Med Surg Adaptive Quizzing Inflammation

A patient underwent a liver transplantation surgery and receives cyclosporine. The nurse monitors the patient for which primary indicator of an acute graft rejection? Tachycardia 2 Hyperventilation 3 Clay-colored stools 4 Foul-smelling urine

A. Acute graft rejection may occur from the 4th to 10th day after a liver transplantation. The symptoms include tachycardia, pain in the right upper quadrant, and change in bile color. Hyperventilation occurs in acute renal failure. Hepatic complications may result in clay-colored stools. Keeping the T-tube in the dependent position will help reduce the hepatic complications. Foul-smelling urine results from infection and can be treated with antibiotics.

A patient who was previously treated for hepatitis B virus (HBV) is tested for the presence of the hepatitis B surface antigen (HBsAg) in the blood. The test is positive. What does this result indicate? Permanent immunity to HBV 2 Recurrence of infection 3 Long-term liver damage 4 Patient is infectious

D. As long as the HBsAg is present, the patient is infectious and may be in a carrier state. It does not indicate permanent immunity, recurrence of infection, or long-term liver damage.

What drug has a complication of hemolytic anemia in a patient with ulcerative colitis if taken in higher doses? Oslalazine 2 Balsalazide 3 Mesalamine 4 Sulfasalazine

D. Sulfasalazine is an aminosalicylate drug that causes haemolytic anemia if taken in high doses. Oslalazine, balsalazide, mesalamine are drugs used for ulcerative colitis that do not necessarily cause hemolytic anemia.

When caring for a patient with Laennec's cirrhosis, which of these does the nurse expect to find on assessment? Select all that apply. Prolonged partial thromboplastin time (PTT) 2 Icterus of skin 3 Swollen abdomen 4 Elevated magnesium 5 Currant jelly stool 6 Elevated amylase level

1, 2, 3, The liver produces clotting factors; when it is damaged, prolonged coagulation times and bleeding may result. Icterus, or jaundice, results from cirrhosis. The patient with cirrhosis may develop ascites, or fluid in the abdominal cavity. Currant jelly stool is consistent with intussusception, a type of bowel obstruction. Cirrhosis is consistent with elevations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase; amylase is typically elevated in pancreatitis.

The nurse is teaching a patient who recently began taking sulfasalazine about the drug. What side effects does the nurse tell the patient to report to the health care provider? Select all that apply. Anorexia 2 Depression 3 Drowsiness 4 Frequent urination 5 Headache 6 Vomiting

1, 5,6 Anorexia, headache, and nausea/vomiting are side effects of sulfasalazine that should be reported to the health care provider. Depression, drowsiness, and urinary problems are not side effects of sulfasalazine.

What are potential complications of Crohn's disease? Select all that apply. Abscess formation 2 Stomach cancer 3 Malabsorption 4 Fistulas 5 Osteoporosis

1345 The complications of Crohn's disease include abscess formation, colon cancer, malabsorption, fistulas, and osteoporosis. Stomach cancer is not a complication of Crohn's disease; colorectal cancer, however, is a possible complication of ulcerative colitis.

When assessing a patient with hepatitis B, the nurse anticipates which assessment findings? Select all that apply. Recent influenza infection 2 Brown stool 3 Tea-colored urine 4 Right upper quadrant tenderness 5 Itching

345 The urine may be brown, tea-, or cola-colored in patients with hepatitis. Inflammation of the liver may cause right upper quadrant pain. Deposits of bilirubin on the skin, secondary to high bilirubin levels, and jaundice irritate the skin and cause itching. Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored.

The nurse is assessing diagnostic test results for a patient with hepatitis. Which elevated test result does the nurse correlate to the presence of jaundice? Bilirubin 2 Blood urea nitrogen (BUN) 3 Aspartate aminotransferase (AST) 4 Alanine aminotransferase (ALT)

A. Elevation of the bilirubin level correlates to yellow stain of the skin and sclera secondary to biliary obstruction and inflammation. BUN is a measure of renal function. AST and ALT are enzymes released in response to liver inflammation, but do not correlate to jaundice.

