Unit 3

The nurse is assessing a patient who is hospitalized with suspected tuberculosis (TB) and expects which initial manifestations?

- dry cough that becomes productive - malaise - low grade fever - unexplained weight loss Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats).

Which diagnostic tests would the nurse anticipate will be prescribed to confirm a patient's diagnosis of acute pancreatitis?

- serum lipase - serum amylase - CT scan Serum amylase and lipase levels usually increase in acute pancreatitis due to pancreatic fibrosis. CT scan is used to confirm pancreatitis and its related complications.

Which type of deficiency causes hemophilia B in a patient?

Christmas factor deficiency Christmas factor, or factor IX, is a clotting protein, and its deficiency causes hemophilia B; this leads to prolonged or spontaneous bleeding.

Which statement by the patient with human immunodeficiency virus (HIV) demonstrates understanding of the needed monitoring for developing opportunistic diseases taught by the nurse?

"the diseases don't usually occur in people with healthy immune systems" Opportunistic diseases generally do not occur in the presence of a functioning immune system. Organisms that do not cause severe disease in people with functioning immune systems can cause debilitating, disseminated, and life-threatening infections during this stage. Several opportunistic diseases may occur at the same time, compounding the difficulties of diagnosis and treatment. Advances in HIV treatment have decreased the occurrence of opportunistic diseases.

Which statement indicates that the patient, concerned about contracting the human immunodeficiency virus (HIV) infection, understood the teachings about transmission provided by the nurse?

"using a condom with a spermicide will reduce my risk of contracting HIV" Research indicates that using a condom with a spermicidal jelly containing nonoxynol-9 provides the greatest reduction of risk of contracting HIV during sexual intercourse.

When discussing human immunodeficiency virus (HIV) infection with a patient, which statements would the nurse use?

- "Untreated HIV infection has a predictable pattern of progression." - "Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS)." - "Oropharyngeal candidiasis is a common infection associated with the symptomatic stage of HIV infection." The typical course of untreated HIV infectionfollows a predictable pattern. Late chronic HIV infection is known as AIDS. The most common infection associated with the symptomatic phase of HIV infection is oropharyngeal candidiasis. The interval between untreated HIV infection and a diagnosis of AIDS is about 10 years. Untreated HIV infection usually remains in the early chronic stage for about 8 years.

Which patient statements reflect understanding of the educational content presented by the nurse for patients who are newly diagnosed with human immunodeficiency virus (HIV)?

- I need to keep my appointments for follow up lab work - i will call my health care provider if i am too sick to take these meds - i won't take any new drugs or herbal products without checking with my health care provider first It is important to keep the appointments for follow-up laboratory work to monitor the effectiveness of the antiretroviral therapy (ART). Patients should be instructed to take all medications as prescribed without stopping any of them. If the patient is unable to tolerate even one of the drugs, then the health care provider needs to be notified immediately. Instruct patients not to take any other medications, including over-the-counter and herbal products, without checking with the health care provider first. Even at the point when the viral load is undetectable, HIV can still be transmitted to others, and the patient will need to continue protection measures. The medications are part of the ART, which significantly slows progression of HIV. Adherence to the therapy is critical and is the reason the patient would be in remission.

A newly diagnosed patient with human immunodeficiency virus (HIV) inquires as to the requirements for development of acquired immunodeficiency syndrome (AIDS). Which diagnostic criterion for AIDS would the nurse share with the patient?

- a CD4+ T-cell count below 200 - the presence of an opportunistic infection - presence of an opportunistic cancer - loss of 10% of more ideal body mass Diagnostic criteria for AIDS include a CD4+ T-cell count below 200/µL or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia.

Which interventions would the nurse implement for a patient with acute pancreatitis who is restless and reports abdominal pain?

- administer IV morphine - encourage the patient to change positions frequently Patients with pancreatitis may experience restlessness due to pain in the abdomen. The nurse should administer morphine, which is an analgesic and relieves pain. The nurse should encourage the patient to change positions frequently, which may help relieve the restlessness associated with acute pancreatitis. the nurse should not encourage water because patients with acute pancreatitis are on NPO status

A patient with acute hepatitis B will be discharged tomorrow. Which measures will the nurse include in the discharge teaching plan?

- allow for periods of rest during the day - avoid food that are very hot or very cold - eat small meals frequently rather than three larger meals a day Rest is an important factor in promoting hepatocyte regeneration. Several measures are important for ensuring that the patient with hepatitis receives adequate nutrition. Drinking carbonated beverages and avoiding very hot or very cold foods may help alleviate anorexia. The anorexia and distaste for food cause nutritional problems. Small, frequent meals may be preferable to three large ones and may also help prevent nausea. Adequate fluid intake (2500 to 3000 mL/day) is important. Restricting fluid intake and participating in exercise regimens are not appropriate measures. Patients with hepatitis need to avoid alcoholic beverages forever.

