Cirrhosis / GI bleed

1. What are some causes of Cirrhosis? Select all that apply.

A. ETOH

B. Hepatitis A

C. Hepatitis B

D. Hepatitis C

E. Eating healthy

F. Exercise

A. ETOH
C. Hepatitis B
D. Hepatitis C

2. Why would a paracentesis be effective in ascites?

A. It would be effective because a paracentesis removes fluid from around the heart.

B. It would be effective because a paracentesis removes fluid from your chest cavity.

C. It would be effective because a paracentesis can remove fluid from the lungs.

D. It would be effective because a paracentesis removes fluid from the abdomen.

D. It would be effective because a paracentesis removes fluid from the abdomen.

Why do patients with cirrhosis often have decreased serum blood glucose levels?

A. Hypoglycemia is a minor complication during the later stages of liver damage due to decreased appetite and nausea

B. The liver cannot keep up with the body's metabolic demands due to changes in glycogen metabolism

C. When alcoholic patients are diagnosed with cirrhosis, they stop binge-drinking which causes decreases in blood glucose during the withdrawal phase

D. The communication pathway between the liver and pancreas is impaired due to the formation of esophageal varices

B. The liver cannot keep up with the body's metabolic demands due to changes in glycogen metabolism

A patient with late-stage cirrhosis is likely to present with which of the following lab values? (select all that apply)

A. Increased bilirubin

B. Decreased liver enzymes

C. Decreased platelets

D. Decreased INR

A. Increased bilirubin

C. Decreased platelets

1. Which of the following types of hepatitis are transmitted through blood? Select all that apply.

a. Autoimmune hepatitis

b. Hepatitis A

c. Hepatitis B

d. Hepatitis C

c. Hepatitis B

d. Hepatitis C

2. Which of the following would NOT be a result of portal hypertension that is secondary to liver cirrhosis?

a. esophageal varices

b. hematemesis

c. increased albumin levels

d. increased fluid in the abdomen (ascites)

c. increased albumin levels

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

B. Ascites

C. Splenomegaly

E. Esophageal varices

Which of the following is NOT a role of the liver?

A. Removing hormones from the body
B. Producing bile
C. Absorbing water
D. Producing albumin

C. Absorbing water

What is a common complication of cirrhosis that occurs if blood is unable to get through the portal vein?

A. hepatic encephalopathy d/t build up of toxins

B. hepatitis A d/t build up of stool

C. fatty liver disease d/t excess fat in the liver

D. esophageal varices d/t portal hypertension

D. esophageal varices d/t portal hypertension

Which of the following could be causes of cirrhosis? Select all that apply:

A. Chronic alcohol use

B. GI bleed

C. Hepatitis B and C

D. Autoimmune hepatitis

A. Chronic alcohol use

C. Hepatitis B and C

D. Autoimmune hepatitis

1. Which of the following are signs/symptoms of Cirrhosis? (Select all that apply)

A. Ascites

B. Jaundice

C. Weight loss

D. Dehydration

E. Itching

A. Ascites

B. Jaundice

E. itching

2. What are patients with Cirrhosis at a higher risk for?

A. Increased risk of urinary tract infections due to increased bilirubin

B. Increased risk of bleeding due to the liver's clotting factors being damaged

C. Increased risk of dehydration because of fluid loss overtime

D. Increased risk of developing heart failure because of imbalanced fluids

B. Increased risk of bleeding due to the liver's clotting factors being damaged

1. When patients present with scarring of the liver, always ask what caused the scarring before judging. Things that can cause scarring are (select all that apply):

   1. ETOH

   2. Hepatitis B and C

   3. Autoimmune hepatitis

   4. Psoriasis

1. ETOH

2. Hepatitis B and C

3. Autoimmune hepatitis

1. In Cirrhosis, the liver becomes damaged and loses its ability to function properly,  one common finding will include:

   1. elevated BUN

   2.  hypoalbuminemia

   3.  Elevated troponin levels

   4. pruritus

hypoalbuminemia

High blood pressure in the portal vein is brought down by administering:

A. ACE Inhibitors

B. Beta Blockers

C. Antacids

D. BTK Inhibitors

B. Beta Blockers

According to Rideout's Massive Transfusion Protocol, at the start of the Code Crimson the primary nurse should:

A. Identify patient meeting criteria

B. Prior to admin of blood products, initial blood work should be drawn.

C. Place patient's blood band.

D. Identification and verification of patient and blood products with second nurse prior to blood admin.

B. Prior to admin of blood products, initial blood work should be drawn.

C. Place patient's blood band.

D. Identification and verification of patient and blood products with second nurse prior to blood admin. 

1. Which of the following is a common cause of upper GI bleeding?

a. Peptic ulcer disease

b. Hemorrhoids

c. Diverticulitis

d. Inflammatory bowel disease

a. Peptic ulcer disease

2. Which of the following are common signs and symptoms of a GI bleed? Select all that apply

a. Hematemesis (vomiting blood)

b. Black, tarry stools

c. Jaundice

d. Abdominal pain

a. Hematemesis (vomiting blood)

b. Black, tarry stools

d. Abdominal pain

A 47 year old patient is vomiting coffee-ground emesis. What diagnostic test should the nurse anticipate and prepare the patient for?

A. Colonoscopy

B. MRI

C. Endoscopy

D. Electrocardiogram

C. Endoscopy

2. A 49-year-old male patient presents with an upper GI bleed. A blood draw shows that their HGB level is 8.0g/dL (normal range 13-18g/dL). Which of the following treatments should the nurse anticipate for this patient? (CHOOSE ALL THAT APPLY)

A. NG tube placement for suction

B. Blood transfusion

C. Proton-pump inhibitors, like Protonix

D. Steroids

A. NG tube placement for suction

B. Blood transfusion

C. Proton-pump inhibitors, like Protonix

1. Which of the following is a common complication of cirrhosis?

A) Hypertension  
B) Ascites  
C) Diabetes Mellitus  
D) Osteoporosis  

B) Ascites  

2. Which of the following are potential causes of cirrhosis? Select all that apply

A) Chronic alcohol abuse  
B) Viral hepatitis  
C) Non-alcoholic fatty liver disease  
D) Diabetes Mellitus  
E) Autoimmune liver disease  

A) Chronic alcohol abuse  
B) Viral hepatitis  
C) Non-alcoholic fatty liver disease
E) Autoimmune liver disease  

Which of the following is something to educate a patient with an GI bleed about? (Select all that apply)

A) Smoking habits 

B) NSAIDS 

C) ETOH use 

D) Vitamin C intake

A) Smoking habits 

B) NSAIDS 

C) ETOH use 

As a nurse, what would be a good question to ask to help determine if the patient has an upper GI bleed? 

A) "Has the vomit been consisting of frank red blood?" 

B) "What type of alcohol do you drink?" 

C) "What sport do you watch the most?" 

D) "Why do you think you are here?"

A) "Has the vomit been consisting of frank red blood?" 

What is the initial treatment for a patient presenting with significant GI bleeding and signs of shock?

a) Oral rehydration
b) IV fluid resuscitation
c) Antibiotics
d) Antiemetic medications

b) IV fluid resuscitation

What are the clinical signs of significant blood loss in a patient with GI bleeding? (SATA)

a) Tachycardia

b) Hypotension

c) Bradycardia

d) Pale, cool skin

e) Elevated blood pressure

a) Tachycardia

b) Hypotension

d) Pale, cool skin

You are a nursing student following a nurse caring for a patient with a GI bleed. Your patient reports having coffee-ground emesis the day prior. Coffee ground emesis is an indicator that...

A. the patient consumed coffee grounds 

B. acid interacted with the blood that was sitting in the stomach 

C. acid interacted with the food in the patient's stomach 

D. the blood has not reached the stomach and is sitting above the stomach

B. acid interacted with the blood that was sitting in the stomach 

As a nurse taking care of a patient that has a Hgb of 8 with an active bleed, what are your priority actions to take? Select all that apply

A. Monitor H&H frequently 

B. Administer antiemetics IV or SL 

C. Administer antibiotics

D. Establish 2 large bore IVs 

E. Place patient on NPO status 

A. Monitor H&H frequently 

B. Administer antiemetics IV or SL

D. Establish 2 large bore IVs 

E. Place patient on NPO status 

1. Signs and symptoms of hypovolemic shock include (select all that apply):

A. Hypertension

B. Tachycardia

C. Tachypnea 

D. Pale, cool, clammy skin

E. Warm, pink skin

B. Tachycardia

C. Tachypnea 

D. Pale, cool, clammy skin

2. A patient with a history of cirrhosis presents to the ED with a GI bleed due to esophageal varices. What is the nurses priority intervention going to be?