Which assessment finding is consistent with a diagnosis of viral hepatitis? Icteric skin 2 Dark-brown stool 3 Light-colored urine 4 Left upper quadrant tendernes

A. Findings in viral hepatitis include fever, jaundice or icterus, itching, clay-colored stool, dark urine, right upper quadrant tenderness, and nausea.

A patient with an exacerbation of ulcerative colitis (UC) has been prescribed Vivonex PLUS. The patient asks the nurse how this is helpful for improving symptoms. How does the nurse reply? "It is absorbed quickly and allows the affected part of the GI tract to rest and heal." 2 "It provides key nutrients and extra calories to promote healing." 3 "It is bland and reduces the secretion of gastric acids." 4 "It does not contain caffeine or other GI tract stimulants."

A. For less severe exacerbations, an elemental or semi-elemental product such as Vivonex PLUS may be prescribed to induce remission. These products are absorbed in the jejunum and therefore permit the distal small intestine and colon to rest. Nutritional supplements such as Ensure or Sustacal are added to provide nutrients and more calories. GI stimulants such as caffeinated beverages and alcohol should be avoided, but this is not the reason for using Vivonex PLUS.

A patient with a history of osteoarthritis has a 10-inch incision following a colon resection. The incision has become infected, and the wound requires extensive irrigation and packing. What aspect of the patient's care does the nurse make certain to discuss with the health care provider before the patient's discharge? Having a home health consultation for wound care 2 Requesting an antianxiety medication 3 Requesting pain medication for the patient's osteoarthritis 4 Placing the patient in a skilled nursing facility for rehabilitation

A. Home health services are most appropriate for this patient because wound care will be extensive and the patient's mobility may be limited. No indication suggests that the patient is experiencing anxiety regarding postoperative care. Pain medication may be needed for the patient's osteoarthritis, but this is not the highest priority. A skilled nursing facility is not necessary if the patient can remain in his or her home with sufficient support services.

When caring for a patient with Laennec's cirrhosis and portal hypertension, which point is essential for the nurse to emphasize to the patient and family? Do not consume any alcohol. 2 Reduce the amount of sodium in the diet. 3 Avoid saturated fats in the diet. 4 Adhere to anticoagulant therapy.

A. Laennec's cirrhosis is otherwise known as alcoholic cirrhosis; it is caused by chronic alcohol use. Avoiding alcohol is essential to prevent further organ damage. Sodium restriction is recommended for ascites. Fat intolerance may occur with liver disease; however, reduction of alcohol is essential, especially with Laennec's cirrhosis. Anticoagulants are not used to manage cirrhosis as there is a risk of bleeding related to prolonged International Normalized Ratio and prothrombin time.

What type of cirrhosis is caused by hepatitis C? Postnecrotic 2 Laennec's 3 Biliary 4 Cholestatic

A. The hepatitis C virus causes postnecrotic cirrhosis. Laennec's cirrhosis is caused by chronic alcoholism. Biliary cirrhosis is also called cholestatic cirrhosis; it is caused by chronic biliary obstruction or autoimmune disease.

A patient has vague symptoms that indicate an inflammatory bowel disorder. Which symptom is most indicative of Crohn's disease (CD)? Abdominal pain relieved by bending the knees 2 Chronic diarrhea, abdominal pain, and fever 3 Epigastric cramping 4 Hypotension with vomiting

B. Chronic diarrhea, abdominal pain, and fever are symptoms more indicative of CD than of other acute inflammatory bowel disorders. Abdominal pain that is relieved by bending the knees is indicative of peritonitis or pancreatitis. Epigastric cramping is a symptom more indicative of appendicitis. Hypotension with vomiting is not characteristic of CD.

In caring for a patient who has undergone paracentesis, which changes in the patient's status should be promptly reported to the provider? ncreased blood pressure, increased respiratory rate 2 Decreased blood pressure, increased heart rate 3 Increased respiratory rate, increased apical pulse, pallor 4 Tachypnea, diaphoresis, increased blood pressure

B Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the patient's part.

