunosuppressants

Front 73

Unlike viral hepatitis, with Autoimmune (Idiopathic) Hepatitis there is evidence of ____ & ____.

Back 73

cirrhosis and tissue necrosis

Front 74

RX for Autoimmune (Idiopathic) Hepatitis is corticosteroids and immunosuppressant meds. Daily TX is with methylprednisone alone or in combination with ______ which will induce remission in apx 80% of patients.

Back 74

azathioprine (Imuran)

Front 75

RX for Autoimmune (Idiopathic) Hepatitis is corticosteroids and immunosuppressant meds. Daily TX with methylprednisone alone or in combination with Imuran which will induce remission in apx 80% of patients. If these RX & other immunosuppresive therapies do not work?

Back 75

Liver transplant may be indicated for liver failure

Front 76

Associated Lab Tests including the liver profile
almost are all abnormally ______due to destruction of hepatocytes and loss of all liver enzymes into the systemic circulation.

a) decreased
b) elevated

Back 76

b) elevated

Front 77

Peripheral edema sometimes precedes ascites but in some patients its development coincides with or occurs after ascites. Edema results from ____ colloidal oncotic pressure from impaired liver synthesis of albumin & increased portocaval pressure from portal hypertension.


a) decreased
b) increased

Back 77

a) decreased

Front 78

The accumulation of serous fluid in the peritoneal or abdominal cavity.

Back 78

Ascites

Front 79

A diagnostic procedure that can pick up on levels of protein/infection.

Back 79

paracentesis

Front 80

A therapeutic procedure that relieves pressure to aide breathing/comfort caused from ascites.

Back 80

paracentesis

Front 81

A chronic progressive disease of the liver with extensive destruction of parenchymal cells.

Back 81

Cirrhosis of the Liver

Front 82

In cirrhosis, cells attempt to regenerate but are disorganized and abnormal cell regeneration damages ___ ___ and bile ducts

Back 82

blood vessels

Front 83

Cirrhosis is a chronic progressive disease of the liver with extensive destruction of _____ _____

Back 83

parenchymal cells

Front 84

Cirrhosis equally affects men & women.

true/false

Back 84

false

2X more common in men

Front 85

There are 4 types of cirrhosis.

Name them.

Back 85

1 - Alcoholic
2- Post necrotic
3- Biliary cirrhosis
4- Cardiac

Front 86

A type of cirrhosis which is a complication of viral, toxic, or idiopathic hepatitis from which broad bands of scar tissue form.

Back 86

Post necrotic cirrhosis of the of the liver

Front 87

A type of cirrhosis that is associated with biliary obstruction and infection causing diffuse liver fibrosis and jaundice.

Back 87

Biliary cirrhosis

Front 88

Cardiac cirrhosis is caused from long standing ___ heart failure that causes congestion & scarring.

Back 88

right

Front 89

There are 4 major complications of cirrhosis which include
portal hypertension & esophageal varices, Peripheral edema & ascites, hepatic encephelopathy, & ____.

Back 89

Hepatorenal syndrome

Front 90

Incfreased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, systemic hypertension & esophageal varices are charateristic of?

Back 90

portal hypertension

Front 91

Portal hypertension is caused by compression & destruction of the ____ & sinusoids due to structural changes in the liver from the cirrhotic process. These changes result in the obstruction of blood flow through the ____ ____.

Back 91

portal veins

portal system

Front 92

Portal hypertension results in ____ ____ in an attempt to reduce high portal pressure & reduce increased plasma volume & lymphatic flow.

Back 92

collateral circulation

Front 93

In portal hypertension, common sites for collateral circulation are?

Back 93

lower esophagus

(left gastric vein & azygos veins)

Front 94

Variscosities resulting from collateral circulation due to portal hypertension develop in the lower esophagus, the anteior abdominal wall, the parietal peritoneum and the rectum. Variscosities may develop in areas where the collateral & systemic circulations communicate resulting in esophageal & gastric varices and ____.

Back 94

hemmorhoids

Front 95

Esophageal varices are a complex of tortuous veins at the lower end of the esophagus which become _____ & ____ as a result of portal hypertension.

Back 95

emlarged & swollen

Front 96

The most life threatening complication of cirrhosis is?

Back 96

bleeding esophageal varices

Front 97

Approximately 30-50% of patients w/bleeding esophageal varices die within?

Back 97

6 weeks of their 1st esophageal bleed

Front 98

Varices that develop as a result of collateral circulation due to portal hypertension, are fragile & do not tolerate high pressure causing distention, ruptures thus bleeding. Ruptures & bleeds occur in response to ulcerations & irritation usually caused from numerous factors. Name some of these factors.

Back 98

1- ingesting alcohol

2- not chewing food wll
course foods

3- acid reguritation from stomach

4- increased abd pressure
caused by:

a-nausea
b-vomiting
c-straining at stool
d-coughing
e-sneezing
f-heavy lifting

Front 99

A medical emergency as a result of esophageal carices is:

Back 99

massive hemmorrhage

Front 100

Thi scondition results from decreased colloidal oncotic pressure from impaired liver synthesis of albumin & increased portocaval pressure from portal hypertension.

