Liver Cirrhosis Quiz Questions And Answers

1. Situation: Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver:

The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased risk for excessive bleeding primarily because of the following:

Impaired clotting mechanism

Varix formation

Inadequate nutrition

The trauma of the invasive procedure

Cirrhosis of the liver can lead to impaired clotting mechanism due to decreased production of clotting factors by the damaged liver cells. This can result in a decreased ability of the blood to clot properly, leading to an increased risk of bleeding.

Explanation

Cirrhosis of the liver can lead to impaired clotting mechanism due to decreased production of clotting factors by the damaged liver cells. This can result in a decreased ability of the blood to clot properly, leading to an increased risk of bleeding.

2. Mr. Gonzales develops hepatic encephalopathy. Which clinical manifestation is most common with this condition?

Increased urine output

Altered level of consciousness

Decreased tendon reflex

Hypotension

Hepatic encephalopathy is a condition that occurs when the liver is unable to remove toxins from the blood, leading to a buildup of ammonia and other harmful substances. The most common clinical manifestation of hepatic encephalopathy is an altered level of consciousness. This can range from mild confusion and disorientation to severe confusion, coma, and even death. Other symptoms may include changes in behavior, personality, motor function, and sleep patterns. Increased urine output, decreased tendon reflex, and hypotension are not typically associated with hepatic encephalopathy.

Explanation

Hepatic encephalopathy is a condition that occurs when the liver is unable to remove toxins from the blood, leading to a buildup of ammonia and other harmful substances. The most common clinical manifestation of hepatic encephalopathy is an altered level of consciousness. This can range from mild confusion and disorientation to severe confusion, coma, and even death. Other symptoms may include changes in behavior, personality, motor function, and sleep patterns. Increased urine output, decreased tendon reflex, and hypotension are not typically associated with hepatic encephalopathy.

3. Nurse Cynthia is providing discharge teaching to a client with chronic cirrhosis. His wife asks her to explain why there is so much emphasis on bleeding precautions. Which of the following provides the most appropriate response?

“The low protein diet will result in reduced clotting.”

“The increased production of bile decreases clotting factors.”

“The liver affected by cirrhosis is unable to produce clotting factors.”

“The required medications reduce clotting factors.”

The liver affected by cirrhosis is unable to produce clotting factors. In chronic cirrhosis, the liver becomes scarred and loses its ability to function properly. One of the functions of the liver is to produce clotting factors that are necessary for blood to clot and prevent excessive bleeding. When the liver is damaged, it cannot produce these clotting factors, leading to a higher risk of bleeding. Therefore, emphasizing bleeding precautions is important to prevent complications and ensure the client's safety.

Explanation

The liver affected by cirrhosis is unable to produce clotting factors. In chronic cirrhosis, the liver becomes scarred and loses its ability to function properly. One of the functions of the liver is to produce clotting factors that are necessary for blood to clot and prevent excessive bleeding. When the liver is damaged, it cannot produce these clotting factors, leading to a higher risk of bleeding. Therefore, emphasizing bleeding precautions is important to prevent complications and ensure the client's safety.

4. The nurse is caring for a client with cirrhosis of the liver, which has developed esophageal varices. Does the nurse understand that the best explanation for the development of esophageal varices is which of the following?

Chronic low serum protein levels result in inadequate tissue repair, allowing the esophageal wall to weaken.

The development of esophageal varices in a client with cirrhosis of the liver is best explained by increased portal pressure causing blood to be shunted to the esophageal vessels. This increased pressure leads to the formation of varicosities in the esophagus. Chronic low serum protein levels, liver enlargement pressing on the diaphragm, and displacement of the esophagus by the enlarged liver are not the primary factors contributing to the development of esophageal varices in this case.

Explanation

The development of esophageal varices in a client with cirrhosis of the liver is best explained by increased portal pressure causing blood to be shunted to the esophageal vessels. This increased pressure leads to the formation of varicosities in the esophagus. Chronic low serum protein levels, liver enlargement pressing on the diaphragm, and displacement of the esophagus by the enlarged liver are not the primary factors contributing to the development of esophageal varices in this case.

5. The nurse is caring for a male client with cirrhosis. Which of the following assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?

