Question: Mr. Jones is a 67 year-old male living at home with end-stage cirrhosis secondary to hepatitis C infection. His adult son brought him to the ER after finding him laying on the bathroom floor with blood visible in the toilet bowl. In the ER, Mr. Jones reported having black tarry stools and feeling weak the past 2 days. Provider ordered Propranolol. Vital signs in the ER were as follows: [Vital signs listed]. Mr. Jones’ hemoglobin in the ER was 6.8 g/dL [normal – 13-17 g/dL]. He was diagnosed with hypovolemic shock due to GI bleeding and received one unit PRBCs in the ER. He was subsequently admitted to a medical progressive care unit for further treatment and evaluation. MPCU vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. Pain and vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. He feels chilly and his abdomen is distended and tender. Based on the information provided, what complication of end-stage cirrhosis does the RN suspect?
Answer Options:
Encephalopathy, Spontaneous bacterial peritonitis (SBP), Hepatopulmonary syndrome, Hepatorenal syndrome
Answer: Spontaneous bacterial peritonitis (SBP)
Question: What findings should a nurse expect in a patient with compensated liver cirrhosis?
Answer Options:
Elevated liver enzymes, Jaundice, Ascites, Thrombocytopenia.
Answer: Elevated liver enzymes, Jaundice, Ascites, Thrombocytopenia.
Question: What action does the nurse take first for a patient with late-stage cirrhosis and hepatopulmonary syndrome experiencing shortness of breath?
Answer Options:
Raise the head of the bed and apply oxygen as ordered, Document lung sounds, Prepare the patient for thoracentesis, Contact the provider.
Answer: Raise the head of the bed and apply oxygen as ordered.
Question: Aliyah presents to the ER with a 3 day history of abdominal pain, nausea, vomiting, and myalgia. She states she recently traveled to Las Vegas for a bachelorette party and everyone in her travel party has similar symptoms. She is concerned she may have gotten food poisoning from an all-you-can-eat seafood buffet. The ER provider has ordered several labs including a hepatitis panel. Which type of hepatitis does Aliyah most likely have based on her history?
Answer Options:
Hepatitis B, Hepatitis A, Hepatitis E, Hepatitis D
Answer: Hepatitis A
Question: You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient is placed on lactulose. You will monitor effectiveness of this medication by assessing what?
Answer Options:
Liver enzymes, Ammonia level, Pain level, Hemoglobin level
Answer: Ammonia level
Question: Which of the following orders should the RN question for a patient with hepatic encephalopathy?
Answer Options:
Frequent high protein, high calorie meals, Neomycin Sulfate, Imodium to firm up the loose stool caused by lactulose, Frequent low protein, high calorie meals.
Answer: Frequent high protein, high calorie meals, Neomycin Sulfate.
Question: The nurse is evaluating the patient’s lab values and notes that hepatitis B virus antibodies (anti-HBsAg) is present in the blood. How does the nurse interpret this finding?
Answer Options:
Generally interpreted as indicating recovery and immunity from HBV infection, The patient has an active Hepatitis B infection, Generally interpreted as indicating cirrhosis and the need for liver transplantation, The patient has developed chronic Hepatitis B infection.
Answer: The patient has an active Hepatitis B infection
Question: Which findings would alert the student nurse to a serious post-TIPS complication?
Answer Options:
No symptoms of variceal hemorrhage noted, Abdominal girth measurements show significant reduction in ascites, Patient has moved from stage II encephalopathy to stage I encephalopathy, The patient has developed confusion and asterixis.
Answer: The patient has developed confusion and asterixis.
Question: Your patient with end stage liver disease develops fetor hepaticus. Which statement made by a patient’s spouse indicates a correct understanding of this condition?
Answer Options:
It is not uncommon for hospitalized patients to have bad breath., The liver has difficulty filtering out substances in the blood that can cause bad breath., He will follow up with his dentist to make sure there are no any deep cavities or abscessed teeth., Eating a diet high in carbohydrates can produce ketones which lead to bad breath.
Answer: The liver has difficulty filtering out substances in the blood that can cause bad breath.
Question: Which assessment findings indicate the client has deficient vitamin K absorption due to biliary obstruction?
Answer Options:
Purpura and petechiae, Dyspnea and fatigue, Ascites and orthopnea, Itching and palmar erythema.
Answer: Purpura and petechiae.