Back 100

edema

Front 101

Edema as a result of portal hypertension occurs as ankle & ____ edema.

Back 101

presacral

Front 102

The accumulation of serous fluid in the peritoneal or abdominal cavity which is a common manifestation of cirrhosis.

Back 102

ascites

Front 103

Ascites occurs when blood pressure is elevated in the liver causing ____ to move from the blood vessels via the larger pores of the sinusoids into the ____ space.

Back 103

proteins

lymph

Front 104

Occurs when the lymphatic system is unable to carry off the excess proteins & water & begin to leak through the liver capsule into the peritoneal cavity, thus osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity.

Back 104

ascites

Front 105

A second mechanism of ascites formation is hypoalbuminemia that results from the inability of the liver to synthezize _____.

Back 105

albumin

Front 106

Secondary to ascites, this condition results from the inability of the liver to synthezize albumin.

Back 106

hypoalbuminemia

Front 107

Hypoalbuminemia, secondary to ascites results from the inability of the liver to synthesize albumin which causes _____colloidal oncotic pressure.

Back 107

decreased

Front 108

A 3rd mechanism of ascites is hyperaldosteronism. Hyperaldosteronism occurs when aldosterone is not metabolized by damaged hepatocytes causing increased levels of ____ which in turn increases ____ reabsorption by the renal tubules.

Back 108

aldosterone

sodium

Front 109

A 3rd mechanism of ascites is hyperaldosteronism which occurs when aldosterone is not metabolized by damaged hepatocytes causing increased levels of aldosterone which in turn increases sodium reabsorption by the renal tubules. This retention of sodium & increase on antidiuretic hormone causes?

Back 109

additional water retention in patients with ascites

Front 110

Due to edema formation as a result of hyperaldosteronism, there is decreased intravascular volume & subsequently decreased ____ ____ ____ & glomerular filtration.

Back 110

renal blood flow

Front 111

Decreased colloidal pressure from impaired liver synthesis of albumin and increased pressure secondary to portal HTN is?

Back 111

Peripheral Edema

Front 112

Secondary to or in addition to Peripheral Edema may be the development of ____?

Back 112

Ascites

Front 113

Accumulation of serous fluid in the peritoneal or abdominal cavity is?

Back 113

Ascites

Front 114

Manifestations of ascites are weight gain, & if severe, the umbilicus may be inverted, & abdominal striae with distended abd wall veins can be observed. What are some other manifestations?
Can you name 3?

Back 114

1- dehydration

2- dry tongue, dry skin, sunken eyeballs, & muscle weakness

3- decreased urinary output

4- hypokalemia due to excessive loss of K+ because of affects of aldsterone & also resultant from diuretic therapy used to treat ascites

Front 115

With ascites, this e;ectolyte imbalance is likely to occur?

Back 115

hypokalemia

Front 116

Hypokalemia in association with ascites is common & due to an excessive loss of K+ because of the affects of ____?

Back 116

aldosterone

Front 117

Hypokalemia can result in ascites because of the effects of aldosterone but can also occur due to?

Back 117

diuretic therapy used to TX the ascites

Front 118

Too much aldosterone, too much water in the wrong place, decreased renal vascular flow triggers excessive levels of ADH hormone causing what?

Back 118

More water retention!

Front 119

In association with ascites, ___ ___ can occur r/t vasoconstriction due to ?

Back 119

renal failure

decreased reanl blood flow & glomerular filtration

Front 120

A neuropsychiatric manifestation of liver damage that is a terminal complication.

Back 120

Hepatic Encephalopathy

COMA !!!

Front 121

The manifestation which is characteristic of hepatic encephalopathy is?

Back 121

A coma !!!

Front 122

Hepatic encephalopathy is a coma that can occur in any condition in which the liver damage causes ____ to enter the sytemic circulation without liver detoxification.

Back 122

amonia

Front 123

Hepatic Encephalopathy is a terminal complication that can occur in any condition where liver damage causes ammonia to enter the ____ ____ without liver detoxification. The ammonia comes from the ____ then routed through hepatic circulation where it is converted to urea in the kidneys & excreted.

Back 123

systemic circulation

intestines

Front 124

Hepatic Encephalopathy is a terminal complication that can occur in any condition where liver damage causes ammonia to enter the systemic circulation without liver detoxification. Normally, ammonia goes to the ___ via portal circulation. However, due to collateral circulation blood is shunted past the liver & the ammonia is not converted to ____ which is normally excrested by the kidneys but instead remains in the systemic circulation.

Back 124

liver

urea

Front 125

Ammonia doesn’t belong in the systemic circulation & values of ammonia greater than ___ causes neurological changes ranging from lethargy to ___

Back 125

30

coma

Front 126

In association with hepatic encephalopathy, ammonia crosses the ___ ___ ___ which produces neurotoxic manifestations.