Which strategies would the nurse teach a patient with a history of substance abuse about eliminating the risk of human immunodeficiency virus (HIV) transmission?

- always use sterile equipment to inject drugs - clean equipment used to inject the drugs you use - do not participate in sexual intercourse while under the influence of drugs

A patient with cirrhosis of the liver is admitted to the hospital. Which hematologic symptoms are likely in this patient?

- anemia - leukopenia - thrombocytopenia Hematologic problems include thrombocytopenia, leukopenia, anemia, and coagulation disorders. Anemia, leukopenia, and thrombocytopenia are probably caused by the splenomegaly that results from the backup of blood from the portal vein into the spleen (portal hypertension). Overactivity of the enlarged spleen results in increased removal of blood cells from circulation. Anemia is also due to inadequate red blood cell (RBC) production and survival, poor diet, poor absorption of folic acid, and bleeding from varices.

Which interventions would the nurse expect in the treatment plan for a patient who is admitted to the hospital with ascites?

- anticipate paracentesis - monitor fluid and electrolytes - administer an albumin infusion Management of ascites focuses on sodium restriction, diuretics, and fluid removal. The fluid and electrolytes should be closely monitored; an imbalance may lead to an increase in ascites. An albumin infusion may be used to help maintain intravascular volume and adequate urine output by increasing plasma colloid osmotic pressure. Paracentesis can be done to remove the ascitic fluid from the peritoneum. The amount of sodium restriction is based on the degree of ascites. The patient is usually not on restricted fluids unless severe ascites develops; however, high-fluid intake should be avoided.

Which instructions would the nurse include when teaching home care measures to a patient diagnosed with hemophilia?

- avoid contact sports - perform oral hygiene daily - wear gloves while doing household chores A patient diagnosed with bleeding disorders such as hemophilia should be advised to play only noncontact sports such as golf to avoid injuries and should perform oral hygiene daily without causing trauma. Gloves should be used while doing household chores to prevent abrasions and cuts from knives and other tools. Alcohol-based mouthwashes should be avoided because they dry the gums and increase bleeding. If there is a nosebleed, then the patient should be advised to gently pat the nose with a tissue because forceful blowing may further increase bleeding.

Which precautions would the nurse follow while caring for a patient with both hepatitis A and hepatitis B infections?

- carefully dispose of the needles and syringes used for the patient - wear gloves while handling articles contaminated by urine or feces - follow procedures while injecting the patient and avoid getting stuck by the used needle Hepatitis A spreads through the fecal-oral route, and hepatitis B spreads through blood. Hence, the virus can spread through needles and syringes used by the patient. Also, the virus can spread while the nurse is handling the urine or fecal material of the patient; hence, it is necessary to wear gloves.

The parent of a pediatric patient who has hepatitis A is worried about the spread of infection to other family members through using the same bathroom. Which information would the nurse provide to the patient's parent?

- clean the bathroom and commode thoroughly - ask your son to wash his hands thoroughly after using the bathroom - ask all family members to wash their hands thoroughly before eating and after using the bathroom Hepatitis A spreads through the fecal-oral route. Transmission is prevented by maintaining hygiene and thorough cleaning of the bathroom and all the equipment. Proper handwashing is extremely important in preventing the spread of the virus.

A patient is admitted to the hospital with a ruptured abscess on the thigh. Culture and sensitivity of the drainage showed methicillin-resistant Staphylococcus aureus (MRSA). Why is the nurse concerned about this infection?

- community acquired MRSA is more virulent than hospital acquired MRSA - MRSA is a form of Staphylococcus aureus that does not respond to methicillin based therapy - MRSA is a form of Staphylococcus aureus that does not respond to penicillin based therapy

A patient is admitted to the hospital with a ruptured abscess on the thigh. Culture and sensitivity of the drainage showed methicillin-resistant Staphylococcus aureus (MRSA). Why is the nurse concerned about this infection? Select all that apply.

- community acquired MRSA is more virulent than hospital acquired MRSA - MRSA is a form of Staphylococcus aureus that does not respond to methicillin based therapy - MRSA is a form of Staphylococcus aureus that does not respond to penicillin based therapy

Which information about diet would the nurse provide for a patient who is diagnosed with acute pancreatitis?

- consume a low fat diet - avoid consuming alcohol - consume a high carb diet Consuming a low-fat, high-carbohydrate diet is essential in pancreatitis. Fats should be avoided because they stimulate the secretion of cholecystokinin, which then stimulates the pancreas. Alcohol is an irritant and must be avoided. Fluid intake should be increased to prevent dehydration. Carbohydrates are less stimulating to the pancreas and are encouraged.

