Liver Failure & Hepatic Encephalopathy Quiz

1. Which finding on physical exam would suggest worsening hepatic encephalopathy?

Progression from asterixis to rigidity and loss of consciousness

Improvement in orientation and alertness

Increased appetite and energy

Normal pupil response and brisk reflexes

2. A patient with hepatic encephalopathy requires a transjugular intrahepatic portosystemic shunt (TIPS). What is the primary nursing consideration post-procedure?

Monitor for hepatic encephalopathy worsening due to increased shunting

Expect complete resolution of all liver disease

Ensure strict bed rest for 6 weeks

Administer high-protein diet immediately

3. Which assessment tool is most useful for staging the severity of hepatic encephalopathy?

West Haven Criteria

Glasgow Coma Scale alone

Mini-Mental State Exam

National Institutes of Health Stroke Scale

4. A patient with liver failure has portal hypertension. How does this contribute to hepatic encephalopathy development?

Portal hypertension causes portosystemic shunting, bypassing ammonia detoxification

It decreases liver blood flow and improves ammonia clearance

It prevents bacterial translocation

It enhances protein synthesis

5. What is the expected outcome of lactulose therapy in hepatic encephalopathy?

Osmotic diarrhea that increases ammonia excretion and lowers pH

Constipation to prevent bacterial overgrowth

Direct ammonia metabolism in the liver

Increased ammonia absorption from the gut

6. Which medication class should be avoided in hepatic encephalopathy due to risk of worsening mental status?

Sedatives and opioids

Diuretics

Antibiotics

Antiemetics

7. A nurse assesses a patient and notes slurred speech, confusion, and inability to perform simple math. What grade of encephalopathy is this?

Grade III

Grade I

Grade II

Grade IV

8. The pathogenesis of hepatic encephalopathy involves accumulation of which substance?

Ammonia

Bilirubin

Direct hyperbilirubinemia

Albumin

9. Which condition would NOT typically precipitate hepatic encephalopathy in a cirrhotic patient?

Mild dehydration

Spontaneous bacterial peritonitis

Upper gastrointestinal bleeding

Renal failure

10. A patient is prescribed neomycin for hepatic encephalopathy. Why is monitoring kidney function important?

Neomycin is nephrotoxic and renally excreted

It increases urine ammonia excretion

It prevents electrolyte imbalances

It enhances liver synthetic function

11. What is the primary cause of hepatic encephalopathy in patients with cirrhosis?

Accumulation of ammonia and other neurotoxic substances

Direct viral invasion of brain tissue

Acute bacterial infection of cerebrospinal fluid

Hypoglycemia from impaired gluconeogenesis

12. What dietary protein restriction, if any, should be implemented for a patient with hepatic encephalopathy?

Restrict to 40-60g daily; use plant-based or BCAA-enriched sources

Complete protein elimination

Increase protein to 100g daily

No restriction; protein is beneficial

13. A patient with cirrhosis develops asterixis. This sign indicates damage primarily to which structure?

Central nervous system

Peripheral nervous system

Spinal cord

Cranial nerves

14. Which lab value is most critical to monitor in a patient with suspected hepatic encephalopathy?

Serum ammonia level

White blood cell count

Hemoglobin and hematocrit

Platelet count

15. Rifaxomicin is used in hepatic encephalopathy to reduce ammonia-producing bacteria. What is its mechanism?

Non-absorbed antibiotic that targets gut flora

Increases hepatic blood flow

Promotes ammonia metabolism in the liver

Enhances albumin synthesis

16. A patient with liver failure shows Grade II encephalopathy. Which behavior would you expect?

Lethargy, personality changes, and impaired judgment

Complete loss of consciousness

Normal mental status with mild confusion only

Aggressive behavior with violent outbursts

17. Which of the following is a precipitating factor for hepatic encephalopathy?

Infection, gastrointestinal bleeding, or medication noncompliance

Excessive protein intake alone

High carbohydrate diet

Increased physical activity

18. What is the purpose of administering branched-chain amino acids (BCAA) in hepatic encephalopathy?

To compete with aromatic amino acids and reduce neurotoxin formation

To increase urine output and ammonia excretion

To promote rapid healing of hepatic tissue

To prevent bacterial translocation from the gut

19. A patient with cirrhosis has elevated blood ammonia levels. Which medication would be most appropriate to reduce ammonia?

Lactulose

Furosemide

Spironolactone