Dyspnea and fatigue

Ascites and orthopnea

Purpura and petechiae

Gynecomastia and testicular atrophy

Purpura and petechiae are both indicative of bleeding disorders, which can occur due to deficient vitamin K absorption caused by hepatic disease. Vitamin K is necessary for the synthesis of clotting factors in the liver, and when there is a deficiency, it can lead to easy bruising, purpura (purple discoloration of the skin), and petechiae (small red or purple spots on the skin). Dyspnea and fatigue, ascites and orthopnea, and gynecomastia and testicular atrophy are not directly related to vitamin K deficiency in cirrhosis.

Explanation

Purpura and petechiae are both indicative of bleeding disorders, which can occur due to deficient vitamin K absorption caused by hepatic disease. Vitamin K is necessary for the synthesis of clotting factors in the liver, and when there is a deficiency, it can lead to easy bruising, purpura (purple discoloration of the skin), and petechiae (small red or purple spots on the skin). Dyspnea and fatigue, ascites and orthopnea, and gynecomastia and testicular atrophy are not directly related to vitamin K deficiency in cirrhosis.

6. A client with cirrhosis is at risk for developing complications. Which condition is the most serious and potentially life-threatening?

Esophageal varices

Ascites

Peripheral edema

Asterixis (liver flap)

Esophageal varices are the most serious and potentially life-threatening condition for a client with cirrhosis. Esophageal varices are enlarged, swollen veins in the lower part of the esophagus, and they can rupture and cause severe bleeding. This can lead to life-threatening hemorrhage and requires immediate medical intervention. Ascites, peripheral edema, and asterixis are also common complications of cirrhosis, but they are not as immediately life-threatening as esophageal varices.

Explanation

Esophageal varices are the most serious and potentially life-threatening condition for a client with cirrhosis. Esophageal varices are enlarged, swollen veins in the lower part of the esophagus, and they can rupture and cause severe bleeding. This can lead to life-threatening hemorrhage and requires immediate medical intervention. Ascites, peripheral edema, and asterixis are also common complications of cirrhosis, but they are not as immediately life-threatening as esophageal varices.

7. Situation: Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver: Which laboratory test indicates liver cirrhosis?

Decreased red blood cell count

Decreased serum acid phosphate level

Elevated white blood cell count

Elevated serum aminotransferase levels

Elevated serum aminotransferase levels indicate liver cirrhosis. Aminotransferases are enzymes present in liver cells, and their levels increase when there is liver damage or inflammation. In cirrhosis, the liver cells are damaged and replaced by scar tissue, leading to elevated levels of aminotransferases in the blood. This test is commonly used to assess liver function and diagnose liver diseases such as cirrhosis.

Explanation

Elevated serum aminotransferase levels indicate liver cirrhosis. Aminotransferases are enzymes present in liver cells, and their levels increase when there is liver damage or inflammation. In cirrhosis, the liver cells are damaged and replaced by scar tissue, leading to elevated levels of aminotransferases in the blood. This test is commonly used to assess liver function and diagnose liver diseases such as cirrhosis.

8. Which of the following findings would strongly indicate the possibility of cirrhosis?

Dry skin

Hepatomegaly

Peripheral edema

Pruritus

Hepatomegaly, which refers to an enlarged liver, would strongly indicate the possibility of cirrhosis. Cirrhosis is a condition characterized by the progressive scarring and damage of the liver, leading to its dysfunction. Hepatomegaly is a common symptom of cirrhosis and occurs due to the accumulation of scar tissue and fat in the liver, causing it to enlarge. Other symptoms of cirrhosis may include dry skin, peripheral edema (swelling in the legs and ankles), and pruritus (itching). However, hepatomegaly is a more specific and direct indicator of cirrhosis.

Explanation

Hepatomegaly, which refers to an enlarged liver, would strongly indicate the possibility of cirrhosis. Cirrhosis is a condition characterized by the progressive scarring and damage of the liver, leading to its dysfunction. Hepatomegaly is a common symptom of cirrhosis and occurs due to the accumulation of scar tissue and fat in the liver, causing it to enlarge. Other symptoms of cirrhosis may include dry skin, peripheral edema (swelling in the legs and ankles), and pruritus (itching). However, hepatomegaly is a more specific and direct indicator of cirrhosis.