A patient with a chronic hepatitis C virus (HCV) infection is admitted to the hospital. Which factors contribute to this patient's high risk for development of cirrhosis?

- diabetes - alcohol consumption - elevated total cholesterol level HCV infection is more likely than hepatitis B virus (HBV) to become chronic. An infection with HCV can lead to development of cirrhosis of the liver. People with diabetes mellitus have a compromised immune function and are at risk of developing cirrhosis. Alcohol consumption may further deteriorate the liver function and lead to development of cirrhosis of the liver. Elevated cholesterol or triglycerides suppresses liver function and may lead to progression of HCV to cirrhosis.

When assessing for a patient's human immunodeficiency virus (HIV) risk, which questions would the nurse ask?

- have you ever had unprotected sexual intercourse - have you ever had unprotected sexual intercourse - have you ever had a sexually transmitted infection To help a patient assess risk of HIV, the nurse should ask questions regarding history of blood transfusion, unprotected sexual intercourse, and sexually transmitted disease. These questions provide the minimum information needed to initiate a risk assessment. A positive response to any of these questions should be followed by an in-depth exploration of issues related to the identified risk.

Which statements would the nurse include when teaching an awareness program on acquired immunodeficiency syndrome's (AIDS') routes of transmission?

- having intercourse with only one stable partner can still infect a person - even if a condom is used each time there is sexual intercourse, a person can be infected - if sexual contact is limited to those without HIV antibodies, an individual can still become infected The risk of transmission depends on the partner's prior behavior. Although condoms do offer protection, they are subject to failure because of condom rupture or improper use; risks of infection are present with any sexual contact. An individual may be infected before testing positive for the antibodies; the individual can still transmit the virus.

The nurse presents information about hemophilia to a group of nursing students. Which information would the nurse include?

- hemophilia B is transmitted by female carriers - Von Willebrand disease is seen in both genders - Hemophilia A is displayed almost exclusively in men

Which clinical manifestations are seen with chronic hepatitis?

- hepatomegaly - elevated liver enzymes Chronic hepatitis is manifested by hepatomegaly and elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Fever, nausea, vomiting, and decreased sense of taste are associated with acute hepatitis.

Which clinical findings would be consistent with a patient developing a pancreatic abscess?

- high fever - leukocytosis - abdominal pain A pancreatic abscess is a collection of pus and manifests with symptoms of infection, such as high fever, leukocytosis, and abdominal pain.

A patient with pancreatitis is irritable, has jerking movements, and reports a loss of sensation in the fingers. Which laboratory test results would the nurse expect?

- hypocalcemia - hypomagnesemia Acute pancreatitis is associated with complications of hypocalcemia and hypomagnesemia. Hypocalcemia is manifested by jerking, irritability, and numbness in fingers and around the lips. Hypomagnesemia causes weakness, abnormal heart rhythms, and tremors.

Which patient statements indicate understanding of the information taught by the nurse on postsurgical cataract care?

- i might feel some scratchiness in my left eye after surgery - i will call my HCP if i notice white drainage or redness of my left eye - prior to surgery, i need to remove potential obstacles to prevent falling The patient will notice an improvement in vision after surgery, not in a few days. Cataract surgery typically results in little to no pain, but the patient may have some scratchiness in the operative eye. Mild analgesics are usually sufficient to relieve any discomfort, but if the pain is sudden or intense, the patient should notify the health care provider because this may indicate hemorrhage, infection, or increased intraocular pressure (IOP). The patient should be instructed to call the health care provider if redness or drainage occurs in the affected eye; these symptoms can be signs of infection. Some patients may still need glasses or contact lenses to achieve their best visual acuity. Patients may have significant visual impairment after surgery or until the permanent lens is implanted. Patients should remove potential obstacles prior to surgery to maintain an adequate level of safe functioning, such as moving area rugs and furniture out of common pathways.

When admitted with pneumonia and a history of bilateral cataracts, which interventions would the nurse implement to facilitate an elderly patient's ability to see?

- increase the amount of light for near vision - obtain teaching materials with enlarged print

A patient is admitted with severe acute pancreatitis. Which clinical manifestations would the nurse expect?

- jaundice - exocrine function - pancreatic necrosis Jaundice may be associated with severe pancreatitis. Patients with severe pancreatitis have diminished exocrine and endocrine function and necrosis of the pancreas

A patient with severe acute pancreatitis has abdominal distention, frequent belching, and excessive flatulence. Which drug in the patient's medication orders would the nurse hold until the health care provide is contacted?

- morphine - dicyclomine The patient's signs and symptoms indicate a possible paralytic ileus; antispasmodics such as dicyclomine and pain relievers such as morphine, which can cause constipation, are contraindicated in patients with paralytic ileus.

