Cirrhosis Quiz

A client is at high risk for developing ascites because of cirrhosis of the liver. How should the nurse assess for the presence of ascites?

• Observe the client for signs of respiratory distress.

• Percuss the client’s abdomen and listen for dull sounds

• Palpate the lower extremities over the tibia and observe for edema.

• Listen for decreased or absent bowel sound while auscultation the abdomen.

Answer explanation

Percussing over the client’s abdomen will produce a dull, not tympanic, sound if fluid is

present. Respiratory distress occurs with ascites, but it is not an early sign; the client

does not have ascites but is at risk for ascites at this time. Palpating the lower

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Cirrhosis Quiz

A client is admitted to the hospital for acute gastritis and ascites secondary to alcoholism and cirrhosis. For which condition is it most important for the nurse to assess this client?

• Nausea.

• Blood in the stool.

• Food intolerances.

• Hourly urinary output.

Answer explanation

Erosion of blood vessels may lead to hemorrhage, a life-threatening situation further complicated by decreased prothrombin production, which occurs with cirrhosis. Although food intolerances should be identified, there is no immediate threat to life. Although increased intraabdominal pressure because of ascites may precipitate nausea, there is no immediate threat to life. Hourly urine output measurements are unnecessary.

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Cirrhosis Quiz

What will the nurse do to assess a client's response to ongoing serum albumin therapy for cirrhosis of the liver?

• Monitor the client’s vital signs.

• Measure the client’s urine output every half hour

• Obtain the client’s weight at least once every day.

• Determine the client’s urine albumin level each shift.

Answer explanation

The increased osmotic effect after the administration of albumin increases intravascular volume and urinary output; weight loss reflects fluid loss. Vital signs do not change drastically; however, they should be checked routinely. Urinary output is measured hourly, every 8 hours, and every 24 hours; half-hour outputs are insignificant in this instance. Serum albumin levels are significant; however, albumin in the urine indicates kidney dysfunction, not liver dysfunction.

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Cirrhosis Quiz

The nurse is administering lactulose to a client with a history of cirrhosis of the liver. The client asks the nurse why this medication is needed because the client is not constipated. How will the nurse respond?

• “This medication helps you to stop drinking so much alcohol.”

• “This medication helps you relax and not feel anxious.”

• “This medication helps you lower the high ammonia level caused by your liver disease.

• “This medication helps you keep your abdomen from being so distended.”

Answer explanation

Lactulose is a hyperosmotic laxative and ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease. Lactulose has no effect on the craving for alcohol or anxiety and is not prescribed to reduce abdominal distension. 

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Cirrhosis Quiz

A client with cirrhosis of the liver develops ascites, and the health care provider prescribes spironolactone. What should the nurse monitor the client for?

• Bruising

• Tachycardia

• Hyperkalemia

• Hypoglycemia

Answer explanation

Spironolactone is a potassium-sparing diuretic that is used to treat clients with ascites; therefore the nurse should monitor the client for signs and symptoms of hyperkalemia. Bruising and purpura are associated with cirrhosis, not with the administration of spironolactone. Spironolactone does not cause tachycardia. Spironolactone does not cause hypoglycemia.

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Cirrhosis Quiz

Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking this medication?

• Prevents an infection.

• Limits abdominal distention.

• Minimizes intestinal edema.

• Reduces the blood ammonia level.

Answer explanation

Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to prevent infection. Neomycin has little or no effect on intestinal edema. Neomycin does not reduce abdominal distention.

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Cirrhosis Quiz

A nurse administers lactulose to a client with cirrhosis of the liver. Which laboratory test change leads the nurse to determine that the lactulose is effective?

• Decreased amylase.

• Decreased ammonia.

• Increased potassium

• Increased hemoglobin

Answer explanation

Lactulose destroys intestinal flora that break down protein and in the process give off ammonia. In clients with cirrhosis, ammonia is inadequately detoxified by the liver and can build to toxic levels. Amylase levels are associated with pancreatic problems. Increased potassium levels are associated with kidney failure. Hemoglobin is increased when the body needs more oxygen-carrying capacity, such as in smokers, or in high altitudes.

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Cirrhosis Quiz

A client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. The client reports frequent nausea, pain that increases after meals, and black, tarry stools. The client recently joined Alcoholics Anonymous. The nurse should give priority to which client history item?

• Black, tarry stools

• Frequent nausea

• Joining Alcoholics Anonymous

• Pain that increases after meals

Answer explanation

The priority is black (tarry) stools that indicate upper gastrointestinal (GI) bleeding; digestive enzymes act on the blood, resulting in tarry stools. Hemorrhage can occur if erosion extends to blood vessels. Nausea is a common symptom of gastritis but is not life threatening. Attempts to control alcoholism should be supported, but this is a longterm goal; assessment of bleeding takes priority. Investigation of bleeding takes priority; later the nurse should help to identify irritating foods that may be increasing the pain after eating and are to be avoided.

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Cirrhosis Quiz

The nurse is assessing a client with severe cirrhosis and discovers fetor hepaticus. What did the nurse assess?

• Urine

• Stool

• Hands

• Breath

Answer explanation

The client's breath has a sweet odor (fetor hepaticus) because the liver is not metabolizing the food, especially proteins. The urine is dark. The stool is clay-colored. The hands develop asterixis or flapping tremors.

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Cirrhosis Quiz

A client with hepatic cirrhosis begins to develop slurred speech, confusion, drowsiness, and a flapping tremor. Which diet can the nurse expect will be prescribed for this client based upon the assessment?

• No protein

• Moderate protein

• High protein

• Strict protein restriction

Answer explanation

Because the liver is unable to detoxify ammonia to urea and the client is experiencing impending hepatic encephalopathy coma, protein intake should be moderate. Strict protein and no protein restrictions are not required because clients need protein for healing. High protein is contraindicated in hepatic encephalopathy.

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Cirrhosis Quiz