Viral Hepatitis, Cirrhosis NUR210

When planning care for a client with hepatitis A, the nurse should review laboratory reports for which laboratory values? 1. prolonged prothrombin time 2. decreased blood glucose level 3. elevated serum potassium level 4. decreased serum calcium level

1. The prothrombin time may be prolonged because of decreased absorption of vitamin K and decreased production of prothrombin by the liver. The client should be assessed carefully for bleeding tendencies.

The nurse is developing a teaching plan for a client with viral hepatitis. What information should the nurse include in the plan? 1. Obtain adequate bed rest 2. Increase fluid intake 3. Take antibiotic therapy as prescribed 4. Drink 8 oz of an electrolyte solution every day

1. Treatment of hepatitis consists primarily of bed rest with bathroom privileges. Bed rest is maintained during the acute phase to reduce metabolic demands on the liver, thus increasing its blood supply and promoting liver cell regeneration.

A client had a liver biopsy 1 hour ago. What should the nurse do first? 1. Auscultate lung sounds 2. Check for fever 3. Obtain a CBC 4. Apply packing in the biopsy site.

1. because the biopsy needle insertion site is close to the lung, there is a risk of lung puncture and pneumothorax; therefore, immediately after the procedure, the nurse should determine diminished or absent lung sounds in the right lung.

A client with jaundice has pruritus and areas of irritation from scratching. What measures can the nurse suggest the client use to prevent skin breakdown? Select all that apply 1. Avoid lotions containing calamine 2. Add baking soda to the water in the tub bath 3. Keep nails short and clean 4. Rub the skin when it itches with knuckles instead of nails 5. Massage skin with alcohol 6. Increase sodium intake in diet

2, 3, 4

A client with chronic hepatitis C is experiencing nausea, anorexia, and fatigue. During the health history, the client states that he is homosexual, drinks one tot two glasses of wine with dinner, is taking St. John's wort for a "bit of depression," and takes acetaminophen for frequent headaches. What should the nurse do? Select all that apply 1. Instruct the client that the wine with means can be beneficial for cardiovascular health 2. Instruct the client to ask the HCP about taking any other medications as they may interact with medications the client is currently taking 3. Instruct the cline to increase the protein in his diet an eat less frequently 4. Advise the client of the need for additional testing for HIV 5. Encourage the client to obtain sufficient rest

2, 4, 5 Clients with chronic hepatitis C should abstain from alcohol as it can spreed cirrhosis and end-stare liver disease. Client should also check with their HCPs broke taking any non-prescription or prescription medication, or herbal supplements. It is also important that the clients who are infected with HCV be tested for HIV, as clients who have both HIV and HCV have a more rapid progression of liver disease than do those who have HCV alone. Clients with HCV and nausea should be instructed to eat four to five times a day to help reduce anorexia and nausea. The client should obtain sufficient rest to manage the fatigue

A client with ascites and peripheral edema is at risk for impaired skin integrity. To prevent skin breakdown, what should the nurse do? 1. institute ROM exercise every 4 hours 2. massage the abdomen once a shift 3. use an alternating air pressure mattress 4. elevate the lower extremities

3. Edematous tissue is easily traumatized and must receive meticulous care. An alternating air pressure mattress will help decrease pressure on the edematous tissue

The nurse is assessing a client with cirrhosis who has developed hepatic encephalopathy. The nurse should notify the health care provider of a decrease in which serum lab value that is a potential precipitating factor for hepatic encephalopathy? 1. aldosterone 2. creatinine 3. potassium 4. protein

3. Hypokalemia is a precipitating factor in hepatic encephalopathy. A decrease in creatinine results from muscle atrophy; an increase in creatinine would indicate renal insufficiency. With liver dysfunction, increased aldosterone levels are seen. A decrease in serum protein will decrease colloid osmotic pressure and promote edema

A client plans to travel to a country where hepatitis B is common. What should the nurse advise the client about the most effective way to prevent the disease? 1. Drink purified water 2. Avoid crowed, enclosed spaces. 3. Complete the vaccination series 4. Observe safe sex practices

3. The hepatitis B vaccine is the most effective way to prevent infection. The client must complete the series of 3 or 4 injections over a period of time for the vaccine to be effective

A nurse is providing discharge instructions to a client with cirrhosis. Which statement best indicates that the client has understood the teaching? 1. "I should eat a high-protein, high-carbohydrate diet to provide energy." 2. "It is safer for me to take acetaminophen for pain instead of aspirin." 3. "I should avoid constipation to decrease chances of bleeding." 4. "If i get enough rest and follow my diet, it's possible for my cirrhosis to be cured."