A patient with chronic acquired immunodeficiency syndrome (AIDS) is taking antiretroviral therapy (ART) as well as medication for tuberculosis. Which laboratory data changes would the nurse anticipate?

- neutropenia - abnormal liver function tests The patient may have abnormal liver function tests due to treatment with antitubercular drugs such as isoniazid (INH) and rifampin (RIF). These drugs are hepatotoxic and may derange the liver function tests. The patient is treated on ART, which may also cause neutropenia.

A patient with factor VIII deficiency experiences joint bleeding. Which interventions would be included in the patient's plan of care?

- pack the joint with ice - provide analgesics such as acetaminophen - encourage the patient to perform range of motion exercises when bleeding is stopped Factor VIII deficiency leads to hemophilia, which is a severe bleeding disorder. When joint bleeding occurs, the joint should be packed in ice to reduce bleeding. Analgesics such as acetaminophen should be provided to reduce pain. When bleeding is stopped, the patient should be encouraged to perform range-of-motion exercises to increase mobilization

Which information would the nurse provide the patient with human immunodeficiency virus (HIV) who asks about factors determining progression to acquired immunodeficiency syndrome (AIDS)?

- progression of HIV can be assessed by your viral load - your CD4+T cell count is one of several factors identified The progression of HIV infection to AIDS is monitored by CD4+ T-cell counts, viral load, opportunistic infections, and wasting syndrome. Laboratory tests that measure viral levels provide an assessment of disease progression. The CD4+ T-cell count is obtained to monitor the progression of HIV infection and response to treatment. The normal range for CD4+ T cells is 800 to 1200 cells/μL

A nurse is caring for a patient who has cirrhosis of the liver. Which clinical manifestations would the nurse expect to find?

- small areas of bleeding into the skin - vascular lesions formed by small blood vessels - small dilated blood vessels with spider like branches Ecchymoses are small areas of bleeding into the skin or mucous membrane forming blue or purple patches. Because there is decreased synthesis of prothrombin in the liver, the bleeding and clotting time may be deranged. Telangiectasia is a vascular lesion formed by a group of small blood vessels. Spider angioma is also seen in cirrhosis of the liver.

Which information would the nurse emphasize while teaching a patient ways to avoid exposure to hepatitis B infection?

- use disposable needles and syringes - avoid sharing toothbrushes and razors - avoid unsafe sex with multiple parterres and always use condoms Hepatitis B spreads through sexual contact and through blood. Sharing razors or toothbrushes with an infected person may introduce infection in another person's body. Similarly, a needle used by an infected person can spread the infection. Hepatitis B also spreads via sexual exposure with an infected person. Using a condom gives some protection against the spread of infection.

A patient with advanced liver disease has esophageal varices. Which interventions would the nurse use to prevent bleeding?

- use the smaller gauge needle possible when giving injections or drawing blood - teach the pt to avoid straining at stool, vigorous nose blowing and coughing - advise the pt to use soft bristle toothbrush and to avoid ingesting irritating food - instruct the patient to avoid NSAIDs and aspirin

A nurse is collecting data from a patient admitted with hepatitis A. Which information given by the patient may indicate the patient's susceptibility to contract hepatitis A?

- working as a plumber - working as a sewage cleaner Hepatitis A spreads mainly through the fecal-oral route. Sewage may harbor this virus; hence, plumbers and sewage cleaners may be exposed to it.

Acute hemarthrosis

Acute hemarthrosis is characterized by bleeding into the joint spaces, as is seen in hemophilia. Bleeding in the joints causes local inflammation. The image shows inflammation of the knee joint and is therefore acute hemarthrosis.

A high blood level of which substance causes hepatic coma?

Ammonia A high ammonia level in the blood is a late manifestation of liver failure that results in hepatic coma, causing neurologic dysfunction and brain damage.

The nurse discovers a bluish discoloration of the periumbilical area on a patient who has been admitted with severe pancreatitis. How would the nurse document this finding?

Cullen's sign Bluish discoloration of the periumbilical region is called Cullen's sign and can result from seepage of blood-stained exudate from the pancreas, which may occur in severe pancreatitis.

Which therapy would be beneficial for a patient who experiences a minor bleeding episode during a dental procedure?

Desmopressin acetate Desmopressin acetate is used to treat minor bleeding episodes and dental procedures.

Which treatment would the nurse anticipate incorporating into the plan of care for a patient with mild hemophilia A?

Desmopressin acetate (DDAVP) DDAVP is beneficial for a patient with mild hemophilia A and certain subtypes of von Willebrand disease. It is a synthetic analog of vasopressin and may be used to stimulate an increase in factor VIII and von Willebrand factor (vWF).