9. Which is the largest lobe of the liver?

Right

Left

Quadrate

Caudate

The right lobe of the liver is the largest lobe. It is located on the right side of the body and is responsible for performing many vital functions such as detoxification, metabolism, and production of bile. The right lobe is larger than the left lobe and is divided into two further lobes, the anterior and posterior lobes. This division allows for efficient functioning and distribution of blood flow within the liver. The right lobe also has a larger surface area compared to the other lobes, enabling it to carry out its functions effectively.

Explanation

The right lobe of the liver is the largest lobe. It is located on the right side of the body and is responsible for performing many vital functions such as detoxification, metabolism, and production of bile. The right lobe is larger than the left lobe and is divided into two further lobes, the anterior and posterior lobes. This division allows for efficient functioning and distribution of blood flow within the liver. The right lobe also has a larger surface area compared to the other lobes, enabling it to carry out its functions effectively.

10. Ultrasound is the best modality to differentiate a liver cyst from a solid mass.

True

False

Ultrasound is the best modality to differentiate a liver cyst from a solid mass because it is a non-invasive imaging technique that uses sound waves to create real-time images of the liver. It can accurately distinguish between fluid-filled cysts and solid masses based on their characteristic appearance on the ultrasound images. Cysts typically appear as well-defined, anechoic (black) lesions, while solid masses may have irregular borders and show different echogenicity (brightness) patterns. Other imaging modalities like CT or MRI may also be used, but ultrasound is often preferred as the initial imaging modality due to its high sensitivity and specificity in differentiating liver cysts from solid masses.

Explanation

Ultrasound is the best modality to differentiate a liver cyst from a solid mass because it is a non-invasive imaging technique that uses sound waves to create real-time images of the liver. It can accurately distinguish between fluid-filled cysts and solid masses based on their characteristic appearance on the ultrasound images. Cysts typically appear as well-defined, anechoic (black) lesions, while solid masses may have irregular borders and show different echogenicity (brightness) patterns. Other imaging modalities like CT or MRI may also be used, but ultrasound is often preferred as the initial imaging modality due to its high sensitivity and specificity in differentiating liver cysts from solid masses.

11. A Sengstaken-Blakemore tube is inserted in an effort to stop the bleeding of esophageal varices in a patient with complicated liver cirrhosis. Upon insertion of the tube, the client complains of difficulty of breathing. The first action of the nurse is to:

Deflate the esophageal balloon.

Monitor VS

Encourage him to take deep breaths.

Notify the MD

The correct answer is to deflate the esophageal balloon. When a Sengstaken-Blakemore tube is inserted, it has two balloons - one in the esophagus and one in the stomach. The purpose of the esophageal balloon is to apply pressure to the bleeding varices and stop the bleeding. However, if the client complains of difficulty breathing, it indicates that the esophageal balloon may be obstructing the airway. Deflating the esophageal balloon will relieve the obstruction and improve the client's breathing. Monitoring vital signs and notifying the MD are important actions, but the immediate priority is to address the client's breathing difficulty.

Explanation

The correct answer is to deflate the esophageal balloon. When a Sengstaken-Blakemore tube is inserted, it has two balloons - one in the esophagus and one in the stomach. The purpose of the esophageal balloon is to apply pressure to the bleeding varices and stop the bleeding. However, if the client complains of difficulty breathing, it indicates that the esophageal balloon may be obstructing the airway. Deflating the esophageal balloon will relieve the obstruction and improve the client's breathing. Monitoring vital signs and notifying the MD are important actions, but the immediate priority is to address the client's breathing difficulty.

12. A client with advanced cirrhosis of the liver is not tolerating protein well, as tested by abnormal laboratory values. Does the nurse anticipate what medications will be prescribed for the client?

Lactulose (Chronulac)

Ethacrynic acid (Edecrin)

Folic acid (Folvite)

Thiamine (Vitamin B1)

not-available-via-ai

Explanation

not-available-via-ai

13. A male client with a history of cirrhosis and alcoholism is admitted to the hospital with severe dyspnea resulting in ascites. The nurse must be aware that the ascites are most likely the result of increased.