Question: Mr. Jones’ hemoglobin in the ER was 6.8 g/dL [normal – 13-17 g/dL]. He was diagnosed with hypovolemic shock due to GI bleeding and received one unit PRBCs in the ER. He was subsequently admitted to a medical progressive care unit for further treatment and evaluation. MPCU vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. Pain and vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. He feels chilly and his abdomen is distended and tender. Patient is diagnosed with spontaneous bacterial peritonitis (SBP). Which medication will the nurse expect to be ordered?
Answer Options:
Metoprolol 25mg po BID, Lactulose 30ml po QID, Furosemide 40mg IV push, Cefotaxime 2g IVBP q 8 hours
Answer: Cefotaxime 2g IVBP q 8 hours
Question: Mr. Jones is a 67 year-old male living at home with end-stage cirrhosis secondary to hepatitis C infection. His adult son brought him to the ER after finding him laying on the bathroom floor with blood visible in the toilet bowl. In the ER, Mr. Jones reported having black tarry stools and feeling weak the past 2 days. EGD detected esophageal varices. What medication the nurse anticipates?
Answer Options:
Morphine, Valium, Propranolol, Lasix
Answer: Propranolol
Question: Mr. Jones’ hemoglobin in the ER was 6.8 g/dL [normal – 13-17 g/dL]. He was diagnosed with hypovolemic shock due to GI bleeding and received one unit PRBCs in the ER. He was subsequently admitted to a medical progressive care unit for further treatment and evaluation. MPCU vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. Pain and vital signs on arrival to MPCU are as follows: [MPCU vital signs listed]. He feels chilly and his abdomen is distended and tender. Mr. Jones is placed on antibiotics for SBP and scheduled for paracentesis. What nursing interventions you should implement before a paracentesis? Select all that apply.
Answer Options:
Have patient void before the procedure, Insert a foley catheter, Obtain vital signs including weight, Position the patient flat in bed, Place a small towel under the patient’s mouth to catch secretions
Answer: Have patient void before the procedure, Obtain vital signs including weight, Position the patient flat in bed
Question: What does the nurse expect to see in the plan of care for a patient with Non-alcoholic fatty liver disease (NAFLD)?
Answer Options:
Pain management, Weight loss management, Fluid restriction, Blood transfusion.
Answer: Weight loss management.
Question: What condition does the nurse suspect in a patient with cirrhosis demonstrating marked disorientation and a flapping motion of the hands?
Answer Options:
Stage III encephalopathy, Spontaneous bacterial peritonitis (SBP), Portal hypertension, Stage IV encephalopathy.
Answer: Stage III encephalopathy.
Question: Which interventions would be most appropriate to include in Mr. Abraham’s plan of care given his symptoms and diagnosis of hepatitis C?
Answer Options:
Skin care to relieve pruritis, Lactated ringers at 125 mL/hour, Frequent small meals with low protein content, Acetaminophen 1000 mg every 4 hours for pain.
Answer: Frequent small meals with low protein content.
Question: Mr. Jones is a 67 year-old male living at home with end-stage cirrhosis secondary to hepatitis C infection. His adult son brought him to the ER after finding him laying on the bathroom floor with blood visible in the toilet bowl. In the ER, Mr. Jones reported having black tarry stools and feeling weak the past 2 days. The ER nurse anticipates and prepares for what procedure based on Mr. Jones history and assessments?
Answer Options:
Paracentesis, Transjugular intrahepatic portosystemic shunt (TIPS), Liver biopsy, Esophagogastroduodenoscopy (EGD)
Answer: Esophagogastroduodenoscopy (EGD)
Question: What laboratory finding is expected in a patient with ascites secondary to late-stage liver disease?
Answer Options:
Hypoalbuminemia, Hypobilirubinemia, Leukocytosis, High lactic acid.
Answer: Hypoalbuminemia.
Question: The community outreach RN is providing education about hepatitis prevention to a group of volunteers preparing for a trip to South America. Which statement made by a volunteer indicates the need for further education?
Answer Options:
I will use bottled water for both drinking and brushing my teeth while in South America., I will avoid getting a tattoo while in South America., I will receive recommended hepatitis vaccinations prior to travel., I will eat plenty of fresh fruits and raw vegetables to boost my immune system while in South America.
Answer: I will eat plenty of fresh fruits and raw vegetables to boost my immune system while in South America.