When planning the care for a patient with human immunodeficiency virus (HIV) infection, which nursing action is helpful in preventing patient complications?

Educate the patient about the importance of adherence to drug therapy The priority nursing action is to be sure the patient understands the importance of adhering to the antiviral medication regimen to prevent increasing viral loads.

A patient with chronic kidney disease (CKD) experiences peripheral neuropathy, specifically asterixis. Which assessment finding does the nurse expect?

Hand tremors while extending the wrist Peripheral neuropathy initially manifests as a slowing of nerve conduction to the extremities. Asterixis is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings. This motor disorder is characterized by an inability to maintain a position, which is demonstrated by jerking movements of the outstretched hands when bent upward at the wrist. The patient may describe a burning sensation in the feet and legs, which are paresthesias.

A patient is diagnosed with chronic liver cirrhosis. The nurse expects which assessment finding when examining the abdomen?

Hard, enlarged liver An enlarged and hard liver with an irregular surface or edge is seen in patients with cirrhosis of the liver. Rebound tenderness is indicative of peritoneal inflammation. Liver dullness during percussion is a normal finding.

Which hepatitis virus is transmitted from mother to fetus?

Hep B The hepatitis B virus is transmitted perinatally from mother to fetus. Studies show that most mother-to-child hepatitis B virus (HBV) transmission occurs during or shortly before delivery.

Which condition would the nurse suspect when a patient's assessment findings include asterixis, hyperventilation, fetor hepaticus, and continuous lip smacking?

Hepatic encephalopathy Hepatic encephalopathy is a mental disorder that occurs due to acute or chronic liver injury. Hypothermia, grimacing reflexes (actions like lip smacking and lip puckering), fatigue, asterixis, hyperventilation, and fetor hepaticus are the clinical manifestations of hepatic encephalopathy.

The treatment plan for a patient with tuberculosis includes isoniazid and rifampin. Which data found in the patient's health history cause the nurse to question the medication prescriptions?

Hepatitis Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. Hepatotoxicity is a common side effect.

A patient with pancreatitis has a nasogastric tube connected to low intermittent gastric suction. Which intervention would the nurse expect to be prescribed?

Infusion of LR Frequent vomiting and gastric suction decrease the level of electrolytes, such as sodium, potassium, and chloride. Lactated Ringer's solution is infused to correct electrolyte imbalances.

For the patient who tests positive for human immunodeficiency virus (HIV), which clinical manifestation would the nurse identify as the higher priority, warranting follow-up care?

New or productive cough The patient who tests positive for HIV should be informed to report a new or productive cough within 24 hours after symptoms begin as the cough may indicate development of an opportunistic infection.

A patient with hemophilia has developed inhibitors to factors VIII and IX. The nurse recognizes that which replacement factor would be beneficial for the patient?

NovoSeven NovoSeven is a replacement factor that is beneficial for a patient who has developed inhibitors to factors VIII or IX.

Which drug would the nurse anticipate administering to a patient to reduce gastric acid secretion?

Omeprazole Omeprazole is a proton pump inhibitor that acts by decreasing production of hydrochloric acid in the stomach.

Which laboratory test would the nurse anticipate being normal in a patient with von Willebrand disease?

Prothrombin time (PT) Prothrombin time is normal; there is no involvement of extrinsic system.

Which method of transmission precaution would the nurse use when providing care for a patient suspected of being positive for human immunodeficiency virus (HIV) in the hospital setting?

Standard Precautions The standard precautions system applies to (1) blood; (2) all body fluids, secretions, and excretions; (3) non-intact skin; and (4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms in hospitals. Standard precautions should be applied to all patients regardless of diagnosis or presumed infection status.

In the early stages of human immunodeficiency virus (HIV) infection, which cells protect the human body from infections?

T cells In the early stages of HIV infection, T cells protect the body from infections. T cells play a key role in the immune system's ability to recognize and defend against pathogens. Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells.

The nurse anticipates administering which antibiotic to a patient with methicillin-resistant Staphylococcus aureus (MRSA)?

Vancomycin

The nurse collaborates with the health care team to arrange for home care for a patient with pulmonary tuberculosis (TB). Of the family members who live with the patient, which one is at the greatest risk for contracting the disease?

a 75 year old parent who takes prednisone The patient's parent would be most susceptible to TB as a consequence of advanced age and immunosuppression by the corticosteroid.

A patient with cancer that has metastasized to the liver has developed edema and ascites. Which parameter would the nurse assess to determine the effectiveness of prescribed diuretic therapy?

abdominal girth Daily measurement of the abdominal girth provides a direct indication of ascitic fluid increase or decrease.