Pressure in the portal vein

Production of serum albumin

Secretion of bile salts

Interstitial osmotic pressure

Ascites is the accumulation of fluid in the abdominal cavity and is a common complication of cirrhosis. In cirrhosis, there is increased resistance to blood flow in the liver, leading to increased pressure in the portal vein. This increased pressure causes fluid to leak out of the blood vessels and into the abdominal cavity, resulting in ascites. Therefore, the correct answer is "Pressure in the portal vein."

Explanation

Ascites is the accumulation of fluid in the abdominal cavity and is a common complication of cirrhosis. In cirrhosis, there is increased resistance to blood flow in the liver, leading to increased pressure in the portal vein. This increased pressure causes fluid to leak out of the blood vessels and into the abdominal cavity, resulting in ascites. Therefore, the correct answer is "Pressure in the portal vein."

14. In a female, the liver weighs about

1200 to 1400 g

1400 to 1600 g

1800 mg

1000 g

The correct answer is 1200 to 1400 g. This is because the average weight of the liver in a female is approximately 1200 to 1400 grams.

Explanation

The correct answer is 1200 to 1400 g. This is because the average weight of the liver in a female is approximately 1200 to 1400 grams.

15. What is the normal liver span?

8-13cm

2-3cm

1 foot

6-12cm

The normal liver span is typically between 6-12cm. This range represents the average size of a healthy liver in adults. The liver span can vary slightly depending on factors such as age, sex, and body size. It is important to note that liver span can be influenced by certain medical conditions or abnormalities, so individual variations may occur.

Explanation

The normal liver span is typically between 6-12cm. This range represents the average size of a healthy liver in adults. The liver span can vary slightly depending on factors such as age, sex, and body size. It is important to note that liver span can be influenced by certain medical conditions or abnormalities, so individual variations may occur.

16. The right lobe of the liver occupies the epigastrium.

True

False

The right lobe of the liver does not occupy the epigastrium. The epigastrium is the upper central region of the abdomen, while the right lobe of the liver is located on the right side of the abdomen, beneath the diaphragm. Therefore, the statement is false.

Explanation

The right lobe of the liver does not occupy the epigastrium. The epigastrium is the upper central region of the abdomen, while the right lobe of the liver is located on the right side of the abdomen, beneath the diaphragm. Therefore, the statement is false.

17. A man is admitted to the nursing care unit with a diagnosis of cirrhosis. He has a history of alcohol dependence. In the late evening following his admission, the patient became increasingly disoriented and agitated. What would the patient be least likely to experience?

Diaphoresis and tremors.

Increased blood pressure and heart rate.

Illusions.

Delusions of grandeur.

Delusions of grandeur are not typically associated with cirrhosis or alcohol dependence. They are more commonly seen in conditions such as schizophrenia or bipolar disorder. The patient is more likely to experience symptoms such as diaphoresis and tremors, increased blood pressure and heart rate, and illusions due to the effects of alcohol withdrawal.

Explanation

Delusions of grandeur are not typically associated with cirrhosis or alcohol dependence. They are more commonly seen in conditions such as schizophrenia or bipolar disorder. The patient is more likely to experience symptoms such as diaphoresis and tremors, increased blood pressure and heart rate, and illusions due to the effects of alcohol withdrawal.

18. Which of the following is NOT a liver function?

Conversion of excess glucose into glycogen for storage

Conversion of conjugated bile to unconjugated bile

Regulation blood coagulation

Production of bile salts

Conversion of ammonia to urea

The liver performs various functions, including the conversion of excess glucose into glycogen for storage, regulation of blood coagulation, production of bile salts, and conversion of ammonia to urea. However, the liver does not convert conjugated bile to unconjugated bile. Bile is produced by the liver and stored in the gallbladder, and it plays a role in the digestion and absorption of fats. Conjugated bile refers to bile that has been modified by the liver to make it water-soluble, while unconjugated bile refers to bile that has not undergone this modification.

