Liver Diseases Practice Questions
20 free Liver Diseases practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
A nurse is caring for a client with advanced cirrhosis who has developed hepatic encephalopathy. Which laboratory result best correlates with the client's altered mental status?
- A Alanine aminotransferase (ALT) 120 U/L
- B Total bilirubin 3.2 mg/dL
- C Serum sodium 135 mEq/L
- D Serum ammonia 160 mcg/dL
Correct answer: Serum ammonia 160 mcg/dL
In liver failure, the liver is unable to convert ammonia, a byproduct of protein metabolism, into urea. Elevated ammonia levels cross the blood-brain barrier, leading to cognitive impairment and neuromuscular disturbances seen in hepatic encephalopathy.
A client with cirrhosis and esophageal varices is prescribed lactulose. The nurse determines the medication is effective based on which assessment finding?
- A The client's skin appears less jaundiced.
- B The client's abdominal girth has decreased by 2 inches.
- C The client's prothrombin time (PT) has returned to normal.
- D The client has two to three soft stools per day.
Correct answer: The client has two to three soft stools per day.
Lactulose is an osmotic laxative used in liver disease to promote the excretion of ammonia through the stool. The goal of therapy is typically two to three soft, acidic bowel movements per day to lower systemic ammonia levels.
A nurse is providing discharge teaching to a client recently diagnosed with Hepatitis A. Which statement by the client indicates a correct understanding of the transmission of this disease?
- A 'I should avoid sharing needles with others.'
- B 'I must use a condom during all sexual encounters.'
- C 'I need to wash my hands after using the bathroom.'
- D 'I will need to receive a yearly booster shot for life.'
Correct answer: 'I need to wash my hands after using the bathroom.'
Hepatitis A is primarily transmitted through the fecal-oral route, often via contaminated food or water and poor hand hygiene. Prevention focuses on proper handwashing and the use of the Hepatitis A vaccine.
The nurse is assessing a client with cirrhosis for signs of 'asterixis.' How should the nurse perform this assessment?
- A Ask the client to extend their arms and dorsiflex their wrists.
- B Firmly stroke the lateral aspect of the plantar surface of the foot.
- C Tap the facial nerve just below the temple.
- D Auscultate for a bruit over the abdominal aorta.
Correct answer: Ask the client to extend their arms and dorsiflex their wrists.
Asterixis, also known as 'liver flap,' is a flapping tremor of the hands when the wrists are extended. It is a classic sign of worsening hepatic encephalopathy due to high levels of metabolic toxins.
A client with cirrhosis and massive ascites is scheduled for a paracentesis. Which nursing action is the priority immediately before the procedure?
- A Measure the client's weight and abdominal girth.
- B Maintain the client on NPO status for 8 hours.
- C Instruct the client to empty the bladder.
- D Position the client in a prone position.
Correct answer: Instruct the client to empty the bladder.
Emptying the bladder before a paracentesis is essential to prevent accidental bladder puncture by the needle during the procedure. The client is typically placed in a high-Fowler's or upright sitting position.
A client with chronic Hepatitis B is prescribed interferon alfa-2b. The nurse should monitor the client for which common side effect?
- A Flu-like symptoms such as fever and fatigue
- B Fluid volume overload and edema
- C Persistent constipation and fecal impaction
- D Hypoglycemia and tremors
Correct answer: Flu-like symptoms such as fever and fatigue
Interferon therapy frequently causes flu-like symptoms, including fever, chills, myalgia, and fatigue. These symptoms can often be managed by administering the medication at bedtime and using acetaminophen.
The nurse is reviewing the medical record of a client with cirrhosis. Which finding is the most likely cause of the client's spontaneous bruising and epistaxis?
- A Decreased production of clotting factors
- B Vitamin C deficiency
- C Increased pressure within the portal venous system
- D Hemolysis of red blood cells
Correct answer: Decreased production of clotting factors
The liver is responsible for synthesizing many clotting factors, including prothrombin. In cirrhosis, the damaged liver cannot produce these factors, leading to an increased risk of bleeding and a prolonged prothrombin time (PT).
A nurse is caring for a client who had a percutaneous liver biopsy 1 hour ago. How should the nurse position the client?
- A Right side-lying with a pillow under the biopsy site
- B Left side-lying with the bed flat
- C Semi-Fowler's position with the head of bed at 30 degrees
- D Supine with the feet elevated above the heart
Correct answer: Right side-lying with a pillow under the biopsy site
Post-liver biopsy, the client should be positioned on their right side for at least 2 hours. This position uses the pressure of the body weight against the liver to compress the biopsy site and prevent hemorrhage.
A client with cirrhosis and portal hypertension has developed esophageal varices. Which medication should the nurse expect to be prescribed to prevent variceal bleeding?
- A Propranolol
- B Spironolactone
- C Furosemide
- D Lansoprazole
Correct answer: Propranolol
Beta-blockers like propranolol are used to reduce portal venous pressure and lower the risk of bleeding from esophageal varices. Diuretics like spironolactone manage fluid, but do not directly reduce the risk of variceal rupture.
Which dietary instruction is most appropriate for a client with cirrhosis who has developed peripheral edema and ascites?
- A Restrict sodium intake to 2 grams or less per day.
- B Increase daily protein intake to 2 grams per kilogram.
- C Limit fat intake to 10% of total calories.
- D Increase daily fluid intake to 3,000 mL.
Correct answer: Restrict sodium intake to 2 grams or less per day.