Which measurement would provide the most specific information about the outcome of a paracentesis for a patient who has ascites?

abdominal girth Paracentesis involves the removal of fluid from the abdominal cavity. A large-bore needle connected to tubing is inserted by the health care provider into the distended abdomen. The other end of the tubing also has a large-bore needle, which is inserted into a vacuum bottle. The vacuum bottle is then held below the level of the abdomen, facilitating gravity-flowed removal of the ascites. Several bottles of fluid can be removed, with the result measured by reduction in abdominal girth.

Which enzyme is responsible for autodigestion of the pancreas and leads to bleeding in a patient with acute pancreatitis?

activated trypsin In acute pancreatitis, trypsin that is present in the pancreas autodigests the pancreas, resulting in bleeding.

A patient reports severe, piercing pain in the abdomen, accompanied by shortness of breath. The laboratory reports demonstrate elevated serum amylase, triglycerides, and lipase levels, as well as hyperglycemia. Which condition would the nurse suspect?

acute pancreatitis

A patient reports severe pain in the abdomen. The patient's body temperature is 100°F (37.7°C). The laboratory reports show a white blood cell (WBC) count of 13,000/µL, lipase of 180 U/L, and amylase of 150 U/L. Which condition would the nurse suspect?

acute pancreatitis Acute pancreatitis is manifested by abdominal pain, low-grade fever, tachycardia, leukocytosis, and elevated amylase and lipase values. A normal WBC count is 4,000 to 11,000/-µL, a normal lipase range is 0 to 160 U/L, and a normal amylase range is 30 to 122U/L.

A parent brings a child to a primary health care center and reports that the child has abdominal pain, back pain, and fever. The nurse assesses that the child has diminished bowel sounds and a bluish discoloration adjacent to the navel. Which condition would the nurse suspect?

acute pancreatitis Acute pancreatitis is manifested by fever and abdominal pain radiating to the back. Acute pancreatitis may cause absence of bowel sounds and bluish discoloration in the periumbilical region called Grey Turner's spots. Because the child has bluish discoloration adjacent to the navel, abdominal pain, and fever, the nurse suspects the diagnosis to be acute pancreatitis.

Which risk factor is most commonly associated with cirrhosis?

alcohol abuse Cirrhosis is highly correlated with alcohol abuse and chronic hepatitis C.

The health care provider prescribes lactulose for a patient with hepatic encephalopathy. Which data would the nurse monitor for effectiveness of this medication?

ammonia levels Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy.

Which effect would the nurse expect after administering nortriptyline to a patient with chronic pancreatitis?

reduction in neuropathic pain Nortriptyline is an antidepressant that is effective in reducing neuropathic pain in patients with chronic pancreatitis

The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response would the nurse provide?

an injection of immunoglobulin will need to be given to prevent or minimize the effects of exposure Immunoglobulin provides temporary (one to two months') passive immunity and is effective for preventing hepatitis A if given within two weeks after exposure

Which symptom would a patient most likely report first over the course of developing hepatitis A?

anorexia The preicteric phase of hepatitis is usually marked by severe anorexia, malaise, and fever.

Which nursing intervention would be helpful to a patient with hemophilia who experiences severe joint bleeding?

applying direct pressure with ice at the joint A patient with hemophilia who experiences joint bleeding should have the involved joint totally immobilized. Pressure should also be applied with ice to prevent crippling deformities from hemarthrosis

The nurse is caring for a patient with a diagnosis of active tuberculosis (TB) and anticipates that which item will be included in the patient's treatment plan?

avoid alcohol because it increases the hepatotoxicity associated with isoniazid

Which teaching would the nurse recommend to a patient with chronic hepatitis B virus (HBV) infection concerning prevention of relapses based on patient-reported information in the electronic health record (EHR)?

avoid alcohol entirely Patients with chronic hepatitis can have relapses. Alcohol intake can lead to a relapse and should be avoided entirely. Fluid intake should be 2500 to 3000 mL daily. Carbonated beverages may help ease anorexia related to the hepatitis. Small, frequent meals are recommended; however, anorexia is often less severe in the morning. Thus a good breakfast and smaller dinner may be helpful.

A patient is stable after treatment of recently diagnosed esophageal varices. Which information would the nurse include in the teaching plan for this patient?

avoid straining during defecation to keep venous pressure low Straining during a bowel movement increases venous pressure and could cause rupture of the varices.

Which information would the nurse include when reinforcing the health teachings for a patient diagnosed with primary open-angle glaucoma?

pressure damage to the optic nerve may occur because of clogged drainage channels

The nurse suspects a patient may have von Willebrand disease. Which assessment finding supports the nurse's suspicion?

prolonged bleeding after a minor tooth extraction

Which laboratory value would the nurse expect to be decreased for a patient with acute pancreatitis?

calcium Hypocalcemia is a complication of acute pancreatitis, which is characterized by decreased levels of calcium. Therefore decreased serum calcium is an abnormal finding in acute pancreatitis.

