Hepatitis NCLEX question
A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis? a. Elevated hemoglobin level B.. Elevated serum bilirubin level c. Elevated blood urea nitrogen leveld. d. Decreased erythrocycle sedimentation rate
Correct: B Answer B. Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis
"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal... a. hepatitis B surface antigen (HBsAg). b. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."
"ANSWER: D Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."
"A client with acute hepatitis is prescribed lactulose. The nurse knows this medication will: A. Prevent the absorption of ammonia from the bowel. B. Prevent hypoglycemia. C. Remove bilirubin from the blood. D. Mobilize iron stores from the liver"
"Correct Answer: A Rationale: Lactulose helps prevent the absorption of ammonia from the bowel because it will cause frequent bowel movements, which facilitates the removal of ammonia from the intestines."
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which of the following responses by the nurse is most appropriate? A) The hepatitis vaccine will provide immunity from this exposure and future exposures."" B) I am afraid there is nothing you can do since the patient was infectious before admission."" C) You will need to be tested first to make sure you don't have the virus before we can treat you."" D) An injection of immunoglobulin will need to be given to prevent or minimize the effects of this exposure."""
"Correct Answer: D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks of exposure. It may not prevent an infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."
Which priority teaching information should the nurse discuss with the client to help prevent contracting hep. A? 1.Explain the importance of good hand washing. 2.Tell the client to take the hepatitis B vaccine in three (3) doses. 3.Tell the client not to ingest unsanitary food or water. 4.Discuss how to implement standard precautions.
Answer 1 would be appropriate for prevention of hepatitis A.
"The female nurse sticks herself with a dirty needle. Which action should the nurse implement first? 1.Notify the infection control nurse. 2.Cleanse the area with soap and water. 3.Request post-exposure prophylaxis. 4.Check the hepatitis status of the client.
Answer 2. The nurse should first clean the needle stick with soap and water to help remove any virus that is on the skin
The RN is providing discharge information to a client with hep B. The RN instructs the client to prevent transmission via: 1. airborne pathogens 2. blood and body secretions 3. skin contact 4. fecal and oral routes
Answer 2: Hep b is transmitted via blood and body secretions. The RN instructs the client to prevent transmission through correct use of latex condoms, and by not sharing personal care items that may have blood on them. Diseases such as pneumonia are spread by airborne pathogens, hep A is spread by fecal and oral routes. Hep B is not transmitted by skin contact.
"Which statement by the client diagnosed with hepatitis warrants immediate intervention by the clinic nurse? 1) ""I will not drink any type of beer or mixed drink."" 2)""I will get adequate rest so I don't get exhausted."" 3) ""I had a big hearty breakfast this morning."" 4) ""I took some cough syrup for this nasty head cold.""
Answer 4: "Rationale: 1) The client should avoid all alcohol to prevent further liver damage and promote healing. 2) Rest is needed for healing of the liver and to promote optimum immune function. 3) Clients with hepatitis need increased caloric intake so this is a good statement. 4)The client needs to understand some types of cough syrup have alcohol and all alcohol must be avoided to prevent further injury to the liver; therefore, this statement requires intervention"
A female client who has just been diagnosed with hepatitis A asks, "How could I have gotten this disease?" What is the nurse's best response? A. "You may have eaten contaminated restaurant food." b. "You could have gotten it by using I.V. drugs." c. "You must have received an infected blood transfusion." d. "You probably got it by engaging in unprotected sex.""
Answer A. Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn't transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
"During an admission assessment, the nurse notes a client with hepatitis exhibits all of the following signs or symptoms. Which one is not related to hepatitis? A. Anorexia B. Bloody stools C. Dark urine D. Yellow sclera"
Answer: B "RATIONALE (A) Anorexia is an expected assessment finding with hepatitis. (B) Rectal bleeding is not related to hepatitis. Further assessment 358 Clinical Specialties: Content Reviews and Testsis needed to identify the cause. (C) Dark urine is an expected assessment finding with hepatitis and is a result of increased serum bilirubin being excreted by the kidneys. (D) Yellow sclera is a sign of jaundice and is an expected assessment finding with hepatitis. Jaundice is caused by increased serum bilirubin"
The nurse instructs a client diagnosed with hepatitis A about signs and symptoms related to hepatitis that may develop. The one that should be reported to the practitioner is: 1)Fatigue 2)Anorexia 3)Yellow urine 4)Clay-colored stools
Correct 4: Clay-colored stools are indicative of hepatic obstruction because bile is prevented from entering the intestines. 1)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 2)It is unnecessary to call the practitioner because this symptom is characteristic of hepatitis from the onset of clinical manifestations. 3) This is the expected color of urine.
Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. Hepatitis D"
Correct A Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
A client is admitted with ongoing symptoms of the flu. There are not other obvious signs of illness. This client should be tested for hepatitis because... A. She could have anicteric hepatitis, which means no jaundice B. She has an allergy to shellfish C. She has a blood pressure of 90/50 D. She was living with a roommate who had similar symptoms"
Correct A Rationale: A. Only about 25% percent of people with aute hepatitis develop jaundice. Patients with anicteric hepatitis may have severely compromised her liver function that is overlooked due to lack of jaundice.
A college student is required to be inoculated for hepatitis before starting college. The nurse recognizes that he will be inoculated for: 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D
Correct Answer 2 Hepatitis B is considered a significant sexually transmitted disease and is seen in all age groups. A vaccine is available for this type of hepatitis.
The client is in the preicteric phase of hepatitis. Which signs/symptoms would thenurse expect the client to exhibit during this phase? 1.Clay-colored stools and jaundice. 2.Normal appetite and pruritus. 3.Being afebrile and left upper quadrant pain. 4.Complaints of fatigue and diarrhea.
Correct Answer 4 "Flu-like" symptoms are the first com-plaints of the client in the preicteric phase of hepatitis, which is the initial phase and may begin abruptly or insidiously
"A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal" A. hepatitis B surface antigen (HBsAg). B. anti-hepatitis B core immunoglobulin M (anti-HBc IgM). C. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG). D. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)."
Correct Answer D "Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen or antibodies for hepatitis B. Anti-HAV IgG would indicate past infection and lifelong immunity."
A sexually active 20-year-old client has developed viral hepatitis. Which of the following statements, if made by the client, would indicate a need for futher teaching? 1. "A condom should be used for sexual intercourse." 2. "I can never drink alcohol again." 3. "I won't go back to work right away." 4. "My close friends should get the vaccine."
Correct Answer: 2. "I can never drink alcohol again." Rationale: To prevent transmission of hepatitis, a condom is advised during sexual intercourse and vaccination of the partner. Alcohol should be avoided because it is detoxified in the liver and may interfere with recover. Rest is especially important until laboratory studies show that liver function has returned to normal. The client's activity is increased gradually
The school nurse is discussing ways to prevent an outbreak of hepatitis A with a group of high school teachers. Which action is the most important intervention that theschool nurse must explain to the school teachers? 1. Do not allow students to eat or drink after each other. 2.Drink bottled water as much as possible. 3.Encourage protected sexual activity. 4.Thoroughly wash hands.
Correct Answer: 4. Throroughly was hands" "1.Eating after each other should be discouraged,but it is not the most important intervention. 2.Only bottled water should be consumed in Third World countries, but that precaution isnot necessary in American high schools. 3.Hepatitis B and C, not hepatitis A, are trans-mitted by sexual activity. 4.Hepatitis A is transmitted via the fecal-oralroute. Good hand washing helps to prevent its spread. TEST-TAKING HINTS: The test taker must realize that good hand washing is the most important action in preventing transmission of any of the hepatitis viruses. Often, the test taker will not select the answer option that seems"
A health care provider who has not been immunized for hepatitis B is exposed to the hepatitis B virus (HBV) through a needle stick from an infected patient. The infection control nurse informs the individual that treatment for the exposure should include: a. baseline hepatitis B antibody testing now and in 2 months. b. active immunization with hepatitis B vaccine. c. hepatitis B immune globulin (HBIG) injection. d. both the hepatitis B vaccine and HBIG injection.
Correct D The recommended treatment for exposure to hepatitis B in unvaccinated individuals is to receive both HBIG and the hepatitis B vaccine, which would provide temporary passive immunity and promote active immunity. Antibody testing may also be done, but this would not provide protection from the exposure.
"A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission? A. Sexual contact with an infected partner. B. Contaminated food. C. Blood transfusion. D. Illegal drug use.
Correct answer: B" Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.
"The client with hepatitis asks the nurse ""I went to an herbalist, who recommended I take milk thistle. What do you think about the herb?"" Which statement is the nurse's best response? 1. ""You are concerned about taking an herb"" 2. ""The herb has been used to treat liver disease"" 3. ""I would not take anything that is not prescribed"" 4. ""Why would you want to take any herbs?""