Back 126

blood brain barrier

Front 127

A risk associated with the TX of reducing portal hypertension using surgical shunt precedures is?

Back 127

hepatic encephalopathy

Front 128

In the early stages of hepatic encephalopathy, manifestions are?

Back 128

euphoria & depression

apathy & irritability

memory loss & confusion

yawning & drowsiness

slow & slurred speech

emotional lability & impaired judgment

hiccups & slow deep respirations

hyperactive reflexes

POSITVE BABINSKI reflex

Front 129

With hepatic encephelopathy, disorientation to time, place, or person, & flapping tremors (asterixis)are?

Back 129

signs of impending coma

Front 130

Asterixis is?

Back 130

flapping tremors

most commonly rapid flexion & extension movements in hands & arms when stretched out; unable to hold hands & arms in position when stretched out

Front 131

Apraxia is?

Back 131

the inability to construct simple figures as with using a pen or pencil from left to right

Front 132

In addition to disorientation & asterixis, other signs of impending coma (hepatic encephalopathy) are?

Back 132

apraxia, hyperventilation, hypothermia, grimacing, & grasping reflexes.

Front 133

Term used to describe a musty, sweet, odor of the breath caused from an accumulation of digestive by products that the liver cannot degrade.

Back 133

fetor hepaticus

Front 134

Nmae 3 characteristics of hepatic encephelopathy.

Back 134

1- asterixis (flapping tremors)

2- apraxia (difficulty using pen from left to right)

3- fector hepaticus (musty, sweet breath odor)

Front 135

A serious complication of cirrhosis characterized by functional renal failure w/advancing azotemia, oliguria, & intractable ascites.

Back 135

Hapatorenal syndrome

Front 136

In cirrhosis there are abnormalities in most of the liver function studies.

enzyme levels are decreased or elevated?

Back 136

elevated

AST, ALT, SGOT, SGPT, GGT

Front 137

In cirrhosis there are abnormalities in most of the liver function studies of which enzyme levels are elevated in addition to increased ____ levels. Protein metabolism tests are _____.

Back 137

globulin

decreased

Front 138

Early manifestations of cirrhosis may include GI disturbances, anorexia, dypepsia, flatulence, N&V, & change in bowel habits. These symptoms occur as a result of?

Back 138

livers altered metabolism of carbs, fats, proteins

Front 139

Early manifestations of cirrhosis may include GI disturbances, anorexia, dypepsia, flatulence, N&V, & change in bowel habits as a result of result of livers altered metabolism of carbs, fats & proteins. The patient may also complain of?

Back 139

abd pain described as dull, heavy feeling in the R-upper quadrant or epigastrium

may be due to swelling & stretching of liver capsule, spasm of bilary ducts, or intermittant vascular spasm

Front 140

Early manifestations of cirrhosis may include GI disturbances, anorexia, dypepsia, flatulence, N&V, & change in bowel habits as a result of result of livers altered metabolism of carbs, fats & proteins. Patient may also complain of dull, heavy pain in the R-upper quadrant & other manifestations may include?

Back 140

fever, lassitude, slight weight loss, & enlargement of the liver & spleen

Front 141

Later manifestations of cirrhosis are?

Name 5.

Back 141

1-jaundice
2-skin lesions
3-hematologic problems
4-endocrine disturbances
5-peripheral neuropathy

Front 142

attributed to an increase in circulating estrogen as a result of the damaged liver's inability to metabolize steroid hormones:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 142

b) skin lesions

spider angioma's

Front 143

due to an accumulation of bile salts underneath the skin

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 143

a) jaundice

Front 144

Throbocytopenia, leukopenia, & anemia probably caused by splenomegaly in patients with cirrhosis:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 144

c) hematologic problems

Front 145

In patients with cirrhosis hemmorrhagic phenomina or bleeding tendencies such as epitaxis, purpura, petechiae, easy bruising, gingival belleding, & heavy menstrual bleeding are characteristics associated with:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 145

c) hematologic problems

Front 146

Signs & symptoms relating to the metabolism & inactivation of adrenocortical hormones such as estrogen, & testosterone in patients wth cirrhosis are associated with:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 146

d) endocrine disturbances

Front 147

In patients with cirrhosis, gymecomastia, loss of axillary & pubic hair, testicular atrophy, & impotence with a loss in libido occur as a result of:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 147

d) endocrine disturbances

Front 148

In patients with cirrhosis, gymecomastia, loss of axillary & pubic hair, testicular atrophy, & impotence with a loss in libido occur as a result of:

Back 148

estrogen accumulation

Front 149

With cirrhosis, amennorrhea may occur in younger women & in older women there may be?

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 149

vaginal bleeding

Front 150

In cirrhosis, the liver fails to metabolize ______ adequately resulting in hyperaldosteronism with subsequent sodium & water retention & ____ loss.

