Nokea
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.
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A nurse is performing an admission assessment for an 81-year-old patient who generally enjoys good health. When considering normal, age-related changes to hepatic function, the nurse should anticipate what finding?
- A. Similar liver size and texture as in younger adults
- B. A nonpalpable liver
- C. A slightly enlarged liver with palpably hard edges
- D. A slightly decreased size of the liver
Correct Answer: D
Rationale: The most common age-related change in the liver is a decrease in size and weight. The liver is usually still palpable, however, and is not expected to have hardened edges.
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.
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?
- A. The patient will obtain measurement of drainage from the T-tube.
- B. The patient will exercise three times a week.
- C. The patient will take immunosuppressive agents as required.
- D. The patient will monitor for signs of liver dysfunction.
Correct Answer: C
Rationale: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.
A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?
- A. Risk for Infection Related to Immunosuppressant Use
- B. Risk for Injury Related to Decreased Hemostasis
- C. Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
- D. Risk for Contamination Related to Accumulation of Ammonia
Correct Answer: A
Rationale: Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of Risk for Contamination relates to environmental toxin exposure.
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis?
- A. Finish all prescribed courses of antibiotics, regardless of symptom resolution.
- B. Adhere to dosing recommendations of OTC analgesics.
- C. Ensure that expired medications are disposed of safely.
- D. Ensure that pharmacists regularly review drug regimens for potential interactions.
Correct Answer: B
Rationale: Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease. Drug interactions are rarely the cause of drug-induced hepatitis.