Which medication would the nurse anticipate will be prescribed for a patient with pancreatitis who reports tingling around the lips?

calcium gluconate Jerking movements, tingling around the lips, and irritability are symptoms of tetany, which is caused by hypocalcemia. When calcium levels drop, the salt form of calcium is administered; therefore the nurse expects the health care provider to prescribe calcium gluconate.

Which laboratory finding indicates resolution of a patient's acute pancreatitis?

decreasing resumé's amylase level Serum amylase is a major indicator of pancreatic function and will be increased during acute pancreatitis. A decreasing serum amylase level indicates resolution of pancreatic inflammation

The nurse would stress the importance of which information when teaching health promotion activities to a patient with the human immunodeficiency virus (HIV) infection?

delaying disease progression These health promotion activities, along with mental health counseling, support groups, and a therapeutic relationship with health care providers, will promote a healthy immune system, which may delay disease progression.

When preparing a patient for a surgical procedure, which finding would the nurse expect in the history and physical examination report regarding the patient's history of primary open-angle glaucoma?

denial of eye pain or pressure Primary open-angle glaucoma is typically symptom-free, which explains why patients can have significant vision loss before diagnosis, unless regular eye examinations are performed

Which action is likely to exacerbate the condition of a patient who has pancreatitis?

eating three large meals a day Patients with pancreatitis should be given small and frequent meals to reduce or prevent pancreatic stimulation. Therefore avoiding small, frequent meals is responsible for the patient's condition. Pancreatitis is associated with fatty and foul-smelling stools; monitoring of stools is required in patients with this disease.

Which physiologic condition is consistent with mild pancreatitis?

edematous pancreas Mild pancreatitis is manifested by edema. The severe form of pancreatitis is manifested by organ failure, necrosis, and sepsis of the pancreas.

The nurse teaches cataract surgery discharge instructions and includes that the development of which clinical manifestation warrants the patient contacting the surgeon immediately?

eye pain Pain should not be present after cataract surgery, although there may be slight discomfort that is easily relieved with acetaminophen. The patient should be told that the other symptoms, including glare, itching, and blurred vision, may be present and are expected until healing takes place.

Which finding indicates that a patient with advanced cirrhosis is experiencing a serious complication?

frequent nosebleeds and brusing The liver produces clotting factors. As cirrhosis becomes more advanced, the production of clotting factors is disrupted and thereby decreased, making the patient more susceptible to bleeding. Increasing frequency and severity of nosebleeds and bruising would indicate a deterioration in liver function.

Which statement is true regarding hemophilia?

hemophilia can be treated by replacement therapy Hemophilia decreases the clotting ability of the blood in a patient and can be treated by replacement therapy during acute phases of bleeding. Hemophilia is hereditary in nature. Hemophilia is an X-linked recessive genetic disorder. The most common form of hemophilia is hemophilia A.

The patient with cirrhosis is learning self-care. Which statement indicates that the patient needs more teaching?

if i notice a fast heart rate or irregular beats, that is normal for cirrhosis If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider because this is not normal for cirrhosis and is potentially dangerous.

Which therapeutic outcome would the nurse expect for a patient with hemophilia A prescribed desmopressin acetate?

increase in factor VIII Ecchymosis and subcutaneous hematomas are the clinical manifestations of bleeding in a patient with hemophilia A. Desmopressin acetate is used to stimulate an increase in factor VIII in patients with hemophilia.

The nurse is caring for a patient with pancreatitis who is prescribed a regular diet. Which finding indicates to the nurse that food and fluids should be withheld for this patient?

increased abdominal pain A patient with pancreatitis experiences severe pain if he or she has intolerance to oral foods. A patient who shows intolerance to oral foods also experiences increased (not decreased) abdominal girth and elevated levels of serum lipase and amylase.

The nurse recognizes that desmopressin acetate needs to be given to a patient in repeated doses for which reason?

it is relatively short lived Desmopressin acetate is relatively short-lived and therefore should be given in repeated doses to prolong its beneficial effects

The nurse cares for a patient who is immunocompetent and presents with pulmonary tuberculosis (TB). Which clinical manifestation does the nurse expect?

mucopurulent sputum A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary TB.

The nurse cares for a patient with a diagnosis of tuberculosis. Which assessment finding best indicates that the patient has been following the prescribed treatment plan?

negative sputum cultures A patient's sputum is expected to convert to negative within three months of the beginning of treatment. If it does not, the patient is either not taking the medication or has drug-resistant organisms.

