This is a quiz that contains NCLEX review questions about cirrhosis.
As a nurse providing care to a patient with cirrhosis, it is important to know the signs and symptoms, nursing management, complications, patient education, and treatment for this condition.
In the previous NCLEX review series, I explained about other gastrointestinal disorders, so be sure to check those reviews out.
Don’t forget to watch the lecture on cirrhosis before taking the quiz.
(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.)
1. Which condition is NOT a known cause of cirrhosis?
A. Obesity
B. Alcohol consumption
C. Blockage of the bile duct
D. Hepatitis C
E. All are known causes of Cirrhosis
The answer is E. All of these conditions can cause cirrhosis.
2. The liver receives it blood supply from two sources. One of these sources is called the _________________, which is a vessel network that delivers blood _____________ in nutrients but ________ in oxygen.
A. hepatic artery, low, high
B. hepatic portal vein, high, low
C. hepatic lobule, high, low
D. hepatic vein, low, high
The answer is B. Majority of the blood flow to the liver comes from the hepatic portal vein. This vessel network delivers blood HIGH in nutrients (lipids, proteins, carbs etc.) from organs that aid in the digestion of food, but the blood is POOR in oxygen. The organs connected to the hepatic portal vein are: small/large intestine, pancreas, spleen, stomach. Rich oxygenated blood comes from the hepatic artery to the liver.
3. A patient with late-stage cirrhosis develops portal hypertension. Which of the following options below are complications that can develop from this condition? Select all that apply:
A. Increase albumin levels
B. Ascites
C. Splenomegaly
D. Fluid volume deficient
E. Esophageal varices
The answer are B, C, and E. Portal Hypertension is where the portal vein becomes narrow due to scar tissue in the liver, which is restricting the flow of blood to the liver. Therefore, pressure becomes increased in the portal vein and affects the organs connected via the vein to the liver. The patient may experience ascites, enlarged spleen “splenomegaly”, and esophageal varices etc.
4. Your patient with cirrhosis has severe splenomegaly. As the nurse you will make it priority to monitor the patient for signs and symptoms of? Select all that apply:
A. Thrombocytopenia
B. Vision changes
C. Increased PT/INR
D. Leukopenia
The answers are A, C, and D. A patient with an enlarged spleen (splenomegaly) due to cirrhosis can experience thrombocytopenia (low platelet count), increased PT/INR (means it takes the patient a long time to stop bleeding), and leukopenia (low white blood cells). The spleen stores platelets and WBCs. An enlarged spleen can develop due to portal hypertension, which causes the platelets and WBCs to become stuck inside the spleen due to the increased pressure in the hepatic vein (hence lowering the count and the body’s access to these important cells for survival).
5. A patient is admitted with hepatic encephalopathy secondary to cirrhosis. Which meal option selection below should be avoided with this patient?
A. Beef tips and broccoli rabe
B. Pasta noodles and bread
C. Cucumber sandwich with a side of grapes
D. Fresh salad with chopped water chestnuts
The answer is A. Patients who are experiencing hepatic encephalopathy are having issues with toxin build up in the body, specifically ammonia. Remember that ammonia is the byproduct of protein breakdown, and normally the liver can take the ammonia from the protein breakdown and turn it into urea (but if the cirrhosis is severe enough this can’t happen). Therefore, the patient should consume foods LOW in protein until the encephalopathy subsides. Option A is very high in protein while the others are low in protein. Remember meats, legumes, eggs, broccoli rabe, certain grains etc. are high in protein.
6. During your morning assessment of a patient with cirrhosis, you note the patient is disoriented to person and place. In addition while assessing the upper extremities, the patient’s hands demonstrate a flapping motion. What lab result would explain these abnormal assessment findings?
A. Decreased magnesium level
B. Increased calcium level
C. Increased ammonia level
D. Increased creatinine level
The answer is C. Based on the assessment findings and the fact the patient has cirrhosis, the patient is experiencing hepatic encephalopathy. This is due to the buildup of toxins in the blood, specifically ammonia. The flapping motion of the hands is called “asterixis”. Therefore, an increased ammonia level would confirm these abnormal assessment findings.
7. You are receiving shift report on a patient with cirrhosis. The nurse tells you the patient’s bilirubin levels are very high. Based on this, what assessment findings may you expect to find during your head-to-toe assessment? Select all that apply:
A. Frothy light-colored urine
B. Dark brown urine
C. Yellowing of the sclera
D. Dark brown stool
E. Jaundice of the skin
F. Bluish mucous membranes
The answers are B, C, and E. High bilirubin levels are because the hepatocytes are no longer able to properly conjugate the bilirubin because they are damaged. This causes bilirubin to leak into the blood and urine (rather than entering the bile and being excreted in the stool). Therefore, the bilirubin stays in the blood and will enter the urine. This will cause the patient to experience yellowing of the skin, sclera of the eyes, and mucous membranes (“jaundice”) and have dark brown urine. The stools would be CLAY-COLORED not dark brown (remember bilirubin normally gives stool it brown color but it will be absent).
8. A 45 year old male has cirrhosis. The patient reports concern about the development of enlarged breast tissue. You explain to the patient that this is happening because?
A. The liver cells are removing too much estrogen from the body which causes the testicles to produce excessive amounts of estrogen, and this leads to gynecomastia.
B. The liver is producing too much estrogen due to the damage to the liver cells, which causes the level to increase in the body, and this leads to gynecomastia.