The community health nurse is exploring the cause of an outbreak of hepatitis A. Which individual does the nurse suspect may be the source? Individual who recently got a tattoo Correct2 Patients who were infected after eating at the same restaurant 3 Spouse of an intravenous drug abuser who developed hepatitis 4 Patient who had a blood transfusion during cardiac surgery in 1985

B Hepatitis A is spread by the fecal-oral route either by person-to-person contact, or by consuming contaminated food or water; failure to clean the hands after using the toilet and then preparing food is an example of how hepatitis can be spread by this route. Tattoos, injection drug use, and blood transfusions can spread hepatitis B or C through blood or body fluids.

The nurse is teaching a spouse and patient with hepatitis C about preventing the spread of infection. Which instruction does the nurse include in the teaching plan? "Drink only bottled water." Correct2 "Do not share toothbrushes." 3 "Donate blood only once yearly." 4 "You should use a separate bathroom."

B Household members should not share any personal items with the patient infected with hepatitis C such as a toothbrush, razor, drinking glasses, drug paraphernalia, or any item where blood or body fluids could be encountered by others. Bottled water is not necessary as the patient is not at risk for contamination from tap water. The patient with hepatitis C may become a carrier, so blood should not be donated. There is no need to use a separate bathroom if the patient is continent of urine and stool and if the bathroom can be regularly disinfected.

A certified Wound, Ostomy, and Continence Nurse (CWOCN) is teaching a patient about caring for a new ileostomy. What information is most important to include? After surgery, output from your ileostomy may be a loose, dark-green liquid with some blood present." Correct2 "Call the health care provider if your stoma has a bluish or pale look." 3 "Notify the health care provider if output from your stoma has a sweetish odor." 4 "Remember that you must wear a pouch system at all times.

B If the stoma has a bluish, pale, or dark look, its blood supply may be compromised and the health care provider must be notified immediately. It is true that output from the stoma after surgery may be a loose, greenish-colored liquid that may contain some blood, but this information is not the highest priority for instruction. It is normal for output from the stoma to have very little odor or a sweetish smell. Although it is true that the patient will be required to wear a pouch system at all times, this is not the highest priority for instruction.

When providing dietary teaching to a patient with hepatitis, what practice does the nurse recommend? Having a larger meal early in the morning 2 Consuming increased carbohydrates and moderate protein 3 Restricting fluids to 1500 mL per day 4 Limiting alcoholic beverages to once weekly

B To repair the liver, the patient should have a high-carbohydrate and moderate-protein diet; fats may cause dyspepsia. The patient with hepatitis feels full easily and should have four to six small meals daily. Fluids are restricted with ascites caused by cirrhosis; not all patients with hepatitis progress to cirrhosis. Complete abstention from alcohol is necessary until the liver enzymes return to normal.

A patient with refractory ascites has a tunneled ascites drain (PleurX catheter). The community health nurse teaches the patient and family which most important aspect of care while this device is in place? Remaining on bedrest 2 Keeping hands and the area clean 3 Observing for diminished urine output 4 Learning to take blood pressure each day

B. Patients with an indwelling device are prone to infection. Patients with ascites may also develop spontaneous bacterial peritonitis. Therefore, hands should always be cleansed before touching the area or using the device. Bedrest is necessary after a procedure such as paracentesis, but is not necessary while the drainage device is in place. Diminished urine output and a lower blood pressure are typically present with hepatic failure and ascites because fluid is third-spaced. Blood pressure may also drop with bleeding varices; however, daily monitoring is not needed with the ascites drainage device.

The registered nurse is teaching a group of student nurses about assessment findings of each stage of portal systemic encephalopathy. Which statement made by a student nurse indicates a need for further teaching? "The patient in stage I will have slurred speech." 2 "The patient in stage II will have muscle twitching." 3 "The patient in stage III will have hyperreflexia." 4 "The patient in stage IV will have seizures."