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 150

aldosterone

K+

Front 151

In cirrhosis, the liver fails to metabolize aldosterone adequately resulting in hyperaldosteronism with subsequent sodium & water retention & K+ loss whic is associated with later manifestations of ?


a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 151

d) endocrine disturbances

Front 152

A common finding in alcoholics with cirrhosis due to a dietary deficiency of thiamine, folic acid, & cobalamin which are associated with later manifestations associated with:

a) jaundice
b) skin lesions
c) hematologic problems
d) endocrine disturbances
e) peripheral neuropathy

Back 152

e) peripheral neuropathy

Front 153

A red area that blanches with pressure & located on the palms of the hands is termed ______ ______ & associated with an increase in circulating estrogen due to the inability of the damaged liver to metabolize ___ ___.

Back 153

Palmar erythema

steroid hormones

Front 154

Disorder of the liver most commonly caused by viral hepatitis secondary to drugs such as tylenol + ETOH, Isoniazid, sulfa drugs & NSAIDS).

Back 154

Fulminant Hepatic failure

Front 155

A clinical syndrome of which there is severe impairment associated with development of hepatic encephalopathy. Lab studies will reveal increased LFT, prolonged PT, increased bilirubin. This condition may require liver transplant.

Back 155

Fulminant Hepatic failure

Front 156

Primary Liver Cancer originates in the liver, is rare & most common in?

Back 156

males

Front 157

In Fulminant Hepatic failure, hepatic encephelopathy usually occurs with the 1st ___ of the 1st symptoms.

Back 157

8 weeks

Front 158

The most common cause of Fulminant Hepatic failure is?

Back 158

viral hepatitis

in particular with HBV

may also manifest with HAV

less frequent in HCV

Front 159

With viral hepatitis being the most common cause of Fulminant Hepatic failure, the second leading cause is?

Back 159

drugs

Front 160

In considering the second most common cause of Fulminant Hepatic failure, the most common offending agent is?

Back 160

acetaminophen in combination w/alcohol

Front 161

Though the combination of acetaminophen in combination w/alcohol is the most common offending agent in causing Fulminant Hepatic failure other drugs would include?

Back 161

isonizid, fluothane, sulfa containing drugs & NSAIDS

Front 162

Symptoms of Fulminant Hepatic failure are?

Back 162

jaundice & S/S of hepatic encephalopathy

Front 163

TX for Fulminant Hepatic failure may be?

Back 163

liver transplantation

Front 164

Approxinmately 20% of these patients will develop cirrhosis?

Back 164

Chronic Hep C

Front 165

Approxinmately 10-20% of these patients will develop cirrhosis?

Back 165

Chronic Hep B

Front 166

ALthought there is no specific therapy for cirrhosis, certain measures can be taken to promote liver cell regeneration & prevent complications. A significant measure is?

Back 166

rest

reduces metabolic demands of the liver & allows for recovery of liver cells.

Front 167

At various times during the progress of cirrhosis, rest may have to take on the form of complete bed rest.

true/false

Back 167

true

Front 168

Management of ascites is focused on what 3 things?

Back 168

1- sodium restriction
2- diuretics
3- fluid removal

Front 169

Restriction of sodium in TX of patients w/ascites can result in?

Back 169

reduced nutritional intake & subsequent problems associated with malnutrition

Front 170

In patients undergoing TX for ascites, the patient is not on restricted fluids unless severe ascites develops. Accurate assessment of ____ & ____ balance is necessary.

Back 170

fluid & electrolyte

Front 171

In patients with ascites, this is a potassium sparing & effective diuretic even in patients with severe sodium retention.

Back 171

aldactone

(antagonist of aldosterone)

Front 172

In patients with ascites, this is a high-potency loop diuretic that is fequently used in combination with a potassium sparing drug.

Back 172

Lasix

Front 173

A needle puncture of the abdominal cavity that nmay be performed to remove ascitic fluid.

Back 173

paracentesis

Front 174

Paracentesis is a TX for ascites that is reserved for the patient with ____ ____ or abdominal pain caused by severe ascites.

Back 174

impaired respirations

Front 175

A surgical procedure that provides continuous reinfusion of ascitic fluid into the venous system.

Back 175

Paeritonovenous shunt

Front 176

The main goal of patients with esophageal varices is?

Back 176

avoidance of bleeding & hemmorrhage

Front 177

The patient w/esophageal varices should avoid what 3 things?

Back 177

alcohol
aspirin
irritating foods

Front 178

When variceal bleeding occurs, the 1st step is to?

Back 178

stabilize the patient & manage the airway

IV therapy is initiated & may involve administration of blood products

Front 179

DX of esophageal varices is made by?

Back 179

endoscopic examination ASAP

Front 180

The goal of TX for hepatic encephalopathy is?

Back 180

reduction of ammonia formation

protien reduction

Front 181

The diet for patients with cirrhosis without complications is?