A. Place an NG tube

B. Place 2 large bore IVs

C. Give beta-blockers as ordered

D. Give antibiotics as ordered 

B. Place 2 large bore IVs

Which of the following are common symptoms of cirrhosis? Select all that apply:

A) Itching of the skin
B) Jaundice
C) Increased appetite
D) Unintended weight loss

A) Itching of the skin
B) Jaundice
D) Unintended weight loss

Which of the following is a common laboratory finding in patients with cirrhosis?

A) Decreased bilirubin levels
B) Elevated liver enzymes (AST and ALT)
C) Increased albumin levels
D) Normal coagulation factors

B) Elevated liver enzymes (AST and ALT)

1. Select ALL that apply: What are some interventions associated with Cirrhosis: 

1. Long Term Antibiotics

2. Dietary Salt restriction

3. Massive Blood Transfusion

4. Paracentesis

1. Long Term Antibiotics

2. Dietary Salt restriction

   4. Paracentesis

1. What medication class is used to manage portal hypertension in cirrhosis?

1. Beta-Blockers

2. Diuretics

3. ACE inhibitors

4. Calcium channel blockers

1. Beta blockers

1. Which of the following is a common cause of cirrhosis?

a) Diabetes

b) Alcohol abuse

c) Hypertension

d) Asthma

b) Alcohol abuse

Which of the following symptoms are associated with cirrhosis? (Select all that apply)

- A) Jaundice

- B) Fatigue

- C) Increased appetite

- D) Swelling in the legs and abdomen

- E) Confusion

A) Jaundice

B) Fatigue

D) Swelling in the legs and abdomen

E) Confusion

When monitoring a patient for signs of hepatic encephalopathy, which should the nurse note that could indicate a worsening status?

A. Decrease in blood pressure

B. Increases in ammonia

C. Decrease in level of consciousness

D. Increase in respirations.

C. Decrease in level of consciousness

A nurse is caring for a patient with chirrosis, which indicate complications that a GI bleed has occured? SATA

A. Anemia

B. Tachycardia

C. Hematemesis

D. Ascites

A. Anemia

B. Tachycardia

C. Hematemesis

1. Which is the most common cause of GI bleed?

A. NSAID use

B. Smoking

C. H. pylori

D. Peptic Ulcer Disease

D. Peptic Ulcer Disease

2. A patient with a history of esophageal varices presents to the ED with GI bleed.  Which of the following are NOT expected interventions? Select all that apply.

A. Oxygen administration

B. NG tube placement

C. Insertion of 2 IV sites

D. Administration of vasopressin with nitroglycerin

E. Turn, cough, deep breathe every 2 hours

B. NG tube placement

E. Turn, cough, deep breathe every 2 hours

What are the signs of an upper GI bleed? (select all that apply)

a. Vomiting frank blood

b. Vomiting coffee ground looking emesis

c. Black and tarry looking stools

d. Coughing up green sputum

a. Vomiting frank blood

b. Vomiting coffee ground looking emesis

c. Black and tarry looking stools

When preparing to give a patient with a GI bleed a blood transfusion, what do you need to make sure that they have prior to transfusion?

a. 22 gauge IV

b. Large bore IV

c. NG tube

d. Have taken their daily NSAID

b. Large bore IV

1. Which of the following are causes of cirrhosis? Select all that apply:

Hepatitis A

viral hepatitis

ETOH

ascites

viral hepatitis

ETOH

2. The liver is involved in various functions for the body. Which of the following would not be impaired if a patient was diagnosed with cirrhosis?

ability to clot

bile production

lymphocyte production

ammonia excretion

lymphocyte production

A patient presents to the ED with an upper GI bleed caused by esophageal varices. Which of the following would the nurse not do?

a. Insert a large bore IV

b. Draw blood for a cross and type

c. Insert an NG tube.

d. Administer Zofran as needed for nausea.

c. Insert an NG tube.

Which of the following are involved in the process of administering blood? (select all that apply)

a. Start transfusion within 30 minutes of getting blood

b. Administer blood within 6 hours

c. double check blood before starting transfusion

d. Check Vitals every 5 minutes throughout transfusion

e. Administer blood with normal saline

a. Start transfusion within 30 minutes of getting blood
c. double check blood before starting transfusion
e. Administer blood with normal saline

The patient has an upper GI bleed, what medication should we anticipate to be ordered?