3. clients with cirrhosis should be instructed to avoid constipation and straining at stool to prevent hemorrhage. The client with cirrhosis has bleeding tendencies because of the liver's inability to produce clotting factors

The nurse is assessing a client with hepatitis A and notices that the AST and ALT lab values have increased. Which statement by the client indicates the need for further instruction by the nurse? 1. "I require increased periods of rest" 2. "I follow a low-fat, high-carbohydrate diet" 3. "I eat dry toast to relieve my nausea" 4. "I take acetaminophen for arthritis pain"

4. Acetaminophen is toxic to the liver and should be avoided in a client with liver dysfunction

The nurse is caring for a client recently diagnosed with hepatitis C. In reviewing the client's history, what information will be most helpful as the nurse develops a teaching plan? 1. has a history of exercise-induced asthma 2. is a scientist and is frequently exposed to multiple chemicals 3. Travels to Central America recently and ate uncooked vegetables 4. has a known history of sexually transmitted disease.

4. Although primarily blood borne, unprotected sex with multiple partners and a history of sexually transmitted disease are risk factors for transmission of the hepatitis C virus. Other risk factors include blood transfusions, past treatment with chronic hemodialysis, being a child born to a women infected with hepatitis C virus, past/current illicit IV drug use, or needle stick injuries to health care workers.

A client who is recovering from hepatitis A has fatigue and malaise. The client asks the nurse, "When will my strength return?" Which response by the nurse is most appropriate? 1. "Your fatigue should be gone by now. We will evaluate you for secondary infection." 2. "Your fatigue is an adverse effect of your drug therapy. It will disappear when your treatment regimen is complete." 3. "It is important for you to increase your activity level. That will help decrease your fatigue" 4. "It is normal for you to feel fatigued. The fatigue should go away in the next 2-4 months"

4. During the convalescent or posticteric stages of hepatitis, fatigue and malaise are the most common problems. These symptoms usually disappear within 2-4 months.

The nurse is reviewing the chart information for a client with increased ascites. The dat include the following: temp 98.9 F, HR 118 bpm, shallow respirations 26 breaths/min, BP 128/76 mmHg, and SpO2 89% on room air. What should the nurse do first? 1. Assess heart sounds 2. Obtain a prescription for blood cultures 3. Prepare for a paracentesis 4. Raise the head of the bed

4. Elevating the head of the bed will allow for increased lung expansion by decreasing the ascites pressing on the diaphragm

Interferon alfa-2b has been prescribed to treat a client with chronic hepatitis B. The nurse should assess the client for which common adverse effect? 1. retinopathy 2. constipation 3. flulike symptoms 4. hypoglycemia

3. Interferon alfa-2b most commonly causes flulike adverse effects, such as myalgia, arthralgia, headache, nausea, fever, and fatigue

A client's serum ammonia level is elevated, and the HCP prescribes 30 mL of lactulose. Which effect is common for this drug? 1. increased urine output 2. improved LOC 3. increased bowel movements 4. nausea and vomiting

3. Lactulose increases intestinal motility, thereby trapping and expelling ammonia in the feces.

What diet should be implemented for a client who is in the early stages of cirrhosis? 1. high-calorie, high-carbohydrate 2. high-protein, low-fat 3. low-fat, low protein 4. high-carbohydrate, low-sodium

1. For clients who have cirrhosis without complications, a high-calorie, high-carbohydrate diet is preferred to provide an adequate supply of nutrients

The nurse is preparing a client for a paracentesis. What should the nurse do? 1. have the client void immediately before the procedure 2. place the client in a side-lying position 3. initiate an IV line to administer sedatives 4. place the client on NPO status 6 hours before the procedure

1. Immediately before a paracentesis, the client should empty the bladder to prevent perforation. the client will be place in a high Fowler's position or seated on the side of the bed for the procedure

A nurse is developing a care plan for a client with hepatic encephalopathy. Which are goals for the care for this client? Select all that apply 1. Prevent constipation 2. administer lactulose to reduce blood ammonia levels 3. monitor coordination while walking 4. check the pupil reaction 5. Provide food and fluids high in carbohydrate 6. Encourage physical activity

1, 2, 3, 4, 5

The nurse is teaching an adult recreational drug user about measures to avoid acquired hepatitis A. What information should the nurse include in the instruction? Select all the apply 1. observing proper hand washing technique 2. following safe syringe disposal procedures 3. obtaining a vaccination 4. wearing a mask when in crowds 5. using caution with eating fresh fruits and vegetables

1, 2, 3, 5 The client is a t risk for having hepatic C because of recreational drug use. The main rout of transmission for hepatitis A is oral-fecal route; the disease can be prevented by good hand washing. The client should receive a vaccine for hepatitis A. The vaccine is administered in 2 doses 6 months apart. Percutaneous transmission is more common with Hepatitis B, C, and D, but the client should fallow safe needle and syringe precautions.