Back 181

high calories (3000kcal/day)

high carb, low fat & prorein determined by degree of liver damage

Front 182

Diets for patients w/hepatic encephalopathy are low in ?

Back 182

protein to NO protein

Front 183

The common etiologies for cirrhosis are alcohol, malnutrition, hepatitis, biliary obstruction & ___ ___ ___ ___.

Back 183

R-sided heart failure

Front 184

Acute hepatitis must be identified & TX early so that it does not progress to?

Back 184

chronic hepatitis

Front 185

Biliary disease must be TX early so that the stones do not cause ___ & ___.

Back 185

obstruction & infection

Front 186

The focus of NRSG care for patients w/cirrhosis is on?

Back 186

conserving the patients strength; promoting rest

Front 187

The focus on patients w/cirrhosis who are on complete bed rest are what 3 things?

Back 187

1- measures to prevent pneumonia

2- prevent thromboembolic problems

3- prevent pressure ulcers

Front 188

Anorexia, N&V, pressure from ascites & poor eating habits all create problems in maintaining adequate nutrition. NRSG measures would include?

Back 188

1- oral hygiene

2- between meal nourishments

3- provide food preferences when possible

4- explain any necessary dietary restrictions to pt & family

Front 189

NRSG assessment of pts w/ cirrhosis include pt's physiologic response to cirrhosis which include: is jaundice present?; where is it observed?; what is the progression. What observations will you be making?

Back 189

1-presence of pruritus
2- relieve itching (Questran)
3- color of urine
4-color of stools
5- is urine foamy?
6-presence of edema or ascites
7- intake & output
8-daily weights
9-measurements of extremities
10-measurements of abd girth

Front 190

When pts have paracentesis done tghe NRS should have the patient ___ ___ before the procedure to revent puncture of the _____.

Back 190

void immediately

bladder

Front 191

The proper position for a patient undergoing paracentesis is sitting on the side of the bed or in ____ ___.

Back 191

high Fowler's

Front 192

After a pt has paracentesis done, the NRS should do what 3 things?

Back 192

1- monitor for hypovolemia

2- monitor electrolyte imbalances

3- check the dressing for bleeding & leakage

Front 193

A common problem for patients with ascites is___ & should be placed in what position?

Back 193

dyspnea

semi-Fowlers or Fowlers position to allow for maximal respiratory efficiency

Front 194

In caring for patients with ascites, meticulous skin vcare is essential because of?

Back 194

edematous tissue is subject to breakdown

air mattress, turning schedule, pillows, ,ROM, TCDB, elevation of lower extremities

Front 195

In caring for patients with ascites & the patient is taking diuretics, what serum levels should be monitored?

Back 195

K+, CL-, & Bicarbonate

Front 196

In patients with ascites & taking diuretics the patient should be observed for fluid & electrolyte imbalance especially?

Back 196

K+

Front 197

Hypokalemia is manifested by what 4 signs?

Back 197

1-cardiac arrhythmias
2- hypotension
3- tachycardia
4-generalized muscle weakness

Front 198

Excess water retention is manifested by 4 signs?

Back 198

1-muscle cramping
2-weakness
3-lethargy
4-confusion

Front 199

If a patient has esophageal varices in addition to cirrhosis the nurse must observe for any signs of?

Back 199

any signs of bleeding

hematemesis & melena

Front 200

If hematemesis occurs the nurse should assess the patient for _____, call the physician, & be ready to assist with whatever TX is used to control the bleeding.

Back 200

hemmorrhage

Front 201

If hematemesis occurs, the nurse will assess the patient for hemmorrhage, call the physician, & ready to assist with whatever TX is used to control the bleeding. The NRS will anticipate what 2 things will happen next?

Back 201

1- patient will be admitted to ICU

2-patients airway must be maintained

Front 202

The focus of nursing care of patients w/ hepatic encephalopathy is?

Back 202

sustaining life & assisting w/measures to reduce formation of amonia

Front 203

In assessing the patient w/hepatic encephalopathy the NRS will do what 5 things?

Back 203

1- assess level of responsivness (reflexes, pupils, orientation)

2- sensory & motor abnormalities (hypereflexia, asterixis, motor coordination)

3-fluid & electrolyte imbalance

4- acid base imbalance

5- effectiveness of TX measures

Front 204

When Balloon tamponade is is used for esophageal varices the initial nursing task related to insertion of the tube will be to?

Back 204

explain the use of this tube & how it will be inserted

balloons shoul dbe checked for patency

secure tube with a piece of sponge or foam rubber at the nostrils (nasal cuff)

Front 205

Sometimes a saline lavage is used to remove blood from the stomach to prevent degradation to amonia which leads to encephalopathy. The balloon used in this procedure should be deflated every ___-___ to avoid necrosis.

Back 205

8-12 hours

Each lumen must also be labeled to avoid confusion

Front 206

The most common complication of of balloon tamponade is?

Back 206

aspiration pneumonia

Front 207

Nursing care for patients with a balloon tamponade includes monitoring for complications of rupture or erosion of the esophagus, regurgitation & aspiration of gastric contents, &?