A. Metformin

B. Protonix

C. Warfarin

D. Furosemide

B. Protonix

Which of the following are common causes of upper GI bleed? (Select all that apply)

A. Cirrhosis

B. GERD

C. Hyperlipidemia

D. Alcoholism

A. Cirrhosis

B. GERD

D. Alcoholism

Which of the following can cause a GI bleed? (select all that apply)

A) Peptic Ulcer Disease (PUD)

B) Frequent use of NSAIDS

C) Hemorrhoids/constipation

D) Taking Protonix

A) Peptic Ulcer Disease (PUD)

B) Frequent use of NSAIDS

C) Hemorrhoids/constipation

Which of the following is NOT a way of helping to reduce the risk of a GI bleed?

A) Alcohol abuse

B) A high fiber diet

C) Limiting NSAID use

D) Treating causes of ulcers

A) Alcohol abuse

Your patient has been diagnosed with GI bleed due to gastric ulcers. What orders from the MD should you question as the nurse?

A. 40mg Protonix IV push BID

B. NS 120/hr continuous infusion

C. Zofran 10mg SL Q12hr PRN

D. 600mg ibuprofen PO Q6hr PRN

D. 600mg ibuprofen PO Q6hr PRN

Which of the following patient statements require re-education? Select all that apply.

A. I need to wait a week to heal before returning to my daily drinking.

B. I should avoid taking Tylenol and use Ibuprofen for pain.

C. I should come to the hospital if I throw up bright red blood

D. I may feel weak due to all the blood I have lost

A. I need to wait a week to heal before returning to my daily drinking.

B. I should avoid taking Tylenol and use Ibuprofen for pain.

1. As a nurse in the ER, you want to get a proper history on patient XX who has a GI bleed. What questions do you want to ask? Select all that apply

a. presence of cardiovascular, oncologic, or renal comorbidities

b. prior GI surgeries

c. abdominal pain

d. alteration in bowel habits

e. unintentional weight loss.

a. presence of cardiovascular, oncologic, or renal comorbidities

b. prior GI surgeries

c. abdominal pain

d. alteration in bowel habits

e. unintentional weight loss.

2. Patients with a GI bleed who are hemodynamically unstable should

a. be NPO to prevent more bleeding

b. only drink nonclear fluids to see if we still have a bleed

c. receive IV fluids with crystalloids with the goal of normalization of BP and HR

d. recover on their own with no medical intervention

c. receive IV fluids with crystalloids with the goal of normalization of BP and HR

1. Which of the following should the nurse educate a patient with cirrhosis on about preventing ascites? (select one)

A. Limit protein intake.

B. Low sodium diet to prevent fluid retention.

C. Increase sodium intake for fluid balance.

D. Limit alcoholic drinks to 4-5 a day.

B. Low sodium diet to prevent fluid retention.

2. Which clinical findings may present in a patient with cirrhosis? (select all that apply)

A. Peripheral edema

B. Hypoglycemia

C. Hematemesis

D. Jaundice

A. Peripheral edema
C. Hematemesis
D. Jaundice

Why would a patient that is diagnosed with cirrhosis be given lactulose? Select all that apply.

A. To decrease the ammonia levels within the blood

B. Cirrhosis patients have bowel issues

C. To treat constipation

D. Patient's with cirrhosis does not need lactulose. It would be a PRN instead of a scheduled medication.

A. To decrease the ammonia levels within the blood

B. Cirrhosis patients have bowel issues

C. To treat constipation

A patient diagnosed with cirrhosis is being taught self care. which statement indicates the patient needs MORE education?

A. "If I notice a fast heart rate and irregular beat, this is a normal symptom of cirrhosis"

B. "I need to take good care of my belly and ankle skin where it is swollen."

C. "If I stop drinking alcohol, it will revert my liver labs back to normal."

D. "I can use pillows to support my head to help me breathe when I am in bed."

A. "If I notice a fast heart rate and irregular beat, this is a normal symptom of cirrhosis"

If a patient presents to the hospital with complaints of vomiting and really bad stomach pain, what questions would you ask them as part of your assessment?

a. Is your cough productive?

b. What allergies do you have?

c. Can you describe your pain and where its located specifically?

d. What medications are you taking?

a. Is your cough productive?
c. Can you describe your pain and where its located specifically?
d. What medications are you taking?