Explanation

The liver performs various functions, including the conversion of excess glucose into glycogen for storage, regulation of blood coagulation, production of bile salts, and conversion of ammonia to urea. However, the liver does not convert conjugated bile to unconjugated bile. Bile is produced by the liver and stored in the gallbladder, and it plays a role in the digestion and absorption of fats. Conjugated bile refers to bile that has been modified by the liver to make it water-soluble, while unconjugated bile refers to bile that has not undergone this modification.

19. What does the left lobe occupy?

Right and left hypochondrium

Epigastrium and some left hypochondrium

Right hypochondrium and epigastrium

Epigastrium and umbilicus

The left lobe occupies the epigastrium and some left hypochondrium.

Explanation

The left lobe occupies the epigastrium and some left hypochondrium.

20. The pancreas is ____ to the ____ lobe of the liver.

Inferior, left

Inferior, right

Superior, left

Inferior, caudate

The pancreas is located below or inferior to the left lobe of the liver.

Explanation

The pancreas is located below or inferior to the left lobe of the liver.

21. The liver is suspended from the diaphragm and abdominal wall by

Falciform ligament

Ligament teres

Ligament venosum

Subphrenic ligaments

The falciform ligament is a structure that attaches the liver to the diaphragm and abdominal wall. It is a thin, flat ligament that runs from the anterior surface of the liver to the anterior abdominal wall. This ligament helps to stabilize the liver and maintain its position within the abdominal cavity. The other options listed, such as the ligament teres, ligament venosum, and subphrenic ligaments, do not play a role in suspending the liver.

Explanation

The falciform ligament is a structure that attaches the liver to the diaphragm and abdominal wall. It is a thin, flat ligament that runs from the anterior surface of the liver to the anterior abdominal wall. This ligament helps to stabilize the liver and maintain its position within the abdominal cavity. The other options listed, such as the ligament teres, ligament venosum, and subphrenic ligaments, do not play a role in suspending the liver.

22. What separates the right lobe from the left lobe?

Falciform ligament

Right hepatic vein

Ligament teres

Portal vein

The falciform ligament is a thin, crescent-shaped structure that attaches the liver to the anterior abdominal wall and separates the right and left lobes of the liver. It is located in the middle of the liver and serves as a landmark for dividing the liver into its two main lobes. The right hepatic vein, ligament teres, and portal vein are not involved in separating the right lobe from the left lobe.

Explanation

The falciform ligament is a thin, crescent-shaped structure that attaches the liver to the anterior abdominal wall and separates the right and left lobes of the liver. It is located in the middle of the liver and serves as a landmark for dividing the liver into its two main lobes. The right hepatic vein, ligament teres, and portal vein are not involved in separating the right lobe from the left lobe.

23. Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

Alcoholic cirrhosis

Postnecrotic cirrhosis

Biliary cirrhosis

Compensated cirrhosis

Alcoholic cirrhosis is the correct answer because it refers to a chronic liver disease that is caused by excessive and prolonged alcohol consumption. This disease occurs when scar tissue forms in the liver, specifically around the portal areas. The scarring disrupts the normal functioning of the liver and can lead to complications such as liver failure.

Explanation

Alcoholic cirrhosis is the correct answer because it refers to a chronic liver disease that is caused by excessive and prolonged alcohol consumption. This disease occurs when scar tissue forms in the liver, specifically around the portal areas. The scarring disrupts the normal functioning of the liver and can lead to complications such as liver failure.

24. Nurse Juvy is taking care of a patient with cirrhosis of the liver. To lessen the effects of the disorder, the nurse teaches the patient about foods high in thiamine. The nurse determines that the patient has the best understanding of the dietary measures to follow if the client states an intention to increase the intake of:

Pork

Milk

Chicken

Broccoli

Thiamine, also known as vitamin B1, is an essential nutrient that plays a crucial role in the metabolism of carbohydrates. It is commonly found in pork, which is why increasing the intake of pork would be the best choice for a patient with cirrhosis of the liver. Milk, chicken, and broccoli are not particularly high in thiamine compared to pork, so they would not be as effective in lessening the effects of the disorder.