Correct: 2: Milk thistle has an active ingredient, silymarin, which has been used to treat liver disease for more than 2,000 yrs. It is a powerful oxidant and promotes liver cell growth "1. This is a therapeutic response and the nurse should provide factual information 3. The nurse should not discourage complementary therapies. 4. This is a judgmental statement, and the nurse should encourage the client to ask questions."
The home care nurse is visiting a client with a diagnosis of hepatitis of unknown etiology. The nurse knows that teaching has been successful if the patient makes which on of the following statements? 1. ""I am so sad that I am not able to hold my baby."" 2."" I will eat after my family eats."" 3. ""I will make sure that my children don't eat or drink after me."" 4. ""I'm glad that I don't have to get help taking care of my children."""
Correct: 3 "1. not spread by casual contact 2. can eat together, but not share utensils 3. to prevent transmission - do not share eating utensils or drinking glasses, wash hands before eating and after using toilet 4. alternate rest/activity to promote hepatic healing, mother of young children will need help"
The home care nurse is visiting a client during an icteric phase of hepatitis of unknown etiology. The nurse would be MOST concerned if the client made which of the following comments? 1. ""I must not share eating utensils with my family."" 2. ""I must use my own bath towel."" 3. ""I'm glad that my husband and I can continue to have intimate relations."" 4. ""I must eat small, frequent feedings."""
Correct: 3 3. ""I'm glad my husband..."" - CORRECT: avoid sexual contact until serologic indicators return to normal
A client is hospitalized with hepatitis A. Which of the client's regular medications is contraindicated due to the current illness? http://www.rnpedia.com/home/exams/nclex-exam/nclex-rn-practice-questions-6 " 1. Prilosec (omeprazole) 2. Synthroid (levothyroxine) 3. Premarin (conjugated estrogens) 4. Lipitor (atorvastatin)
Correct: 4 Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.
"A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that: A. pruritus is a common problem with jaundice in this phase. B. the patient is most likley to transmit the disease during this phase. C. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. D. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase."
Correct: A The acute phase of jaundice may be icteric (i.e., symptomatic, including jaundice) or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.
A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are: a. whole blood and albumin. b. platelets and packed red blood cells. c. fresh frozen plasma and whole blood. D.cryoprecipitate and fresh frozen plasma.
Correct: D Answer D. The liver is vital in the synthesis of clotting factors, so when it's diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which has most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren't specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
When collecting an admission history, the nurse identifies that the client prefers fish and crustaceans over other sources of protein. When planning discharge teaching for this client the nurse should include the fact that the cooked food most likely to remain contaminated by the virus that causes Hep A is A) canned tuna B) broiled shrimp C) baked haddock D) steamed lobster
D) Steamed lobster. The temperature during steaming is never high enough or sustained long enough to kill organisms
The nurse is performing an assessment on a client being evaluated for viral hepatitis. Which symptom will the nurse most likely assess on this client? 1. Arthralgia 2. Excitability 3. Headache 4. Polyphagia
"ANSWER: 1 Rationale: arthralgia is common in clients with viral hepatitis. Other symptoms of viral hepatits include lethargy, flulike symptoms, anorexia, N/V, abdominal pain, diarrhea, constipation, and fever. The others are not symptoms of viral hepatitis."
"Which type of hepatitis is transmitted by the fecal-oral route via contaminated food, water, or direct contact with an infected person? "1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D"
"Correct answer: 1 Rationale: 1. The hepatitis A virus is in the stool of infected people for up to 2 weeks before symptoms develop 2. Hepatitis B is spread through contact with infected blood and body fluids 3. Hepatitis C is transmitted through contact with infected blood and body fluids 4. Hepatitis D infection only causes infection in people who are also infected with Hepatitis B or C"
The physican has determine the client with Hepatitis has contracted the infection from contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis? 1. Hepatitis A 2. Hepatitis B 3. Hepatitis C 4. Hepatitis D
Answer 1: Hepatitis A is the correct answer because it is transmitted by the oral-fecal route, via contaminated food or food handlers. B, C, and D are transmitted most commonly via infected body fluids
"Several children at a daycare center have been infected with hepatitis A virus. Which instruction by the nurse would reduce the risk of hepatitis A to the other children and staff members? 1. Hand washing after diaper changes 2. Isolation of the sick children 3. Use of masks during contact with the children 4. Sterilization of all eating utensils"
Answer 1: Rationale: children in day care centers are at risk for hepatits A infection which is transmitted via fecal-oral route due to poor hand hygeine practices and poor sanitation. Isolation of sick children, use of mask during contact, and sterilization of all eating utensils would not be useful in breaking the chain of infection.