C. The liver cells are failing to recycle estrogen into testosterone, which leads to gynecomastia.
D. The liver cells are failing to remove the hormone estrogen properly from the body, which causes the level to increase in the body, and this leads to gynecomastia.
The answer is D.
9. You’re providing an in-service to new nurse graduates about esophageal varices in patients with cirrhosis. You ask the graduates to list activities that should be avoided by a patient with this condition. Which activities listed are correct: Select all that apply
A. Excessive coughing
B. Sleeping on the back
C. Drinking juice
D. Alcohol consumption
E. Straining during a bowel movement
F. Vomiting
The answers are A, D, E, and F. Esophageal varices are dilated vessels that are connected from the throat to the stomach. They can become enlarged due to portal hypertension in cirrhosis and can rupture (this is a medical emergency). The patient should avoid activities that could rupture these vessels, such as excessive cough, vomiting, drinking alcohol, and constipation (straining increases thoracic pressure.)
10. While providing mouth care to a patient with late-stage cirrhosis, you note a pungent, sweet, musty smell to the breath. This is known as:
A. Metallic Hepatico
B. Fetor Hepaticus
C. Hepaticoacidosis
D. Asterixis
The answer is B.
11. The physician orders Lactulose 30 mL by mouth per day for a patient with cirrhosis. What findings below demonstrates the medication is working effectively? Select all that apply:
A. Decrease albumin levels B. Decrease in Fetor Hepaticus C. Patient is stuporous. D. Decreased ammonia blood level
E. Presence of asterixis
Part three of our liver lecture will focus on portal hypertension and mainly, ascites.
What is Ascites?
Ascites is what we refer to as “third spacing.” When clients come into the hospital with massive abdomens, it is most likely because of fluid accumulation within the abdominal cavity. But why is there increased fluid inside the abdomen?
Portal Hypertension
Ascites relates back to the scarring of the liver that has caused blockage with portal hypertension; that is if the diagnosed portal hypertension is greater than 10mm/Hg. To measure portal hypertension, doctors would send a small tube down the throat, into the stomach, through the duodenum, and up the portal vein to measure the amount of pressure stressing on the portal vein which caused portal hypertension.
Albumin
So, there’s increased pressure being pushed on the vein and also a decrease in albumin. Albumin levels are usually 3.5 – 5.0; same with potassium. Albumin functions as a water magnet because it attracts water. Albumin also transports drugs and binds heavily with calcium.
The absence of albumin production in the liver will cause calcium levels inside the body to deteriorate, drug transportation within the system will be compromised, and most importantly, water will escape from the vascular spaces because there is are no magnets to pull it inside.
If this happens, there will be increased capillary pressure due to the scarring that is caused by inefficient water absorption into the veins. Thus, water escapes into the third spaces, abdominal cavities, and connective tissues. For this reason, your client will present a huge abdomen.
Medical Management
When your client has ascites, doctors will result in paracentesis. Paracentesis is done by sticking a needle inside the peritoneal cavity and draining the fluid out. Once the needle is inside the abdominal cavity, fluid will be drained into containers. Albumin will then be administered to increase the colloid pressure inside the veins which will cause water to be attracted back into the vascular spaces for “re-vascularization.”
Albumin Side Effects
After giving albumin, there will be significant changes that will happen to your client’s condition.
The client’s blood pressure is going to skyrocket. Because the water magnet has been increased and activated to bring all the fluid back into the veins from the abdominal cavity, the veins are going to swell. Pulses will be strong and bounding. Headaches will also occur because of the increased pressure.
Countering Side Effects
To counter the side effects of giving albumin, excess water must be taken out of the equation. The goal is to get the water or the extra fluid out of the body by administering diuretics.
Diuretics decrease the amount of blood volume. With albumin, water from the third spaces is pulled into the vascular areas resulting in increased dilution but decreased electrolytes; it’s like having so much water but not enough sugar.
So, diuretics like Lasix and hydrochlorothiazide are given to cut down the water supply and make sure that the blood mix is equal. Lasix (furosemide) is the drug of choice due to its ability to push intravenously inside the body.
A Quick Summary
So, we have discussed a couple of noteworthy things about ascites – its causes and management. To review:
- Ascites is that third spacing.
- Third spacing is due to portal hypertension that is greater than 10 mm/Hg.
- The liver, which is mainly affected by portal hypertension caused by scarring, is responsible for the production of albumin.
- Portal hypertension leads to inefficient albumin production which mainly causes ascites. Ascites is a condition that keeps fluid from going into the vascular areas.
- Albumin is given to bring water back into the vascular spaces.
- Diuretics are administered to decrease blood volume and prevent albumin side effects.
Client Education
The main reason why ascites exists is due to a liver problem. Even if all types of measures are given to fix the signs and symptoms, if one does not focus on solving the main problem or replace the liver, the problem will persist.
Help liver clients understand why they are suffering from different liver diseases like the irreversible condition – liver cirrhosis. Treating the signs and symptoms are not enough; there must be long-term solutions to fix the primary problem.
Client education is important. Suggest Alcoholics Anonymous for liver clients who are into deep with their alcohol consumption. Make your clients understand the ill-effects of their actions which can also lead to a variety of health conditions like pancreatitis, esophageal varices, and ascites. By being aware of the toxic effects of alcohol, you are teaching your client how to take care of themselves and lead a healthy lifestyle.
Client education is a primary responsibility of nurses – educate the community with risk factors that are damaging to the liver and its surrounding organs.
In our next lecture, we will be discussing hepatitis and its difference with cirrhosis.
Until next time!