B. Stage II of portal systemic encephalopathy is characterized by mental changes, mental confusion, and asterixis. Muscle twitching is not observed in stage II; therefore, this statement of the student nurse indicates a need for further teaching. Stage IV, comatose, is the stage in which patients experience seizures. Stage III is stuporous, characterized by hyperreflexia and muscle twitching. Stage I, prodromal, is characterized by slurred or slowed speech.

The nurse is caring for patients in the outpatient clinic. Which of these phone calls should the nurse return first? Patient with hepatitis A reporting severe and ongoing itching 2 Patient with severe ascites who has a temperature of 101.4° F (38° C) 3 Patient with cirrhosis who has had a 3-pound weight gain over 2 days 4 Patient with esophageal varices and mild right upper quadrant pain

B. The patient with ascites and an elevated temperature may have spontaneous bacterial peritonitis; the nurse should call this patient first. Itching is anticipated with jaundice, this patient may be called last. Weight gain with cirrhosis is not uncommon owing to low albumin levels. Cirrhosis may cause mild right upper quadrant pain; this patient should be called after the patient with severe ascites.

A patient tests positive for immunoglobulin G (IgG) hepatitis A virus (HAV) antibodies. For which condition is this result indicative? Active HAV infection with acute liver changes 2 Immunity to HAV after previous HAV infection 3 Ongoing liver inflammation caused by HAV 4 Possible hepatic cirrhosis as a result of HAV infection

B. The presence of IgG HAV antibodies indicates previous infection with HAV with resulting lifetime immunity. It does not indicate active infection. Immunoglobulin M (IgM) HAV antibodies are present during infection and ongoing inflammation. These antibodies are not diagnostic for hepatic cirrhosis.

The patient requires a large amount of calories daily to promote the healing of a fistula. Which kind of diet should the nurse provide to the patient? High-fiber food 2 Low-vitamin food Correct3 High-protein food 4 Low-calorie meals

C A high-protein diet is beneficial for wound healing. High-fiber foods cause discomfort and indigestion problems. High-vitamin foods are suggested to speed up the wound cure. Low-calorie meals do not increase caloric intake.

A patient has been newly diagnosed with ulcerative colitis (UC). What does the nurse teach the patient about diet and lifestyle choices? Drinking carbonated beverages will help with your abdominal distress." 2 "It's OK to smoke cigarettes, but you should limit them to ½ pack per day." 3 "Lactose-containing foods should be reduced or eliminated from your diet." 4 "Raw vegetables and high-fiber foods may help to diminish your symptoms.

C Lactose-containing foods are often poorly tolerated and should be reduced or eliminated from the diet of patients with UC. Carbonated beverages are GI stimulants that can cause discomfort and should be used rarely or completely eliminated from the diet. Cigarette smoking is a stimulant that can cause GI distress symptoms; nurses should never advise patients that any amount of cigarette smoking is "OK." Raw vegetables and high-fiber foods can cause GI symptoms in patients with UC.

A patient with viral hepatitis has clay-colored stools and dark urine. These findings are typically characteristic of which complication of hepatitis? Cirrhosis of the liver 2 Hepatic carcinoma 3 Intrahepatic obstruction 4 Obstructive jaundice

C Patients with hepatitis may develop intrahepatic obstruction, which will cause clay-colored stools and dark urine when the bile ducts are blocked. These findings may occur with hepatic obstruction in cirrhosis or carcinoma, but do not necessarily indicate that these have occurred. Obstructive jaundice is another sign of intrahepatic obstruction.

When assessing a patient for possible liver dysfunction, the nurse notices round, pinpoint, red-purple lesions on the patient's skin. What term is used to document such lesions? Ecchymosis 2 Telangiectases Correct3 Petechiae 4 Spider angioma

C The term petechiae is used for round, pinpoint, red-purple lesions. Ecchymoses are large purple, blue, or yellow patches. Telangiectases and spider angioma are terms used for vascular lesions with a red center and radiating branches.

