Adult Nursing 5 Test 6
After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take (select all that apply)?
-Administer hepatitis B vaccine. -Test for antibodies to hepatitis B -Give hepatitis B immune globulin
The nurse is instructing a patient with chronic pancreatitis on measures to prevent further attacks. What information should be provided (select all that apply)?
-Avoid nicotine. -Eat bland foods. -Observe stools for steatorrhea
Acalculous cholecystitis is diagnosed in an older, critically ill patient. Which factors may be associated with this condition (select all that apply)?
-Fasting -Parenteral nutrition -Prolonged immobility
Of the following characteristics, identify those that are most commonly associated with cholelithiasis (select all that apply).
-Obesity -Age over 40 -Multiparous female -Family history of gallbladder disease -Use of estrogen or oral contraceptives
The patient is an older woman with cirrhosis who also has anemia. What pathophysiologic changes may contribute to this patient's anemia (select all that apply)?
-Vitamin B deficiencies -Vascular congestion of spleen -Decreased prothrombin production
A patient was diagnosed with nonalcoholic fatty liver disease (NAFLD). What treatment measures should the nurse plan to teach the patient about (select all that apply)?
-Weight loss -Diabetes management -Dietary management of hyperlipidemia
The patient being treated with diuretics for ascites from cirrhosis must be monitored for (select all that apply)?
-hypokalemia -renal function
The patient asks why the serologic test of HBV DNA quantitation is being done. What is the best rationale for the nurse to explain the test to the patient?
. Indicates viral replication and effectiveness of therapy for chronic HBV
The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been effective when the patient's blood specimen reveals
. anti-HBs
During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first
A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)
. A patient with advanced cirrhosis has a nursing diagnosis of imbalanced nutrition: less than body requirements related to anorexia and inadequate food intake. What would be an appropriate midday snack for the patient?
A fresh tomato sandwich with salt-free butter
A patient with chronic cholecystitis asks the nurse whether she will need to continue a low-fat diet after she has a cholecystectomy. What is the best response by the nurse
A low-fat diet is recommended for a few weeks after surgery until the intestine adjusts to receiving a continuous flow of bile
A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective
Abdominal pain is decreased.
A patient with an obstruction of the common bile duct has clay-colored fatty stools among other manifestations. What is the pathophysiologic change that causes this clinical manifestation?
Absence of bilirubin and bile salts in the small intestine prevents conversion to urobilinogen and fat emulsion and digestion
In discussing long-term management with the newly diagnosed patient with alcoholic cirrhosis, what should the nurse advise the patient
Abstinence from alcohol is the most important factor in improvement of the patient's condition.
The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?
Administer prescribed opioids to relieve pain as needed
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take
Administer the spironolactone
Which focused data will the nurse monitor in relation to the 4+ pitting edema assessed in a patient with cirrhosis
Albumin level
Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a patient who has acute pancreatitis
Amylase
Although HAV antigens are not tested in the blood, they stimulate specific IgM and IgG antibodies. Which antibody indicates there is acute HAV infection
Anti-HAV IgM
Which action should the nurse take to evaluate treatment effectiveness for a patient who has hepatic encephalopathy
Ask the patient to extend both arms forward
A patient born in 1955 had hepatitis A infection 1 year ago. According to CDC guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination?
Ask whether the patient has been screened for hepatitis C.
The patient has hepatic encephalopathy. What is a priority nursing intervention to keep the patient safe?
Assist the patient to the bathroom.
A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?
Asterixis and lethargy
Which topic is most important to include in patient teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis
Avoiding alcohol ingestion
Which conditions contribute to the formation of abdominal ascites
Blood flow through the portal system is obstructed, which causes portal hypertension
Which action should the nurse in the emergency department take first for a new patient who is vomiting blood
Check blood pressure and heart rate
When taking the blood pressure (BP) on the right arm of a patient with severe acute pancreatitis, the nurse notices carpal spasms of the patient's right hand. Which action should the nurse take next
Check the calcium level in the chart.
What is a risk factor associated with cancer of the pancreas
Cigarette smoking
A patient with cirrhosis asks the nurse about the possibility of a liver transplant. What is the best response by the nurse
Cirrhosis is an indication for transplantation in some cases. Have you talked to your doctor about this?
What causes the systemic effects of viral hepatitis?
