Annual Liver Competency Quiz
1) Connie Fused is listed for liver transplant and is well known to the 5S team due to
frequent admissions secondary to complications of liver disease. Upon assessment
today, she does not know where she is and gets increasingly agitated as you try to
complete her assessment. You note she is neurologically intact but is nonsensical. This
is most concerning for:
a. Withdrawal
b. Stroke
c. Encephalopathy
d. personality
2) Flo Bloch is listed for liver transplant. She’s frequently seen for ERCPs and stent
exchanges. Which is mostly likely the underlying cause of her liver disease:
a. Alcoholic (Laennec’s) Cirrhosis
b. Hepatitis C Virus
c. Primary Biliary Cirrhosis
d. Nonalcoholic steatohepatitis (NASH)
3) Renee L. Sydrum has cirrhosis complicated by portal hypertension, diuretic resistant
ascites, history of spontaneous bacterial peritonitis, esophageal variceal bleeding
requiring banding, and her creatinine level has increased from 1.3 to 2.6. Given this
information, you can conclude that:
a. Renee likely has fulminant liver failure secondary to viral illness
b. Renee likely has hepatorenal syndrome type I if symptoms presented rapidly,
within two weeks, given the doubling of serum creatinine with a level > 2.5 This
carries a mortality rate of > 50% in 1 month
c. Renee has likely hepatorenal syndrome type II if symptoms present gradually
and if Urine Sodium is < 10 μmol/L, given the serum creatinine level > 1.5,
diuretic resistant, ascites, and portal hypertension
d. Both B and C
4) Mel Dah is listed for liver transplant with a MELD of 18. He’s admitted secondary to GI
bleed and anemia. A CMP and CBC with Diff were drawn on admit. His Hemoglobin is
6.8, sodium is 129, creatinine increased from 1.5 to 2.3, and total bilirubin is 3. We can
not calculate current MELD score without what additional labs?
a. PT/INR
b. Iron studies
c. ABG
d. None of the above
5) Mrs. Ima Hurt is POD 2 and transferred to 5 South. Pain management plan includes On Q
pump of and PCA pump of Morphine. Why would a patient need both pain devices?
a. On Q pump gives systemic pain relief through the veins with narcotic
medications with a push of a button.
b. The PCA pump gives localized pain relief at the operative site with a push of a
button.
c. The On Q Pump gives localized pain relief with a continuous, regulated flow to
the operative site.
d. The PCA gives systemic pain relief through the veins with narcotic medication
with a push of a button.
e. A and B
f. C and D
6) Juan Statez is POD 3 following liver transplant and is complaining of new onset of
abdominal pain. Labs show an increase of LFT’s. As a RN you know that these
symptoms are concerning for Hepatic Artery Thrombosis (HAT). What test is typically
ordered STAT to evaluate for HAT?
a. CT of abdomen with IV and oral contrast
b. Ultrasound of abdomen with duplex doppler
c. MRI of the liver with Eovist
d. KUB
e. All of the above
7) Mrs. Emma Syse is POD 3 and has both NG tube and a post pyloric Dobhoff feeding
tube. The NG tube has been clamped for 6 hrs. The patient is now complaining of
nausea. Glucerna is running via Dobhoff at 45ml/hr. You call the doctor to inform them
that patient is having nausea. What orders do you expect?
a. Place NG to suction
b. Stop Tube Feeding
c. X-ray to re-check placement of Dobhoff
d. All of the above
8) Sam T. Hingrows is POD 5 and is starting to have a low grade temperature of 99.9 at 2
AM. Lungs are coarse and he is staring to cough up yellow sputum. You call the doctor
on call to explain new assessment changes. You expect to see all the orders EXCEPT?
a. 2 view chest x-ray
b. Blood cultures
c. CBC w/ Diff
d. UA and Micro
e. Prograf Level
f. Sputum culture
9) Homer Ward Bound is s/p liver transplant POD 5 and has completed liver transplant
education with the transplant coordinator and self medication has been initiated.
While you observe him complete his morning medication routine you notice a
significant tremor. The patient dismisses this tremor and informs you he’s probably just
nervous about discharge home. You reinforce transplant education by telling the
patient:
a. He’s right, it can be very nerve racking to go home for the first time after
transplant
b. Prednisone can make you feel very jittery
c. Prograf can have side effects that include neurologic changes such as fine
tremors.
d. Inform the patient to notify the team of observed new or worsening symptoms.
e. All of the above
10) Mr. William Rubin is POD 6 and complaining of right shoulder pain with an increase of
WBC and Bilirubin. Patient also has a new onset of a low grade fever. These are
concerning for what post-op complication?
a. Rejection
b. Biliary Leak
c. Hepatic artery thrombosis (HAT)
d. Hepato-Renal Syndrome (HRS)
11) A Prograf trough level should be drawn 30 minutes prior to taking Prograf. Mrs. Polly
Rex took her Prograf prior to the phlebotomist drawing her morning labs. What should
the RN do to ensure an accurate level is drawn?
a) Call liver team to potentially reschedule lab
b) Re-educate the patient on the prograf level and when to take medications when labs
are scheduled
c) Cancel and draw lab at 1730 instead without orders
d) Draw labs, it is close enough.
e) Both A and B are correct
12) Emily Verzymes was readmitted POD 21 with an increase of LFT’s. Biopsy confirms
rejection. A decrease trend in what labs would support rejection is resolving with
treatment?
a. AST, ALT, Bilirubin and Alk Phos
b. WBC, and platelet count
c. Prograf level
d. All of the above
13) Di A. Rhea is s/p liver transplant 3 months and was re-admitted secondary to new onset
of abdominal pain, cramping, and diarrhea. Her medication list includes: Prograf,
cellcept, prednisone, bactrim, valcyte, nystatin, protonix, norvasc, multivitamin, and vit
d supplement. Di was CMV negative prior to transplant and her donor was CMV
positive. Given this information, you are concerned for:
a. C Diff
b. CMV infection
c. Nothing, Di is on Cellcept and it’s a normal side effect
d. A and B
e. All of the above
14) You are reviewing transplant education with your transplant recipient, Sam, and his care
partner, Ella. Ella tells you she loves to bake and Sam tries to sneak a taste of the
cookie dough whenever she turns her back. Its important that you educate your
patient:
a. A little bite won’t hurt, and he needs the calories to heal his incision
b. Unbaked cookie dough contains raw eggs, which can cause food born illness and
infections, especially in patients who are taking immunosuppression medication.
c. Complete frequent hand washing when preparing meals and remember to keep
meal prep surfaces separate from where you eat.
d. Both B and C are correct