How does a GI bleed affect your blood pressure?

a. causes hypertension

b. causes hypotension

c. There is no effect on blood pressure

d. If taken with specific medications, it could potentially cause tachycardia

b. causes hypotension

How would you manage ascites in a patient with cirrhosis?

a. fluid bolus

b. sodium restriction

c. discourage diuretics

d. increase sodium intake

b. sodium restriction

What are the most common causes of cirrhosis? Select all that apply.

a. hepatitis A infection

b. hepatitis B infection

c. hepatitis C infection

d. ETOH abuse

b. hepatitis B infection

c. hepatitis C infection

d. ETOH abuse

A possible complication of blood flow averting for esophageal varices can include:

A. MI

B. Liver failure

C. Ataxia

D. Rhabdomyolysis

B. Liver failure

Medications that the provider may prescribe to treat esophageal varices may include: (Select all that apply)

A. Beta blockers

B. NSAIDS

C. Vasopressin

D. Blood transfusion

A. Beta blockers
C. Vasopressin
D. Blood transfusion

Which of the following below are signs and symptoms of liver cirrhosis? Select all that apply.

Jaundice

Ascites

Esophageal varices

Hypotension

Portal hypertension

Jaundice

Ascites

Esophageal varices

Portal hypertension

Which nursing intervention would be the highest priority when caring for a patient with a ruptured esophageal varices? Multiple choice.

Place an NG Tube

Obtain IV access and start fluids

Protecting the airway

Place the patient in Trendelenburg

Protecting the airway

Which of the following signs might suggest the onset of hepatic encephalopathy?

A) Increased urine output

B) Confusion or altered mental status

C) Pain in the upper right quadrant

D) Decreased bowel sounds

B) Confusion or altered mental status

2. Which of the following points should be included in patient teaching when educating about liver cirrhosis? (Select all that apply)

A) Restrict sodium intake

B) Avoid alcohol consumption

C) Increase protein in the diet

D) Monitor for jaundice

E) Take acetaminophen for pain management

A) Restrict sodium intake

B) Avoid alcohol consumption

D) Monitor for jaundice

1. What lab tests should be ordered for a patient with a GI bleed? Select all that apply. 

a) PT/PTT/INR

b) AST/ALT

c) Lipid Panel

d) CBC 

a) PT/PTT/INR

b) AST/ALT

d) CBC 

2. What medications should be avoided for a patient with a GI bleed?

a) Proton Pump Inhibitors

b) NSAIDS

c) PRBCs/Blood products 

d) antiplatelets 

b) NSAIDS

A person with a GI bleed may present with which of the following symptoms. Select all that apply:

a. Frank blood

b. Coffee ground emesis

c. Tachycardia

d. Bradycardia

a. Frank blood

b. Coffee ground emesis

c. Tachycardia

Which of the following could potentially cause a GI bleed?

a. NG tube placement

b. Fingerstick test

c. Cryoprecipitate transfusion

a. NG tube placement

1 - Which of the following puts someone more at risk for GI bleeds

A) Use of NSAIDS

B) Excess Alcohol Consumption

C) Stress

D) Antacids

A) Use of NSAIDS

B) Excess Alcohol Consumption

C) Stress

2 - An Upper GI bleed can present with all of the following except, 

A) Dark Tarry Stools

B) Coffee Ground Emesis

C) Blood in stool

D) Vomiting Frank Blood

C) Blood in stool (if it refers specifically to bright red blood).

1) A nurse is caring for a patient with a suspected upper GI bleed. Which of the following symptoms would the nurse expect to find?

A) Bright red blood in the stool

B) Black, tarry stools

C) Abdominal cramps only

D) Weight gain

B) Black, tarry stools

A nurse is educating a group of students about the assessment of a patient with GI bleeding. Which of the following findings should the nurse tell the students to monitor? (Select all that apply)

A) H&H levels

B) Signs of shock (tachycardia, hypotension)

C) Presence of abdominal tenderness

D) Changes in skin color (pallor, jaundice)

E) Patient's appetite and dietary preferences

A) H&H levels

B) Signs of shock (tachycardia, hypotension)

C) Presence of abdominal tenderness

D) Changes in skin color (pallor, jaundice)

Out of the following medications, select all of the medications that may be given to a patient with a GI bleed

a. Protonix 

b. Zofran

c. Xanax

d. Gabapentin

a. Protonix 

b. Zofran

Which of the following is contraindicated in a patient with esophageal varices

a. NPO

b. NG tube 

c. HOB 30 degrees or higher 

d. IV NS

NG tube