Complement system activation by antigen-antibody complexes
The patient has been newly diagnosed with Wilson's disease. D-penicillamine, a chelating agent, has been prescribed. What assessment finding should the nurse expect
Corneal Fleischer rings
Which etiologic manifestations occur in the patient with cirrhosis related to esophageal varices
Development of collateral channels of circulation in inelastic, fragile esophageal veins as a result of portal hypertension
A patient admitted with an abrupt onset of jaundice and nausea has abnormal liver function studies but serologic testing is negative for viral causes of hepatitis. Which question by the nurse is appropriate
Do you use any over-the-counter drugs
The patient experienced a blood transfusion reaction. What is the best explanation the nurse can give to the patient to explain the cause of the hemolytic jaundice that occurred
Due to increased breakdown of RBCs that causes elevated serum unconjugated bilirubin
In a radical pancreaticoduodenectomy (Whipple procedure) for treatment of cancer of the pancreas, what anatomic structure is completely resected that will affect the patient's nutritional status?
Duodenum adjoining the pancreas
Which finding indicates to the nurse that a patient's TIPS placed 3 months ago has been effective
Fewer episodes of bleeding varices
Following a needle stick, what is used as prophylaxis against HBV?
HBIG and HBV vaccine
What test will be done before prescribing treatment for the patient with positive testing for HCV
HCV genotyping
Following a laparoscopic cholecystectomy, what should the nurse expect to be part of the plan of care?
Have up to four small abdominal incisions covered with small dressings
Which type of hepatitis is a DNA virus, can be transmitted via exposure to infectious blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer?
Hepatitis B (HBV)
The patient returned from a 6-week mission trip to Somalia with complaints of nausea, malaise, fatigue, and achy muscles. Which type of hepatitis is this patient most likely to have contracted
Hepatitis E (HEV)
The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement
I can remove the bandages on my incisions tomorrow and take a shower
The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement
I must avoid all physical contact with my family until the jaundice is gone
The nurse determines that further discharge instruction is needed when the patient with acute pancreatitis makes which statement
I shouldn't eat any salty foods or foods with high amounts of sodium
What manifestation in the patient does the nurse recognize as an early sign of hepatic encephalopathy
Impaired computational skills
A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a splenorenal shunt. As a result of this procedure, what should the nurse expect the patient to experience?
Improved hemodynamic function and renal perfusion
Combined with clinical manifestations, what is the laboratory finding that is most commonly used to diagnose acute pancreatitis
Increased serum amylase
When caring for a patient with autoimmune hepatitis, the nurse understands that what about this patient is different from the patient who has viral hepatitis
Is treated with corticosteroids or other immunosuppressive agents
The patient with suspected gallbladder disease is scheduled for an ultrasound of the gallbladder. What should the nurse explain to the patient about this test?
It is noninvasive and is a very reliable method of detecting gallstones.
To treat a cirrhotic patient with hepatic encephalopathy, lactulose, rifaximin (Xifaxan), and a proton pump inhibitor are ordered. The patient's family wants to know why the laxative is ordered. What is the best explanation the nurse can give to the patient's family
It traps ammonia and eliminates it in the feces.
What must the nurse do to care for a T-tube in a patient following a cholecystectomy
Keep the tube supported and free of kinks
A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse
Lamivudine (Epivir) and interferon both decrease viral load and help prevent complications
Which goal has the highest priority in the plan of care for a 26-yr-old patient who is homeless who was admitted with viral hepatitis who has severe anorexia and fatigue
Maintain adequate nutrition
During the treatment of the patient with bleeding esophageal varices, what is the most important thing the nurse should do
Maintain the patient's airway and prevent aspiration of blood.
What is the patient with chronic pancreatitis more likely to have than the patient with acute pancreatitis
Malabsorption and diabetes mellitus
The patient with liver failure has had a liver transplant. What should the nurse teach the patient about care after the transplant?
Monitor closely for infection because of the immunosuppressive medication.
A patient is being treated for bleeding esophageal varices with balloon tamponade. Which nursing action will be included in the plan of care?
Monitor the patient for shortness of breath
Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient with acute pancreatitis?
Muscle twitching and finger numbness
What treatment measure is used in the management of the patient with acute pancreatitis
NG suction to prevent gastric contents from entering the duodenum
What treatment for acute cholecystitis will prevent further stimulation of the gallbladder?