What instruction should the nurse provide to a patient with an Ileostomy to help in self-management? Avoid salt and water." 2 "Consume high fibrous food." 3 "Avoid taking enteric-coated medications." 4 "Take an enema if you have not defecated for 6 hours."

C. A patient with an ileostomy should avoid enteric-coated medications because those drugs take too much time to dissolve. The patient may lose salt and water through Ileostomy; therefore, salt and fluid intake should be increased. The patient should avoid high fiber foods because they can cause digestion problems. The patient should not self-administer an enema; the patient should consult a primary health care provider if no stool has passed in 6 to 12 hours

A patient admitted for treatment of liver disease has a decreased serum total protein. Based on this finding, how may the nurse classify this patient's disease? Acute 2 Advanced 3 Chronic 4 Severe

C. Decreased serum total protein indicates chronic liver disease. Increased serum total protein indicates acute liver disease. Elevated serum ammonia indicates advanced liver disease. Decreased serum albumin indicates severe liver disease.

The nurse administers lactulose to a patient with cirrhosis for which purpose? Provides enzymes necessary to digest dairy productions 2 Reduces portal pressure 3 Promotes gastrointestinal excretion of ammonia 4 Decreases gastrointestinal bleeding

C. Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding.

The nurse is discussing with a nursing student the care of a patient with cirrhosis. Which statement by the student indicates a correct understanding of how to observe for esophageal bleeding in the patient? "I should observe for epistaxis." 2 "Hematuria may indicate bleeding varices." 3 "Any melena should be reported immediately." 4 "Prothrombin time should be monitored daily.

C. Melena (tarry stools) may result from bleeding varices; this should be reported. Epistaxis (nosebleed) and hematuria (blood in the urine) may occur with cirrhosis and its resulting prothrombin time (PT) and International Normalized Ratio (INR), but they are not manifestations of esophageal bleeding. PT is prolonged in cirrhosis; however, it is not a specific manifestation of variceal bleeding.

A patient who has early signs of hepatic encephalopathy may be asked to make which changes in the diet? Eliminate potassium 2 Increase calcium 3 Reduce protein 4 Restrict fluids

C. Patients with hepatic encephalopathy should reduce protein intake since a high-protein diet increases serum ammonia, which can increase the risk. Patients who have hepatic encephalopathy are often hypovolemic and hypokalemic, so neither fluids nor potassium should be restricted. Increasing calcium is not indicated with hepatic encephalopathy.

Which problem for a patient with cirrhosis takes priority? Insufficient knowledge related to the prognosis of the disease process 2 Discomfort related to the progression of the disease process 3 Potential for injury related to hemorrhage 4 Inadequate nutrition related to an inability to tolerate usual dietary intake

C. Potential for injury related to hemorrhage is the priority patient problem because this complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate nutrition are not priorities because these issues are not immediately life-threatening.

The nursing team consists of an RN, an LPN/LVN, and a nursing assistant. Which patient should be assigned to the RN? Patient who is taking lactulose and has diarrhea 2 Patient with hepatitis C who requires a dressing change 3 Patient with end-stage cirrhosis who needs teaching about a low-sodium diet 4 Obtunded patient with alcoholic encephalopathy who needs a blood dra

C. The RN is responsible for patient teaching; therefore, the patient with end-stage cirrhosis should be assigned to the RN. Assisting a patient with toileting and recording stool number and amount can be accomplished by nonprofessional staff. The LPN/LVN can provide dressing changes. Ancillary staff can perform venipuncture.

A patient with a history of esophageal varices has just been admitted to the emergency department after vomiting a large quantity of blood. Which action does the nurse take first? Obtain the charts from the previous admission. 2 Listen for bowel sounds in all quadrants. Correct3 Obtain pulse and blood pressure. 4 Ask about abdominal pain.

C. The nurse should assess vital signs to detect hypovolemic shock caused by hemorrhage. Obtaining charts, assessing bowel sounds, and pain assessment can be delayed until the patient has stabilized. Assessment for adequate perfusion is the highest priority at this time.

