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A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?
- A. Position the patient on the right side with a pillow under the costal margin after the procedure.
- B. Administer 1 unit of albumin 90 minutes before the procedure as ordered.
- C. Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure.
- D. Confirm that the patients electrolyte levels have been assessed prior to the procedure.
Correct Answer: A
Rationale: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation tests should be performed, but electrolyte analysis is not necessary.
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A local public health nurse is informed that a cook in a local restaurant has been diagnosed with hepatitis A. What should the nurse advise individuals to obtain who ate at this restaurant and have never received the hepatitis A vaccine?
- A. The hepatitis A vaccine
- B. Albumin infusion
- C. The hepatitis A and B vaccines
- D. An immune globulin injection
Correct Answer: D
Rationale: For people who have not been previously vaccinated, hepatitis A can be prevented by the intramuscular administration of immune globulin during the incubation period, if given within 2 weeks of exposure. Administration of the hepatitis A vaccine will not protect the patient exposed to hepatitis A, as protection will take a few weeks to develop after the first dose of the vaccine. The hepatitis B vaccine provides protection again the hepatitis B virus, but plays no role in protection for the patient exposed to hepatitis A. Albumin confers no therapeutic benefit.
A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?
- A. Decisional Conflict
- B. Deficient Knowledge
- C. Death Anxiety
- D. Disturbed Thought Processes
Correct Answer: C
Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patients likely fear of death, which is a realistic possibility. For most patients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may not experience disturbances in thought processes.
A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent assessment reveals subtle changes in the patients cognition and behavior. What is the nurses most appropriate response?
- A. Ensure that the patients sodium intake does not exceed recommended levels.
- B. Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.
- C. Inform the primary care provider that the patient should be assessed for alcoholic hepatitis.
- D. Implement interventions aimed at ensuring a calm and therapeutic care environment.
Correct Answer: B
Rationale: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patients mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patients physiologic deterioration.
A patients physician has ordered a liver panel in response to the patients development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.
- A. Alanine aminotransferase (ALT)
- B. C-reactive protein (CRP)
- C. Gamma-glutamyl transferase (GGT)
- D. Aspartate aminotransferase (AST)
- E. B-type natriuretic peptide (BNP)
Correct Answer: A,C,D
Rationale: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.
A patient has been diagnosed with advanced stage breast cancer and will soon begin aggressive treatment. What assessment findings would most strongly suggest that the patient may have developed liver metastases?
- A. Persistent fever and cognitive changes
- B. Abdominal pain and hepatomegaly
- C. Peripheral edema unresponsive to diuresis
- D. Spontaneous bleeding and jaundice
Correct Answer: B
Rationale: The early manifestations of malignancy of the liver include pain a continuous dull ache in the right upper quadrant, epigastrium, or back. Weight loss, loss of strength, anorexia, and anemia may also occur. The liver may be enlarged and irregular on palpation. Jaundice is present only if the larger bile ducts are occluded by the pressure of malignant nodules in the hilum of the liver. Fever, cognitive changes, peripheral edema, and bleeding are atypical signs.