Explanation

Thiamine, also known as vitamin B1, is an essential nutrient that plays a crucial role in the metabolism of carbohydrates. It is commonly found in pork, which is why increasing the intake of pork would be the best choice for a patient with cirrhosis of the liver. Milk, chicken, and broccoli are not particularly high in thiamine compared to pork, so they would not be as effective in lessening the effects of the disorder.

25. Right Lobe length

15-17 cm

20-22 cm

10-12.5 cm

The right lobe length of an organ is typically measured in centimeters. In this case, the correct answer is 15-17 cm, which means that the length of the right lobe falls within this range.

Explanation

The right lobe length of an organ is typically measured in centimeters. In this case, the correct answer is 15-17 cm, which means that the length of the right lobe falls within this range.

26. The fundus of the stomach in relation to the liver

Posterior and superior to the right lobe

Anterior and lateral to the left lobe

Posterior and lateral to the left lobe

Inferior to the left lobe

The fundus of the stomach is located at the upper part of the stomach. It is positioned behind and to the side of the left lobe of the liver. This means that it is posterior (behind) and lateral (to the side) to the left lobe of the liver.

Explanation

The fundus of the stomach is located at the upper part of the stomach. It is positioned behind and to the side of the left lobe of the liver. This means that it is posterior (behind) and lateral (to the side) to the left lobe of the liver.

27. The left hepatic vein divides the left lobe into

Medial and lateral lobes

Anterior and posterior halves

Superior and inferior halves

Left and right parts of the left lobe

The left hepatic vein divides the left lobe into medial and lateral lobes. This means that the left lobe of the liver is divided into two distinct sections - one closer to the middle of the body (medial lobe) and one towards the side (lateral lobe). This division allows for better anatomical understanding and surgical interventions if needed.

Explanation

The left hepatic vein divides the left lobe into medial and lateral lobes. This means that the left lobe of the liver is divided into two distinct sections - one closer to the middle of the body (medial lobe) and one towards the side (lateral lobe). This division allows for better anatomical understanding and surgical interventions if needed.

28. A nurse is completing an assessment of a client with cirrhosis. Which of the following nursing assessments is important to notify the physician?

Expanding ecchymosis

Ascites and serum albumin of 3.2 g/dl

Slurred speech

Hematocrit of 37% and hemoglobin of 12g/dl

Expanding ecchymosis refers to the development of new or worsening bruises on the skin. This can be indicative of impaired clotting mechanisms and may suggest that the client's liver function is deteriorating further. It is important to notify the physician about this finding as it may require immediate medical intervention to prevent further complications.

Explanation

Expanding ecchymosis refers to the development of new or worsening bruises on the skin. This can be indicative of impaired clotting mechanisms and may suggest that the client's liver function is deteriorating further. It is important to notify the physician about this finding as it may require immediate medical intervention to prevent further complications.

29. Which diagnostic test is best to evaluate liver enlargement and ascites?

Ultrasound

X-Ray

CT scan

Nuclear Medicine

Arteriogram

The best diagnostic test to evaluate liver enlargement and ascites is Ultrasound.

Ultrasound is a non-invasive imaging technique that uses sound waves to create real-time images of the liver and abdominal cavity. It is particularly effective in detecting liver enlargement, identifying the presence and extent of ascites (fluid accumulation in the abdomen), and evaluating the overall condition of the liver and surrounding structures. Ultrasound is widely used in clinical practice for this purpose due to its safety, affordability, and effectiveness in providing valuable diagnostic information.

Explanation

The best diagnostic test to evaluate liver enlargement and ascites is Ultrasound.

Ultrasound is a non-invasive imaging technique that uses sound waves to create real-time images of the liver and abdominal cavity. It is particularly effective in detecting liver enlargement, identifying the presence and extent of ascites (fluid accumulation in the abdomen), and evaluating the overall condition of the liver and surrounding structures. Ultrasound is widely used in clinical practice for this purpose due to its safety, affordability, and effectiveness in providing valuable diagnostic information.

30. How many times larger is the right lobe of the liver than the left?

2

4

6

8

The right lobe of the liver is six times larger than the left lobe. This means that the right lobe is significantly bigger in size compared to the left lobe.

Explanation

The right lobe of the liver is six times larger than the left lobe. This means that the right lobe is significantly bigger in size compared to the left lobe.