NPO with NG suction
During the incubation period of viral hepatitis, what should the nurse expect the patient to report
No symptoms except diagnostic results
The patient has a diagnosis of a biliary obstruction from gallstones. What type of jaundice is the patient experiencing, and what serum bilirubin results would be expected
Obstructive jaundice with elevated unconjugated and conjugated bilirubin
Malnutrition can be a major problem for patients with cirrhosis. Which nursing intervention can help to improve nutrient intake?
Oral hygiene before meals and snacks
Which assessment finding is of most concern for a patient with acute pancreatitis
Palpable abdominal mass
Which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis
Pancreatic abscess
A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection. Which patient would be the best choice?
Patient who requires pain management for chronic pancreatitis
A patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the health care provider before administration
Pegylated α-interferon (PEG-Intron, Pegasys) 1.5 mcg/kg PO daily
A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care
Place the patient on a pressure-relief mattress
A patient with acute pancreatitis has a nursing diagnosis of pain related to distention of the pancreas and peritoneal irritation. In addition to effective use of analgesics, what should the nurse include in this patient's plan of care
Position the patient on the side with the head of the bed elevated 45 degrees for pain relief
A 36-yr-old female patient is receiving treatment for chronic hepatitis C with pegylated interferon (PEG-Intron, Pegasys), ribavirin (Rebetol), and telaprevir (Incivek). Which finding is important to communicate to the health care provider to suggest a change in therapy
Positive urine pregnancy test
The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What is the most likely diagnosis the nurse should expect for this patient
Primary sclerosing cholangitis
What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis
Providing adequate nutritional intake
. For a patient with cirrhosis, which nursing action can the RN delegate to UAP?
Providing oral hygiene after a meal
During discharge instructions for a patient following a laparoscopic cholecystectomy, what should the nurse include in the teaching
Report any bile-colored or purulent drainage from the incisions.
Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic NAFLD
Review the patient's current medication list
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?
Schedule for liver cancer screening every 6 months
A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate
Schedule the patient for HCV genotype testing
A patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective
Stools test negative for occult blood
A patient is hospitalized with metastatic cancer of the liver. The nurse plans care for the patient based on what knowledge?
Supportive care that is appropriate for all patients with severe liver damage is indicated
Serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in response to the viruses. What laboratory result indicates that the nurse is immune to HBV after vaccination
Surface antibody anti-HBs
Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago
Temperature 100.8° F (38.2° C)
Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient admitted with bleeding esophageal varices?
The medication will prevent irritation of the enlarged veins
Which finding indicates to the nurse that lactulose is effective for an older adult who has advanced cirrhosis
The patient is alert and oriented
Which information given by a 70-yr-old patient during a health history indicates to the nurse that the patient should be screened for hepatitis C?
The patient used IV drugs about 20 years ago
The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?
The patient's hands flap back and forth when the arms are extended
Which assessment information will be most important for the nurse to report to the health care provider about a patient with acute cholecystitis
The patient's stools are tan colored
The family members of a patient with hepatitis A ask if there is anything that will prevent them from developing the disease. What is the best response by the nurse?
Those who have had household or close contact with the patient should receive IgG
What laboratory test results should the nurse expect to find in a patient with cirrhosis
Total bilirubin: 3.2 mg/dL (54.7 mmol/L)
The occurrence of acute liver failure is most common in which situation
Use of acetaminophen with alcohol abuse
The nurse will ask a patient being admitted with acute pancreatitis specifically about a history of
alcohol consumption.
To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor
ammonia levels
A young adult contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, the nurse would expect serologic testing to reveal
anti-hepatitis A virus immunoglobulin M (anti-HAV IgM).
To prepare a patient with ascites for paracentesis, the nurse
asks the patient to empty the bladder
The nurse administering α-interferon and ribavirin (Rebetol) to a patient with chronic hepatitis C will plan to monitor for
leukopenia
The nurse is planning care for a patient with acute severe pancreatitis. The highest priority patient outcome is
maintaining normal respiratory function
The nurse will plan to teach the patient diagnosed with acute hepatitis B about
measures for improving the appetite
When assessing a patient with acute pancreatitis, the nurse would expect to find
severe left upper quadrant (LUQ) or midepigastric pain
A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to
turn, cough, and deep breathe every 2 hours
The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)
with meals
