A nurse assesses a client who is a possible candidate for a liver transplant for contraindications of a liver transplant. Which findings should the nurse report to the provider? Select all that apply.

End-stage Chronic Obstructive Pulmonary Disease

Advanced cardiac disease

Inability to follow instructions regarding drug therapy and self-management

Hepatitis C

Metastatic tumors

Answer and Explanation

Correct Answer : A,B,C,E

Rationale:

A. Severe pulmonary disease is a relative or absolute contraindication for liver transplantation. End-stage COPD increases perioperative risk and postoperative complications due to impaired oxygenation and poor ventilatory reserve. This finding should be reported to the provider.

B. Significant cardiovascular disease, such as severe heart failure or coronary artery disease, increases surgical risk and can be a contraindication to liver transplant. Cardiac status must be stable to tolerate surgery and immunosuppressive therapy.

C. Post-transplant patients require strict adherence to complex medication regimens, especially immunosuppressants, to prevent graft rejection. A client who cannot reliably follow instructions or manage medications is at high risk for complications, making this a contraindication.

D. Hepatitis C infection is not a contraindication to liver transplantation. In fact, liver transplants are commonly performed for end-stage liver disease secondary to hepatitis C. Antiviral therapy may be used post-transplant.

E. Active malignancy outside the liver (metastatic cancer) is an absolute contraindication because immunosuppression required after transplantation can accelerate tumor growth and metastasis, leading to poor outcomes.

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Correct Answer is B

Explanation

Rationale:

A. While this indicates hypertension, it is not immediately life-threatening unless accompanied by other symptoms such as chest pain, shortness of breath, or neurological changes. This client requires assessment and possible intervention but is not the highest priority.

B. A “ripping” or tearing chest pain is highly suggestive of an aortic dissection, a life-threatening emergency. This condition can rapidly lead to aortic rupture, cardiac tamponade, or death. According to the ABC and Maslow priority frameworks, this client requires immediate assessment and intervention, making them the highest priority.

C. This indicates gastrointestinal bleeding, which can be serious, especially in patients on anticoagulants, but the client is likely hemodynamically stable if vital signs are not provided. While urgent, it is not more immediately life-threatening than a suspected aortic dissection.

D. This is oliguria and may indicate early renal compromise, but it is not an immediate threat to life compared to suspected aortic dissection. This client should be assessed promptly but after addressing the highest-risk patientTop of FormBottom of Form

A. Administer lactulose as prescribed for the client with liver failure. B. Ensure that the balloon of an esophagogastric balloon tube is in place no longer than 12 hours C. Closely monitor respiratory and neurological status. D. Prepare for emergent surgery

Correct Answer is A

Explanation

Rationale:

A. Lactulose is used to treat hepatic encephalopathy by reducing ammonia levels in clients with liver failure. However, in a client admitted with hypovolemic shock from active upper gastrointestinal bleeding, the priority is stabilizing circulation and airway, not administering medications for encephalopathy. Lactulose can worsen dehydration and diarrhea, potentially exacerbating hypovolemia, which is dangerous in a client already in shock. Therefore, this is not an appropriate immediate intervention.

B. For clients with esophageal varices, a balloon tamponade (e.g., Sengstaken-Blakemore tube) may be used to control bleeding. Monitoring balloon placement and duration is critical to prevent tissue necrosis, airway obstruction, or further complications. This is an appropriate intervention.

C. Airway management is critical in a client with an esophagogastric balloon tube and hypovolemic shock. Monitoring respiratory status ensures early detection of airway compromise, while neurological monitoring helps detect hypoperfusion or hypoxia. This is an appropriate and high-priority intervention.

D. If bleeding cannot be controlled with medical therapy or balloon tamponade, emergent surgical or interventional radiology procedures (e.g., variceal ligation or shunt procedures) may be necessary. Preparing for surgery is appropriate in severe, uncontrolled bleeding.

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A nurse assesses a client who is a possible candidate for a liver transplant for contraindications of a liver transplant. Which findings should the nurse report to the provider? Select all that apply.

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Naxlex Comprehensive Predictor Exams

Which client admitted to the emergency department should the nurse see first?

Correct Answer is B

Explanation

The client with esophageal varices was admitted with hypovolemic shock secondary to upper gastrointestinal bleed. Which intervention is not appropriate for this client?

Correct Answer is A

Explanation

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