Back 207

occulsion of the airway by the balloon

Front 208

WHat should be kept at the bedside of a patient with a balloon tamponade?

Back 208

scissors

if the ballon breaks or is deflated, the esophageal balloon will will slip upward obstruct airway & cause asphyxiation. In this event:

cut the tube or deflate the esophageal balloon

Reguritation is minimized by oral & pharengeal suctioning& keeping patient in semi-Fowlers position

Front 209

NRSG assessments of a patient w/hepatic encephalopathy will include neurologic checks q2h. Measures to prevent constipation are important because?

Back 209

need to decrease ammonia production

drugs, laxatives & enemas should be administered as prescribed

encourage fluids if not contraindicated

Patient should not strain at stool to prevent bleeding of hemmorroidal varices

Front 210

The most common primary liver cancer is?

Back 210

hepatocellular carcinoma

Front 211

A high % of patients w/primary cell carcinoma have?

Back 211

cirrhosis of the liver

Front 212

Hepatocellular carcinoma is often associated with chronic liver diseases including?

Back 212

chronic Hep B & C

Front 213

More common than primary liver carcinoma?

Back 213

metastatic carcinoma of the liver

Front 214

In liver cancer, malignant cells cause the liver to be enlarged & _____, hemmorrhage & necrosis is common.

Back 214

misshapened

Front 215

Primary liver tumors commonly metastasisize to the?

Back 215

lung

Front 216

Test used to assist in diagnosis of liver cancer are?

Back 216

CT

hepatic arteriography

ERCP endoscopic retrograde cholangiopancreatography

liver biopsy

AFP alphafetoprotein (+)

Front 217

Lab study in patients with hepatocellular carcinoma (70%) that helps to distinguish primary cancer from metastatic cancer?

Back 217

AFP alphafetoprotein (+)

Front 218

An effective immunosuppressant used in patients with liver transplants that does not impair healing or suppress bone marrow.

Back 218

Cyclosporine

Front 219

Type of jaundice assoc. w/ gallstone is?

Back 219

obstructive

Front 220

With obstructive jaundice, the type of serum bilirubin that is most likely elevated is?

Back 220

conjugated

Front 221

Hemolytic jaundice is caused by?

Back 221

an increased breakdown of RBC's.

Front 222

Hemolytic jaundice caused by an increased breakdown of RBC's will reflect what type of elevated bilirubin?

Back 222

unconjugated

Front 223

Jaundice that occurs from failure of the liver to conjugate & excrete bilirubin is known as?

Back 223

hepatocellular

Front 224

Jaundice that occurs from failure of the liver to conjugate & excrete bilirubin is Hepatocellular jaundice & causes elevations in conjugated & unconjugated ____?

Back 224

bilirubin

Front 225

IV drug use is method of greatest transmission

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 225

c) Hep C

Front 226

Type that is uncommon in the U.S.

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 226

e) Hep E

Front 227

Exists only with Hep B

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 227

d) Hep D

Front 228

Caused by a DNA Virus

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 228

b) Hep B

Front 229

Most common cause of chronic hepatitis

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 229

c) Hep C

Front 230

Often causes asymptomatic anicteric hepatitis

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 230

a) Hep A

Front 231

Chronic carriers have increased risk for hepatocellular cancer

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 231

b) Hep B

Front 232

Has no chronic carrier state

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 232

a) Hep A

Front 233

No readilay available serology tests

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 233

e) Hep E

Front 234

Usual cause of hepatitis epidemics

a) Hep A
b) Hep B
c) Hep C
d) Hep D
e) Hep E

Back 234

a) Hep A

Front 235

The systemic effects of viral hepatitis are caused primarily by:

a) cholestasis
b) impaired portal circulation
c) toxins produced by the infected liver
d) activation of the compliment system by antigen-antibody complexes

Back 235

d) activation of the compliment system by antigen-antibody complexes

Front 236

During the preicteric phase of viral hepatitis, the nurse would expect to report

a) pruritus & malaise
b) dark urine & easy fatigability
c) anorexia & r-upper quadrant discomfort
d) constipation or diarrhea w/light colored stools

Back 236

c) anorexia & r-upper quadrant discomfort

Front 237

Fulimant hepatic failure as a complication of viral hepatitis is highest in those individuals with

a) hep a
b) hep c
c) hep B accompanied w/hep c
d) hep b accompanied w/hep d

Back 237

d) hep b accompanied w/hep d

Front 238

The family members of a patient w/hep A asks if there is anything that will prevent them from developing the disease. The best response is

a) No immunization is available for hep A, nor are you likely to get the disease

b) only people who have had sexual contact w/the patient should receive immunizations

c) all family members should receive the hep A vaccine to prevent or modify the infection

d) those who have had household or close contact w/the patient should receive immune globulin

Back 238

d) those who have had household or close contact w/the patient should receive immune globulin