Which disorder is associated with inflammation of the small intestine? Peritonitis 2 Gastroenteritis 3 Crohn's disease 4 Ulcerative coliti

Crohn's Disease Crohn's disease is an inflammatory disorder of the small intestine, sometimes the colon, or both. Peritonitis is inflammation of the peritoneum. Gastroenteritis is inflammation of the gastrointestinal tract. Ulcerative colitis is inflammation of the rectum and rectosigmoid colon and can extend to the entire colon.

The nurse asks a patient with liver disease to raise the arms to shoulder level and dorsiflex the hands. A few moments later, the hand begins to flap upward and downward. How does the nurse correctly document this in the medical record? Positive Babinski's sign 2 Hyperreflexia 3 Kehr's sign Correct4 Asterixis

D Liver flap or asterixis is related to increased serum ammonia levels—the dorsiflexed hands begin to flap upward and downward when outstretched for a few moments. Babinski's sign is positive when the sole of the foot is stroked, the great toe points up, and the toes fan out. Hyperreflexia refers to deep tendon reflexes that are overactive. Kehr's sign is reflected by increased abdominal pain, exaggerated by deep-breathing, and is referred to the right shoulder.

The nurse is caring for a patient with ileo-anal pouch anastomosis who has undergone a restorative proctocolectomy. What pouch care advice given by the nurse will provide effective treatment? A. Do not empty your pouch until it is full." B. Do not change the pouch during inactive times." C. "Change the entire pouch system every 10 days." D. "Change the entire pouch system every 3 to 7 days."

D The entire pouch system must be changed every 3 to 7 days to avoid discomfort and leakage. The pouch should be emptied when it is one-third to one-half full. The pouch should be changed even during inactive times, such as before meals, before retiring at night, and 2 to 4 hours after eating.

The nurse is counseling an asymptomatic patient who is worried about possible hepatitis C exposure several years ago. What does the nurse tell this patient about the risk of this disease? Unless you have signs of liver disease, you are no longer infected." 2 "You have probably cleared the virus since you have not had symptoms." 3 "You may be a carrier, but will never have serious symptoms of the disease." 4 "You may have serious long-term damage even without symptoms."

D. Patients exposed to hepatitis C may develop chronic infection even without symptoms until the damage occurs over decades of infection. A patient is likely to be asymptomatic for months or years before the virus is detected. A carrier may or may not have serious symptoms of the disease. Individuals with HCV do not clear the virus like those with HBV.

A patient with severe cirrhosis of the liver has a urine output of 400 mL for the past 2 days despite adequate intravenous fluid administration. What is the priority nursing action for this patient? ontact the provider to discuss obtaining a urine culture. 2 Encourage the patient to increase oral fluid intake. 3 Perform a bladder scan to assess for urinary retention. 4 Request an order for blood urea nitrogen (BUN) and serum creatinine levels.

D. Patients with cirrhosis may develop hepatorenal syndrome (HRS), which is characterized by oliguria less than 500 mL/day and elevated BUN and creatinine levels. The nurse should request these additional tests to help determine this. Decreased urine output is not a sign of urinary tract infection (UTI), so a culture is not indicated. The patient has been receiving adequate fluids, so additional intake is not indicated. If BUN and creatinine levels are normal, assessing for retention may then be warranted.

What changes take place in a patient after a total proctocolectomy with a permanent ileostomy? The effluent has a foul odor 2 The stool becomes reddish in color 3 Stool volume increases and becomes thin 4 Stool volume decreases and becomes thick

D. After undergoing a total proctocolectomy with a permanent ileostomy, the stool volume decreases and becomes thick or paste-like due to increased absorption of sodium and water. Effluent has little sweet odor; a foul odor only occurs when there is a blockage or infection. After the procedure, the stool becomes yellow-green or yellow-brown in color. If the stool is red in color, the surgery was not successful.