After reviewing the assessment data documented by the student nurse for a patient with severe ascites secondary to cirrhosis, the nurse would take which action?

position patient in fowlers or semi fowlers position It is common for patients with severe ascites to suffer from dyspnea; thus the nurse would position the patient in a Fowler's or semi-Fowler's position to help relieve the dyspnea. Addressing pruritus by administering an antihistamine would have lower priority than addressing breathing. The patient's oxygen saturation levels are within normal parameters; oxygen per nasal cannula is not indicated. Paracentesis is a potential option but would not be the first action taken because it would not immediately address the dyspnea.

While awaiting arrival of the emergency response team, which intervention would the occupational health nurse implement for the patient who sustained a penetrating eye injury from a foreign object?

stabilize the forge in object within the injury site The nurse should stabilize the foreign object penetrating the eye to prevent further damage until the injury can be treated by an emergency medicine specialist and ophthalmologist. The head of the patient should be elevated 45 degrees to prevent excessive pressure within the eye. Bending over is avoided. Irrigation of the eye is indicated only if the injury is caused by chemical exposure.

A patient admitted to the hospital with cirrhosis of the liver suddenly vomits blood. Which action would the nurse take?

stabilize the patient and manage the airway Individuals with cirrhosis of the liver are at risk of bleeding from esophageal and gastric varices. Hematemesis in the patient with cirrhosis of the liver is likely to be variceal bleeding. In this case, the nurse should first stabilize the patient and manage the airway. Once the patient is stable, other steps in treatment can be initiated, such as assessing further and administering necessary medications.

The nurse would teach the patient diagnosed with a hordeolum which intervention for self-management of the red, swollen, circumscribed, and acutely tender area in the lid margin

suggest applying warm, moist compresses at least 4 times a day until the condition improves Hordeolum is an infection caused by the bacteria Staphylococcus aureus. It manifests as a red, swollen, circumscribed, and acutely tender area in the lid margin. Treatment involves applying warm, moist compresses at least four times a day until the condition improves. If it recurs, lid scrubs should be performed daily to aid healing. In addition, appropriate antibiotic ointments or drops are prescribed if required. Wearing glasses may not help in treating hordeolum. The disorder is not a normal body protective mechanism; therefore treatment should not be deferred.

When monitoring the CD4 results of a patient with human immunodeficiency virus (HIV) infection, which CD4 count would prompt the nurse to monitor for clinical manifestations associated with immunity problems?

the CD4 could falls to 500 Immune problems start to occur when the count drops below 500 CD4 T cells. When the value drops below 200 CD4 T cells, severe immune problems will develop, and the patient is diagnosed with acquired immunodeficiency syndrome (AIDS). The immune system generally remains healthy if there are more than 500 CD4 T cells. A count between 800 and 1200 CD4 T cells is normal for adults who do not have any immune dysfunction.

The nurse is assessing a female patient with hemophilia. Which inference is correct about the patient's family?

the father has hemophilia, and the mother is a carrier of hemophilia Hemophilia is an X-linked recessive genetic disorder caused by a defective or deficient coagulation factor. For a female to be hemophilic, both the X chromosomes should carry hemophilia because it is a recessive disorder. The daughter can have hemophilia if her father has hemophilia and the mother is a carrier for hemophilia. If the father or mother is unaffected by hemophilia, then the daughter will not have hemophilia because it is an X-linked recessive disorder.

When interpreting laboratory diagnostics, which statement would the nurse identify as pathophysiology for the human immunodeficiency virus (HIV) infection?

the immune system is impaired from CD4+ T-cell destruction Immune dysfunction in HIV infection is predominantly the result of damage to and destruction of CD4+ T cells (also known as T helper cells or CD4+ T lymphocytes). HIV cannot replicate unless it is inside a living cell. HIV replicates in a "backward" manner (going from RNA to DNA). Antibodies do not destroy the infected monocytes

Which statement would the nurse include when teaching a patient the pathophysiology of their open-angle glaucoma?

there is decreased draining of aqueous humor in the eye, causing pressure damage to the optic nerve With primary open-angle glaucoma, there is increased intraocular pressure because the aqueous humor cannot drain from the eye. This leads to damage to the optic nerve over time.

The nurse recognizes that airborne infection isolation for a patient with pulmonary tuberculosis (TB) can be discontinued when which criterion is met?

three consecutive acid fast bacillus (AFB) smears are negative Airborne infection isolation is indicated for the patient with pulmonary or laryngeal TB until the patient is noninfectious (defined as effective drug therapy, clinical improvement, and three negative AFB smears).

A patient who has cirrhosis of the liver with ascites is being prepared for a paracentesis. Which instructions would the nurse give the patient?

void urine immediately before the procedure The nurse should instruct the patient to void prior to the paracentesis to prevent accidental puncture of the bladder.