Front 239

A patient newly diagnosed w/ acute hep B asks if there is drug therapy to TX the disease. The appropriate response by the nurse is informing the patient that

a) there are no specific drug therapies that are effective for TX viral hepatitis

b) only chronic hep C is treatable w/antiviral agents or interferon

c) no drugs can be used for TX of viral hep C because of risks assoc w/additional damage to liver

d) interferon combined w/epivir will decrease viral load & liver damage if taken for 1 yr

Back 239

a) there are no specific drug therapies that are effective for TX viral hepatitis

Front 240

The nurse identifies a need for further teaching when the patient with hep B states

a) i should avoid alcohol completely for as long as a year
b) i must avoid all physical contact w/my family until the jaundice is gone
c) i should use a condom to prevent spread of the disease to my sexual partner

d) i will need to rest several times a day, gradually increasing my activity as I can tolerate it

Back 240

b) i must avoid all physical contact w/my family until the jaundice is gone

Front 241

One of the most cjhalenging nursing interventions to promote healing in the patient w/viral hep is

a) providing adequate nutritional intake
b) promting strict bed rest
c) providing pain relief w/out using liver metabolized drugs
d) providing quiet diversional activities during periods of fatigue

Back 241

a) providing adequate nutritional intake

Front 242

When caring for a patient with autoimmune hep, the nurse recognizes that unlike viral hep, the patient

a) does not manifest hepatomegaly or jaundice
b) experiences less liver inflammation or damage
c) is TX w/corticosteroids or other immunosuppresant agents
d) is usually an older adult who has used a variety of prescription & over-the-counter drugs

Back 242

c) is TX w/corticosteroids or other immunosuppresant agents

Front 243

Diffuse liver fibrosis

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 243

c) biliary

Front 244

Vascular congestion of liver

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 244

d) cardiac

Front 245

related to malnutrition

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 245

a) alcoholic

Front 246

associated with chemical toxicity

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 246

b) postnecrotic

Front 247

Early fatty infiltration

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 247

a) alcoholic

Front 248

Viral induced

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 248

b) postnecrotic

Front 249

Chronic biliary obstruction

a) alcoholic
b) postnecrotic
c) biliary
d) cardiac

Back 249

c) biliary

Front 250

Testicular atrophy

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 250

c) decreased estrogen metabolism

Front 251

Anemia, leukopenia, thrombocytopenia

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 251

b) vascular congestion of spleen

Front 252

Dull, heavy, RUQ pain

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 252

d) stretching over liver capsule

Front 253

Petechia & pupura

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 253

a) decreased prothrombin production

Front 254

Jaundice

a) decreased bilirubin conjugation & excretion
b) altered carbohydrtate, protein, & fat metabolism
c) decreased testosterone metabolism
d) vitamin B deficiencies

Back 254

a) decreased bilirubin conjugation & excretion

Front 255

anorexia & dyspepsia

a) decreased bilirubin conjugation & excretion
b) altered carbohydrtate, protein, & fat metabolism
c) decreased testosterone metabolism
d) vitamin B deficiencies

Back 255

b) altered carbohydrtate, protein, & fat metabolism

Front 256

amennorrhea

a) decreased bilirubin conjugation & excretion
b) altered carbohydrtate, protein, & fat metabolism
c) decreased testosterone metabolism
d) vitamin B deficiencies

Back 256

c) decreased testosterone metabolism

Front 257

Peripheral neuropathy

a) decreased bilirubin conjugation & excretion
b) altered carbohydrtate, protein, & fat metabolism
c) decreased testosterone metabolism
d) vitamin B deficiencies

Back 257

d) vitamin B deficiencies

Front 258

spider angiomas

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 258

c) decreased estrogen metabolism

Front 259

male gynocomastia

a) decreased prothrombin production
b) vascular congestion of spleen
c) decreased estrogen metabolism
d) stretching over liver capsule

Back 259

c) decreased estrogen metabolism

Front 260

Portal hypertension & the resulting increased hydrostatic pressure cause leakage of plasma into the abd cavity from 3 major sources.

Nmae them.

Back 260

1- liver lympatics

2- liver tissue

3- intestinal vasculature

Front 261

In addition to the liver lympatics, liver tissue, & the intestinal vasculature, fluid also moves into the abd cavity & produces ascites because of decreased serum oncotic colloidal pressure. The decreased serum colloidal pressure is caused by?

Back 261

decreasing liver production of albumin

Front 262

Fluid sequestering in the peritoneal cavity results in (increased/decreased) vascular volume, (increased/decreased) blood return to the heart, & (increased/decreased) cardiac output.

Back 262

decreased
decreased
decreased

Front 263

The change in cardiac output results in (increased/decreased) kidney perfusion & secretion of ____ & ____, both of which increase fluid retention.

Back 263

decreased

aldosterone

ADH

Front 264

The retained fluid has low oncotic colloidal pressure, & it escapes into the interstitial spaces causing _______.