A patient with ulcerative colitis is scheduled for an ileostomy. Which preoperative information should the nurse provide to the patient and family members? Empty the pouch before eating 2 Change the pouch during active times 3 Change the entire pouch system every 4 to 9 days 4 Empty the pouch when it is one-third to one-half full

D. Emptying the Ileostomy pouch when it is one-third to one-half full helps to prevent leakage of the fecal matter. The pouch does not need to be changed before eating. The pouch should be changed at inactive time because there will be less stool output through the stoma. Changing the entire pouch system every 3 to 7 days prevents itching, leakage, and odor.

A patient diagnosed with hepatitis A asks the nurse how this disease may have been contracted. Which answer by the nurse is correct? "If you received a blood transfusion, you may have been exposed." 2 "The virus is airborne, so you may have contracted it from an infected person." 3 "You may have been exposed if you had unprotected sexual intercourse." 4 "You may have consumed foods contaminated with the virus

D. Hepatitis A is transmitted through the fecal-oral route and may be contracted by consuming contaminated foods; it is not a blood-borne or airborne virus. Hepatitis B, C, and D can be transmitted by blood transfusions received before 1992. Unprotected sex is a risk factor for hepatitis B and C (although the rate of sexual transmission with hepatitis C is very low in a monogamous relationship, but increases with multiple sex partners). There is no hepatitis virus that is airborne.

The primary health care provider prescribes natalizumab to a patient with Crohn's disease. Which health teaching is most important before beginning the medication? "This drug masks the symptoms of infection." 2 "A cold and a sore throat are common infections." 3 "A headache and abdominal pain are common side effects." 4 "Cognitive, motor and, sensory changes have very lethal effects.

D. Natalizumab causes progressive multifocal leukoencephalopathy (PML), a deadly infection that affects the brain. Cognitive, motor, and sensory changes indicate PML and should be immediately reported. Glucocorticoids mask the symptoms of infection; natalizumab is a monoclonal antibody drug. Cold, sore throat infections, headache, and abdominal pain are common side effects of infliximab and certolizumab.

The nurse is caring for a patient with cirrhosis and profound ascites. Which assessment finding causes the nurse to notify the provider? Anasarca 2 Marked jaundice 3 Multiple ecchymoses Correct4 Inaudible breath sounds

D. Orthopnea and dyspnea can result from ascites, which limit thoracic expansion and diaphragmatic excursion; this is manifested by decreased or absent breath sounds. Anasarca is an expected finding in cirrhosis as the liver is unable to produce plasma proteins which exert colloid osmotic pressure to pull fluid from interstitial tissues. Jaundice, another expected finding, results when the failing liver cannot excrete bilirubin. Ecchymosis is typical when the patient with cirrhosis cannot produce prothrombin, which promotes blood clotting.

The RN is caring for a patient with end-stage liver disease that has resulted in ascites. Which action does the RN delegate to unlicensed assistive personnel (UAP)? Assessing skin integrity and abdominal distention 2 Drawing blood from a central venous line for electrolyte studies 3 Evaluating laboratory study results for the presence of hypokalemia 4 Placing the patient in a semi-Fowler's position

D. Positioning the patient in a semi-Fowler's position is included within UAP education and scope of practice, although the RN will need to supervise the UAP in providing care and will evaluate the effect of the semi-Fowler's position on patient comfort and breathing. Assessment of skin integrity and abdominal distention, obtaining blood from a central line, and evaluation of laboratory results should be done by the RN.

Which medication is used as the first line treatment for mild ulcerative colitis? Infliximab 2 Prednisone 3 Loperamide Correct4 Sulfasalazine

D. Sulfasalazine is an aminosalicylate used to treat mild-moderate ulcerative colitis. Infliximab alone is not effective in treating ulcerative colitis. Glucocorticoids such as prednisone are prescribed during exacerbations of the disease. Anti-diarrheal drugs such as loperamide provide symptomatic management of the disease.

When providing discharge teaching to a patient with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? Vitamin K-containing products 2 Potassium-sparing diuretics 3 Nonabsorbable antibiotics 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

Patients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The patient with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Nonabsorbable antibiotics are used to decrease ammonia levels.