Sodium restriction is the primary dietary intervention for managing fluid retention (ascites and edema) in cirrhosis. Reducing sodium intake helps prevent the accumulation of extra-cellular fluid.
A nurse is caring for a client with acute liver failure. The nurse notes that the client's breath has a sweet, musty odor. How should the nurse document this finding?
- A Kussmaul's respiration
- B Halitosis
- C Fetor hepaticus
- D Uremic frost
Correct answer: Fetor hepaticus
Fetor hepaticus is a distinctive 'breath of the dead' odor caused by the accumulation of digestive byproducts that the liver is unable to clear. It is a classic sign of severe liver disease and portal-systemic shunting.
Which assessment finding is a classic sign of portal hypertension in a client with cirrhosis?
- A Caput medusae
- B Nystagmus
- C Steatorrhea
- D Positive Chvostek's sign
Correct answer: Caput medusae
Caput medusae refers to dilated, tortuous veins around the umbilicus caused by back-pressure in the portal circulation. Other signs of portal hypertension include splenomegaly and esophageal varices.
The nurse is providing education to a client with Hepatitis C. The nurse explains that the primary mode of transmission for this virus is:
- A Inhalation of respiratory droplets
- B Consumption of undercooked shellfish
- C Close physical or sexual contact with an infected person
- D Exposure to contaminated blood or blood products
Correct answer: Exposure to contaminated blood or blood products
Hepatitis C is a blood-borne virus most commonly transmitted through shared needles, needle-stick injuries, or, less frequently, sexual contact. It is the leading cause of chronic liver disease and liver transplants.
A client with advanced cirrhosis is experiencing intense pruritus (itching). Which nursing intervention would best provide relief?
- A Administering a hot bath with bubble bath solution.
- B Encouraging the client to scratch with their knuckles instead of nails.
- C Limiting the client's use of moisturizing lotions.
- D Applying calamine lotion or giving medications like cholestyramine.
Correct answer: Applying calamine lotion or giving medications like cholestyramine.
Pruritus in liver disease is caused by the accumulation of bile salts under the skin. Cholestyramine binds bile acids in the intestine for excretion, while topical agents and cool baths help soothe the skin.
What is the primary physiological reason for the development of jaundice in a client with hepatitis?
- A Decreased production of bile by the gallbladder.
- B Obstruction of the common bile duct by gallstones.
- C Excessive destruction of red blood cells within the spleen and liver.
- D Inability of the inflamed liver to conjugate and excrete bilirubin.
Correct answer: Inability of the inflamed liver to conjugate and excrete bilirubin.
Hepatocellular jaundice occurs when the liver cells are too damaged or inflamed to remove bilirubin from the blood and conjugate it. This leads to high levels of circulating bilirubin, which stains the skin and sclera yellow.
A client with cirrhosis is admitted with a suspected upper gastrointestinal bleed. Which assessment finding most likely indicates a rupture of esophageal varices?
- A Melena
- B Hematemesis
- C Abdominal guarding
- D Hyperactive bowel sounds
Correct answer: Hematemesis
Esophageal varices are fragile and prone to rupture, which often results in sudden, massive hematemesis (vomiting of bright red blood). This is a life-threatening emergency requiring immediate intervention.
The nurse is assessing a client for signs of hypocalcemia following a liver transplant. Which finding would indicate a positive Trousseau's sign?
- A Twitching of the lip when the facial nerve is tapped.
- B Hand and wrist spasm when a blood pressure cuff is inflated.
- C Sharp pain in the calf upon dorsiflexion of the affected foot.
- D Numbness and tingling sensation around the mouth and lips.
Correct answer: Hand and wrist spasm when a blood pressure cuff is inflated.
Trousseau's sign is a carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for 3 minutes. It is a sign of hypocalcemia, which can occur after massive blood transfusions during liver surgery.
Which laboratory finding would the nurse expect to see in a client with obstructive jaundice?
- A Decreased serum alkaline phosphatase
- B Decreased urine bilirubin
- C Increased clay-colored stools
- D Decreased serum cholesterol
Correct answer: Increased clay-colored stools
In obstructive jaundice, bile cannot reach the duodenum, which means bilirubin is not converted to stercobilin, the pigment that makes stool brown. This results in light-colored or 'clay-colored' stools.
A client is diagnosed with Non-Alcoholic Fatty Liver Disease (NAFLD). Which recommendation should the nurse include in the teaching plan?
- A Avoid all carbohydrates in the diet.
- B Begin a rapid weight loss program losing 5 lbs per week quickly.
- C Manage blood glucose levels and maintain a healthy weight.
- D Take high doses of Vitamin A to support liver repair.
Correct answer: Manage blood glucose levels and maintain a healthy weight.
NAFLD is strongly linked to obesity, diabetes, and metabolic syndrome. The primary treatment is gradual weight loss through diet and exercise, along with management of underlying metabolic conditions.
A client with Hepatitis B asks the nurse if they are now immune to all types of hepatitis. What is the best response by the nurse?
- A 'Yes, once you have one type of hepatitis, you cannot get the others.'
- B 'No, Hepatitis B immunity offers no protection against other types.'
- C 'Only if you also received the Hepatitis A vaccine at the same time.'
- D 'You will be immune only if your liver enzymes return to normal.'
Correct answer: 'No, Hepatitis B immunity offers no protection against other types.'
The viruses that cause hepatitis (A, B, C, D, E) are different. Infection or vaccination for one type provides immunity only for that specific virus and does not protect against the others.