Back 264

peripheral edema

Front 265

Excessive fluid cntinues to be reabsorbed from the kidney because of the altered kidney perfusion & because ____ is not metabolized by the impaired liver.

Back 265

aldosterone

Front 266

The changes in lab test results that relate to this process are ____ & ____.

Back 266

hypoalbuminemia

hypokalemia

Front 267

Lab tests results that the nurse would expect to find in a patient with cirrhosis include

a) serum albumin: 7.0 g/dl (70g/L)
b) bilirubin: total 3.2 mg/dl (54.7 umol/L)
c) serum cholesterol: 260 mg/dl (6.7 mmol/L)
d) asparate aminotransferase (AST): 6U/L (0.1 ukat/L)

Back 267

b) bilirubin: total 3.2 mg/dl (54.7 umol/L)

Front 268

The nurse recognizes early signs of hepatic encephalopathy in the patient who

a) menifests asterixis
b) becomes unconscious
c) has increasing oliguria
d) is irritable & letahrgic

Back 268

d) is irritable & letahrgic

Front 269

A patient w/cirrhosis has a nursing diagnosis of disturbed body image. Common etiologic factors for this diagnosis include:

a) jaundice & ascites
b) dyspnea & pruritus
c) alopecia & skin lesions
d) periorbital edema & decreased sensory perception

Back 269

a) jaundice & ascites

Front 270

A patient w/advanced cirrhosis has a nursing diagnosis of imbalanced nutrition, less than body requirements related to anorexia & inadequate food intake. An appropriate midday snack for the patient would be

a) peanut butter & salt free crackers
b) popcorn w/salt free butter & herbal seasoning
c) canned chicken noodle soup w/low protein bread
d) a tomato sandwhich w/low protein bread & salt free butter

Back 270

d) a tomato sandwhich w/low protein bread & salt free butter

Front 271

A [patient w/ascites is short of breath & has an increased respiratory rate. The nurse should

a) notify the physician so a paracentesis can be performed
b) initiate 02 therapy at 2L/min to increase gas exchange
c) ask the patient to cough & deep breath to clear respiratory secretions
d) place the patient in Fowlers position to relieve pressure on the diaphragm

Back 271

d) place the patient in Fowlers position to relieve pressure on the diaphragm

Front 272

During the TX of the patient w/bleeding esophageal varices, it is most important that the nurse

a) prepares the patient for immediate portal shunting surgery
b) performs guaiac testing on all stools to detect occult blood
c) maintains the patients airway & prevents aspiration of blood
d) monitiors for the cardiac stimulant effects of IV vasopressin & nitroglycerin

Back 272

d) monitiors for the cardiac stimulant effects of IV

Front 273

A patient w/cirrhosis that is refractory to other TX for esophageal varices undergoes a peritoneovenous shunt. As a result of this procedure, the nurse would expect the patient to experience:

a) an improved survival time
b) decreased serum ammonia levels
c) improved metabolism of nutrients
d) improved hemodynamic fxn & renal perfusion

Back 273

d) improved hemodynamic fxn & renal perfusion

Front 274

In discussing the patient w/alcoholic cirrhosis, the nurse advises the patient that

a) a daily exercise regimen is important to increase the blood flow through the liver
b) cirrhosis can be reversed if the patient follows a regimen of proper rest & nutrition
c) abstinence from alcohol is the most important factor in improvement of the patients condition
d) the only O-T-C analgesic that should be used for minor aches & pains is aceaminophen

Back 274

c) abstinence from alcohol is the most important factor in improvement of the patients condition

Front 275

A patient is hospitalized w/metastatic cancer of the iver. The nurse plans care for the patient based on the knowledge that

a) chemotherapy is highly successful in the TX of liver cancer
b) the patient will undergo surgery to remove the involved portions of the liver
c) supportive care that is appropriate for all patients w/severe liver damage is indicated
d) metastatic cancer of the liver is more responsive to TX than primary carcinoma of the liver

Back 275

c) supportive care that is appropriate for all patients w/severe liver damage is indicated

Front 276

A patient w/cirrhosis asks the nurse about the possibility of a liver transplant. The best response by the nurse is

a) liver transplants are only indicated in children w/irreversible liver disease
b) if you are interested in a transplant you really should talk to your doctor about it
c) rejection is such a problem in liver transplants that it is seldom attempted in patients w/cirrhosis
d) cirrhosis is an indication for transplantation in some cases. Have you talked to your DR about this?

Back 276

d) cirrhosis is an indication for transplantation in some cases. Have you talked to your DR about this?-

Front 277

An estimated 136,000 cases of hep occurr annually in the U.S. & _____ of these are in children

a) 1/8th
b) 1/4th
c) 1/3rd
d) over 1/2

Back 277

c) 1/3rd

Front 278

The most common form of hep is acute, highly contagious, & traditionally called infectious hepatitis

a) hep A
b) hep B
c) hep C
d) hep D

Back 278

a) hep A

fecal-oral