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A patient with cirrhosis has experienced a progressive decline in his health; and liver transplantation is being considered by the interdisciplinary team. How will the patients prioritization for receiving a donor liver be determined?
- A. By considering the patients age and prognosis
- B. By objectively determining the patients medical need
- C. By objectively assessing the patients willingness to adhere to post-transplantation care
- D. By systematically ruling out alternative treatment options
Correct Answer: B
Rationale: The patient would undergo a classification of the degree of medical need through an objective determination known as the Model of End-Stage Liver Disease (MELD) classification, which stratifies the level of illness of those awaiting a liver transplant. This algorithm considers multiple variables, not solely age, prognosis, potential for adherence, and the rejection of alternative options.
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A patient with esophageal varices is being cared for in the ICU. The varices have begun to bleed and the patient is at risk for hypovolemia. The patient has Ringers lactate at 150 cc/hr infusing. What else might the nurse expect to have ordered to maintain volume for this patient?
- A. Arterial line
- B. Diuretics
- C. Foley catheter
- D. Volume expanders
Correct Answer: D
Rationale: Because patients with bleeding esophageal varices have intravascular volume depletion and are subject to electrolyte imbalance, IV fluids with electrolytes and volume expanders are provided to restore fluid volume and replace electrolytes. Diuretics would reduce vascular volume. An arterial line and Foley catheter are likely to be ordered, but neither actively maintains the patients volume.
A patient has been admitted to the critical care unit with a diagnosis of toxic hepatitis. When planning the patients care, the nurse should be aware of what potential clinical course of this health problem? Place the following events in the correct sequence. 1. Fever rises. 2. Hematemesis. 3. Clotting abnormalities. 4. Vascular collapse. 5. Coma.
- A. 1,2,5,4,3
- B. 1,2,3,4,5
- C. 2,3,1,4,5
- D. 3,1,2,5,4
Correct Answer: B
Rationale: Recovery from acute toxic hepatitis is rapid if the hepatotoxin is identified early and removed or if exposure to the agent has been limited. Recovery is unlikely if there is a prolonged period between exposure and onset of symptoms. There are no effective antidotes. The fever rises; the patient becomes toxic and prostrated. Vomiting may be persistent, with the emesis containing blood. Clotting abnormalities may be severe, and hemorrhages may appear under the skin. The severe GI symptoms may lead to vascular collapse. Delirium, coma, and seizures develop, and within a few days the patient may die of fulminant hepatic failure unless he or she receives a liver transplant.
A nurse has entered the room of a patient with cirrhosis and found the patient on the floor. The patient states that she fell when transferring to the commode. The patients vital signs are within reference ranges and the nurse observes no apparent injuries. What is the nurses most appropriate action?
- A. Remove the patients commode and supply a bedpan.
- B. Complete an incident report and submit it to the unit supervisor.
- C. Have the patient assessed by the physician due to the risk of internal bleeding.
- D. Perform a focused abdominal assessment in order to rule out injury.
Correct Answer: C
Rationale: A fall would necessitate thorough medical assessment due to the patients risk of bleeding. The nurses abdominal assessment is an appropriate action, but is not wholly sufficient to rule out internal injury. Medical assessment is a priority over removing the commode or filling out an incident report, even though these actions are appropriate.
A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.
- A. Administering diuretics
- B. Administering calcium channel blockers
- C. Implementing fluid restrictions
- D. Implementing a 1500 kcal/day restriction
- E. Enhancing patient positioning
Correct Answer: A,C,E
Rationale: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. Calcium channel blockers and caloric restriction do not address this problem.
A nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan?
- A. Mobilization with assistance at least 4 times daily
- B. Administration of beta-adrenergic blockers as ordered
- C. Vitamin B12 injections as ordered
- D. Administration of diuretics as ordered
Correct Answer: D
Rationale: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.