Liver Cirrhosis (15 Questions)

1.1 Mr. Jean-Marc Thibault, 67 years old, has a history of liver cirrhosis secondary to chronic alcohol use. He is admitted with increasing abdominal distension and shortness of breath. On assessment, you note that his abdomen is tense and distended, and he is visibly uncomfortable when lying flat.

The physician diagnoses ascites and prescribes a therapeutic paracentesis, which is performed in the procedure room. A total of 4 liters of fluid is drained, and the patient returns to the unit stable.

Question:
What is the most appropriate assessment to confirm the effectiveness of the paracentesis? *
1.2 Mr. Jean-Marc Thibault, a 67-year-old man with liver cirrhosis and a history of esophageal varices, is under observation in the medical unit. He is afebrile, but today his white blood cell (WBC) count is 12.3 × 10⁹/L (normal: 4.0 – 11.0 × 10⁹/L) and his hemoglobin (Hgb) is 172 g/L (normal: 135 – 170 g/L for males).

This morning, he had a bowel movement and appears slightly pale and more fatigued than usual.

Question:
Which of the following questions should you ask Mr. Thibault? *
1.3 Mr. Jean-Marc Thibault, diagnosed with liver cirrhosis and a history of esophageal varices, has been on a soft diet since his hospital admission. Today, he asks the nurse:

“Why do I have to eat only soft foods? I’ve been here a few days, and I haven’t had any regular meals.”

Question:
Which explanation is the most appropriate? *
2. M. Jacques Tremblay, 58 years old, has a history of alcohol-induced cirrhosis. He is brought to the Emergency Department after vomiting a large amount of bright red blood. Upon assessment, he is pale, anxious, and lethargic. His abdomen is distended (ascites).

Vital Signs:
*BP 88/50 mmHg.
*HR 120 bpm.
*RR 24.
*SpO2 92%.

Medical Orders:
*Establish 2 large-bore IVs STAT.
*Type and Crossmatch 4 units PRBCs.
*Octreotide (Sandostatin) 50 mcg IV bolus, then 50 mcg/hr.
*Pantoprazole 80 mg IV bolus.

Question:
What is the nurse’s priority action? *
3. Mme. Ginette Roy, 65 years old, is admitted with decompensated cirrhosis. Her family reports that she has been confused, forgetful, and has been sleeping all day (somnolence). The nurse notes a distinct sweet/musty odor to her breath (Fetor Hepaticus) and flapping tremors of the hands (Asterixis).

Lab Results:
*Ammonia: 110 µmol/L (High).

Medical Orders:
*Lactulose 30 mL PO QID.
*Goal: 2-3 soft stools per day.

Question:
The patient’s daughter asks, "Why are you giving her a laxative when she is confused? She isn't constipated." What is the nurse’s explanation? *
4. M. Pierre Gagnon, 50 years old, has tense ascites causing severe shortness of breath. The physician plans to perform a bedside Paracentesis to remove 4 Liters of fluid.

Medical Orders:
*Prepare for Paracentesis.
*Albumin 25% IV infusion post-procedure.

Question:
What is the priority nursing intervention before the procedure begins? *
5. Mme. Claire Bouchard, 48 years old, with Primary Biliary Cholangitis (Cirrhosis), complains of intense, unbearable itching (pruritus) all over her body. Her skin is jaundiced and has multiple scratch marks.

Medical Orders:
*Cholestyramine (Questran) powder PO.
*Skin care protocol.

Question:
What teaching should the nurse provide regarding the administration of Cholestyramine? *
6. M. Robert Fortin, 60 years old, is being discharged with stable cirrhosis and mild ascites. The nurse is reviewing his diet.

Medical Orders:
*Diuretic therapy (Spironolactone/Furosemide).
*Dietary modifications.

Question:
Which dietary instruction is most critical for managing his fluid retention? *
7. M. Sylvain Cote, 55 years old, is scheduled for a liver biopsy. The nurse reviews his morning coagulation profile.

Lab Results:
*INR: 2.5 (Normal < 1.1).
*Platelets: 60 x 10⁹/L (Low).
*aPTT: 50 seconds (Prolonged).

Medical Orders:
*Liver Biopsy at 14:00.

Question:
What is the nurse’s priority action? *
8. Mme. Sophie Lemieux, 62 years old, is admitted with confusion. The nurse asks her to extend her arms and hold her hands out in a "stop" position with wrists dorsiflexed. The nurse observes a rapid, non-rhythmic flapping of the hands.

Question:
How should the nurse document this finding? *
9. M. Michel Desjardins, 64 years old, has advanced cirrhosis and massive ascites. Over the last 24 hours, his urine output has dropped significantly.

Assessment:
*Urine Output: < 20 mL/hr.
*BP: 90/60 mmHg.
*Creatinine: Rose from 90 to 180 µmol/L.
*BUN: Elevated.

Medical Orders:
*Challenge with Albumin IV.

Question:
What complication does the nurse suspect? *
10. Mme. Valérie Turcotte, 40 years old, has cirrhosis and low platelets (50,000). The nurse is planning her daily care.

Question:
Which nursing intervention is appropriate to prevent injury? *
11. M. André Lemieux, 52 years old, is being discharged. He asks the nurse what he can take for a headache or mild pain at home.

Medical Orders:
*Discharge teaching.

Question:
What is the safest recommendation? *
12. M. Claude Gagnon, 52 years old, has cirrhosis with massive esophageal variceal bleeding that could not be controlled by endoscopy. A Sengstaken-Blakemore tube was inserted 2 hours ago, and both the esophageal and gastric balloons are inflated. The nurse enters the room and finds M. Gagnon sitting bolt upright, gasping for air, cyanotic, and pointing frantically at his throat. The nurse auscultates and hears stridor and diminished breath sounds. The patient cannot speak.

Medical Orders:
*Sengstaken-Blakemore tube in place.
*Monitor airway continuously.
*Keep emergency equipment at bedside.

Question:
What emergency equipment must be kept immediately available at the bedside for this patient? *
13. Mme. Isabelle Tremblay, 48 years old, is in the ICU with a Sengstaken-Blakemore tube in place to control massive variceal hemorrhage. Both balloons are inflated to the prescribed pressure. While checking the patient, the nurse observes that Mme. Tremblay suddenly becomes extremely anxious, cyanotic, and grabs her throat. She is making choking sounds, and her SpO2 drops rapidly to 80%.

Medical Orders:
*Strict bed rest.
*Monitor airway and tube placement.
*Emergency scissors at bedside.

Question:
What is the nurse’s initial priority intervention? *