Chapter 49 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition


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Chapter 49  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition



Complete Chapter Questions And Answers

Sample Questions


1. A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patient’s increased risk of bleeding. The nurse recognizes that this risk is related to the patient’s inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

  1. A)  Alterations in glucose metabolism
  2. B)  Retention of bile salts
  3. C)  Inadequate production of albumin by hepatocytes
  4. D)  Inability of the liver to use vitamin K

Ans: D


Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.

2. A nurse is performing an admission assessment of a patient with a diagnosis of cirrhosis. What technique should the nurse use to palpate the patient’s liver?

  1. A)  Place hand under the right lower abdominal quadrant and press down lightly with the

    other hand.

  2. B)  Place the left hand over the abdomen and behind the left side at the 11th rib.
  3. C)  Place hand under right lower rib cage and press down lightly with the other hand.
  4. D)  Hold hand 90 degrees to right side of the abdomen and push down firmly.

Ans: C


To palpate the liver, the examiner places one hand under the right lower rib cage and presses downward with light pressure with the other hand. The liver is not on the left side or in the right lower abdominal quadrant.

3. A patient with portal hypertension has been admitted to the medical floor. The nurse should prioritize which of the following assessments related to the manifestations of this health problem?

  1. A)  Assessment of blood pressure and assessment for headaches and visual changes
  2. B)  Assessments for signs and symptoms of venous thromboembolism
  3. C)  Daily weights and abdominal girth measurement
  4. D)  Blood glucose monitoring q4h

Ans: C


Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.

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4. A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.

  1. A)  Immunization
  2. B)  Use of standard precautions
  3. C)  Consumption of a vitamin-rich diet
  4. D)  Annual vitamin K injections
  5. E)  Annual vitamin B12 injections

Ans: A, B


People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. The consistent use of standard precautions is also highly beneficial. Vitamin supplementation is unrelated to an individual’s risk of HBV.

5. A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse’s most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse’s best response to this assessment finding?

  1. A)  Document the presence of normal bile output.
  2. B)  Irrigate the drainage system with normal saline as ordered.
  3. C)  Aspirate a sample of the drainage for culture.
  4. D)  Promptly report this assessment finding to the primary care provider.

Ans: A


Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

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6. A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?

  1. A)  The patient will obtain measurement of drainage from the T-tube.
  2. B)  The patient will exercise three times a week.
  3. C)  The patient will take immunosuppressive agents as required.
  4. D)  The patient will monitor for signs of liver dysfunction.

Ans: C


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.

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