A client with a Sengstaken-Blakemore tube has a sudden drop in SpO2 and an increase in respiratory rate to 40 breaths/min. What should the nurse do in order from first to last? all options must be used 1. Affirm airway obstruction by the tube 2. Remove the tube 3. Deflate the tube by cutting with bedside scissors 4. Apply oxygen via face mask

1, 3, 2, 4

Which position would be appropriate for a client with severe ascites? 1. Fowler's 2. side-lying 3. reverse Trendelenburg 4. Sims'

1. Ascites can compromise the action of the diaphragm and increase the client's risk of respiratory problems

A client with cirrhosis is receiving lactulose. The nurse notes the client is more confused and has asterixis. What should the nurse do next? 1. Assess GI bleeding 2. Withhold the lactulose 3. Increase protein in the diet 4. Monitor serum bilirubin levels

1. Clients with cirrhosis can develop hepatic encephalopathy caused by increased ammonia levels. Asterixis, a flapping tremor, is a characteristic symptom of increased ammonia levels. Bacterial action on increased protein in the bowel will increase ammonia levels and cause the encephalopathy to worsen. GI bleeding and protein consumed i the diet increase protein in the intestine and can elevate ammonia levels. Lactulose is given to reduce ammonia formation in the intestine and should not be held since neurological symptoms are worsening. Bilirubin is associated with jaundice

A client with cirrhosis who has ascites receives 100 mL of 25% serum albumin IV. Which finding would best indicate that the albumin is having its desired effect? 1. reduced ascites 2. increased serum albumin level 3. decreased anorexia 4. increased ease of breathing

1. Normal serum albumin is administered to reduce ascites. Hypoalbuminemia, a mechanism underlying ascites formation, results in decreased colloid osmotic pressure. Administering serum albumin increases the plasma colloid osmotic pressure, which causes fluid to flow from the tissue space into the plasma

The nurse monitors a client with cirrhosis for the development of hepatic encephalopathy. Which would be an indication that hepatic encephalopathy is developing? 1. decreased mental status 2. elevated BP 3. decreased urine output 4. labored respirations

1. The client should be monitored closely for changes in mental status. Ammonia has a toxic effect on central nervous system tissue and produces an altered LOC, marked by drowsiness and irritability. If this process is unchecked, the cline may lapse into coma

The nurse is developing a teaching plan for the client with hepatitis A. what should the nurse tell the client to do? 1. Limit caloric intake and reduce weight 2. Increase carbohydrates and protein in the diet 3. Avoid contact with others and sleep in a separate room 4. Intensify routine exercise and increase strength

2. A low-fat, high-protein, high-carbohydrate diet is encouraged for a client with hepatitis to promote liver rejuvenation.

Which health promotion activity should the nurse suggest that the client with cirrhosis add tot he daily routine at home? 1. supplement the diet with daily multivitamins 2. abstain from drinking alcohol 3. take a sleeping pill a t bedtime 4. limit contact with other people whenever possible

2. General health promotion measures include maintaining good nutrition, avoiding infection, and abstaining from alcohol

Which finding is normal for a client during the icteric phase of hepatitis A? 1. tarry stools 2. yellowed sclerae 3. shortness of breath 4. light, frothy urine

2. Liver inflammation and obstruction block the normal flow of bile. excess bilirubin turns the skin and sclerae yellow and the urine dark and frothy

A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect? 1. constipation 2. hyperkalemia 3. irregular pulse 4. dysuria

2. Spironolactone is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, HA, and rash

The nurse is establishing goals for the client with hepatitis A. Which goal is appropriate? The client will......... 1. demonstrate a decrease in fluid retention related to ascites 2. verbalize the importance of reporting bleeding gums or bloody stools. 3. limit use of alcohol to two to three drinks per week 4. restrict activity to within the home to prevent disease transmission

2. The client should be able to verbalize the importance of reporting any bleeding tendencies that could be the result of a prolonged prothrombin time

A client is to be discharged with a prescription for lactulose. The nurse teaches the client how to administer this medication. Which statement would indicate that the client has understood the information? 1. "I will take it with an antacid." 2. "I will mix it with apple juice." 3. "I will take it with a laxative." 4. "I will mix the crushed tablets in some gelatin."