"A patient with hepatitis B is being discharged in 2 days. In the discharge teaching plan the nurse should include instructions to: a. Avoid alcohol for the first 3 weeks b. Use a condom during sexual intercourse c. Have family members get an injection of immunoglobin d. Follow a low-protein, moderate-carbohydrate, moderate-fat diet
Answer B Hepatitis B virus may be transmitted by mucosal exposure to infectious blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.
The nurse is caring for a client with a diagnosis of hepatitis who is experiencing pruritis. Which would be the most appropriate nursing intervention? A.Suggest that the client take warm showers. B.Add baby oil to the client's bath water. C.Apply powder to the client's skin. D.Suggest a hot-water rinse after bathing.
Answer B. Applying baby oil could help soothe the itchy skin. Answer A, C, and D would increase dryness and worsen the itching.
During evaluation of a patient at an outpatient clinic, the nurse determines that administration of hepatitis B vaccine has been effective when a specimen of the patient's blood reveals: a. HBsAg. b. anti-HBs c. anti-HBc IgM. d. anti-HBc IgG"
Answer B: The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV
"To prevent the spread of hepatitis A virus (HAV) infection the nurse is especially careful when A. Disposing of food trays B. Emptying bed pan C. Taking an oral temperature D. Changing IV tubing"
Answer: B Rationale: HAV is transmitted primarily person-to-person by the fecal-oral route. Food can be a method of transmission but needs to be fecally contaminated. Since the transmission of hepatitis A is fecal-oral and not saliva or blood like hepatitis B, taking a temperature and changing IV tubing would not spread hepatitis A.
"When planning care for a patient with cirrhosis, the nurse will give highest priority to which of the following nursing diagnoses? A: Imbalanced nutrition: less than body requirements B: Impaired skin integrity related to edema, ascites, and pruritis C: Eccess fluid volume related to portal hypertension and hyperaldosteronism D: Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume
CORRECT: D Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, AIRWAY and BREATHING are always the highest priorities.
"What type of precautions should the nurse implement to protect from being exposed to any of the hepatitis viruses? 1. Airborne precautions 2. Standard precautions 3. Droplet precautions 4. Exposure precautions"
Correct 2 2. Standard precautions apply to blood, all body fluids, secretions, and excretions, except sweat, regardless of whether they contain visible blood
"The client is admitted to the hospital with viral hepatitis, complaining of ""no appetite"" and ""losing my taste for food."" What instruction should the nurse give the client to provide adequate nutrition? "1. Select foods high in fat 2. Increase intake of fluids, including juices 3. Eat a good supper when anorexia is not as severe 4. Eat less often, preferbly only three large meals daily"
Correct 2: Rationale: Although no specific diet is required to treat viral hepatitis, it is recommended that clients consume a low-fat diet because fat may be poorly tolerated because of decreased bile production. Small frequent meals are preferable and may even prevent nausea. Frequently, appetite is better in the morning so it is easier to eat a good breakfast. An adequate fluid intake of 2500 to 3000 mL/day that includes nutritional juices is also important.
A 40-year-old woman has been diagnosed with hepatitis A and asks the nurse if other members of her family are at risk for""catching"" the disease. The nurse's response should be based on the understanding that hepatitis A is transmitted primarily:" 1. during sexual intercourse 2. by contact with infected body secretions. 3. through fecal contamination of food or water. 4. through kissing that involves contact with mucous membranes."
Correct 3: "Hepatitis A is primarily transmitted through ingestion of organisms on fecally contaminated hands, food, or water. Care should be taken in the handling of food and water as well as contaminated items such as bed linens, bedpans, and toilets. Hand hygiene and personal protective equipment such as gloves are important to prevent the spread of infection for hospital personnel. In the home, hand hygiene and good personal hygiene are important to decrease transmission.
"A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which of the following? 1. Malaise 2. Dark stools 3. Weight gain 4. Left upper quadrant discomfort"
Correct Answer 1: Rationale: Hepatitis causes GI symptoms such as anorexia, nausea, right upper quadrant discomfort and weight loss. Fatigue and malaise are common. Stools will be light or clay colored if conjugated bilirubin is unable to flow out of the liver because of inflammation or obstruction of the bile ducts.
"The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill themselves. Which of the following responses by the nurse is most appropriate?" A. "The hepatitis vaccine will provide immunity from this exposure and future exposures." B. "I am afraid there is nothing you can do since the patient was infectious before admission." C. "You will need to be tested first to make sure you don't have the virus before we can treat you." D. "An injection of immunoglobulin will need to be given to prevent or minimize the effects from this exposure.""
Correct C "Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis."