2. the taste of lactulose isa problem for some clients. missing it with fruit juice, water, or milk can make it more palatable

The HCP instructs a client with alcohol-induced cirrhosis to stop drinking alcohol. The nurse should assess the client for which expected outcome 1. absence of delirium tremens 2. having a balanced diet 3. improved liver function 4. reduced weight

3. The goal of abstinence from alcohol in clients with alcohol-induced cirrhosis is to improve liver function; most client have improved liver function when they abstain from alcohol.

The nurse develops a teaching plan for the client about how to prevent the transmission of hepatitis A. Which discharge instruction is appropriate for the client? 1. Spray the house to eliminate infected insects 2. Tell family members to try to stay away from the client 3. Ask family members to wash their hands frequently 4. Disinfect all clothing and eating utensils

3. The hepatitis A virus is transmitted via the fecal-oral route. It is spread through contaminated hands, water, and food, especially shellfish growing in contaminated water.

The nurse is preparing a community education program about preventing hepatitis B infection. Which information should be incorporated into the teaching plan? 1. Hepatitis B is relatively uncommon among college students 2. Frequent ingestion of alcohol can predispose an individual to development of hepatitis B 3. Good personal hygiene habits are most effective at preventing the spread of hepatitis B 4. The use of a condom is advised for sexual intercourse

4. Hepatitis B is spread through exposure to blood or blood products and through his-risk sexual activity. Hepatitis B is considered to be a sexually transmitted disease. High-risk sexual activities include sex with multiple partners, unprotected sex with an infected individual, male homosexual activity, and sexual activity with IV drug users

A client has advanced cirrhosis of the liver. The client's spouse asks the nurse why his abdomen is swollen, making it very difficult for him to fasten his pants. How should the nurse respond to provide the most accurate explanation of the disease process? 1. "He must have been eating too many foods with salt in them. Salt pulls water with it." 2. "The swelling in his ankles must have moved up closer to his heart so the fluid circulates better." 3. "He must have forgotten to take his daily water pill." 4. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels."

4. Portal hypertension and hypoalbuminemia as a result of cirrhosis cause a fluid shift onto the peritoneal space causing ascites.

The nurse is caring for a client with esophageal varies. The nurse should discuss which laboratory report finding with the HCP? 1. normal serum albumin 2. decreased ammonia 3. slightly decreased levels of calcium 4. elevated PT/INR

4. The client with esophageal varices is at even higher risk for bleeding with elevated PT/INR

The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. What is the most appropriate goal for the client? 1. Increase mobility 2. Learn new self-care skills 3. Adapt to new levels of energy 4. Gradually increase activity tolerance

4. The most appropriate goal for this client with hepatitis is to increase activity gradually as tolerated. Perios of alternating rest and activity should be included in the plan of care

The nurse is assessing a client for ascites. Where does the nurse place the hands to percussion for presence of fluid? picture of man laying down with hand flexed tot he chest

the nurse places the client in a supine position and peruses each FLANK for shifting dulness. If fluid is present, dullness is noted

A client recently diagnosed with hepatitis C states: "Now that you know what's wrong with me, you can just get me those new drugs to take care of it, right?" What should the nurse tell the client? 1. "There are new antiviral drugs available that may make treatment more effective and help you tolerate it better." 2. "There are drugs to help with he symptoms, but once you have hepatitis C you will never be cured." 3. "The medicine currently used to treat hepatitis C is very expensive, and your insurance probably will not pay for it." 4. "If you continue to make the same lifestyle choices, the medicine will not make any difference."

1. The nurse should explain to the client that current therapy includes the use of antiviral agents which may be administered over a course of 8012 weeks and usually cure the disease. Although the other answers choices may be true, it is not appropriate for the nurse to make judgments about a client's health insurance or lifestyle choices.

The nurse is assessing a client who is in the early stages of cirrhosis of the liver. Which focused assessment is appropriate? 1. peripheral edema 2. ascites 3. anorexia 4. jaundice

3. early clinical manifestations of cirrhosis are subtle and usually include GI symptoms, such as anorexia, N/V, and changes in bowel patterns. These changes are caused by the liver's altered ability to metabolize carbohydrates, proteins, and fats.