CH 30 MED SURG

The nurse is caring for a patient who presents to the emergency department with severe nausea and vomiting with stomach pain that radiates to his right scapula. The patient has a temperature of 101.2° F. The nurse anticipates that this patient will undergo workup for which problem? a. Cholecystitis b. Hepatitis c. Pancreatitis d. Gastroenteritis

A

The nurse is discussing the impact of cirrhosis on liver function with the family of a dying patient. The nurse explains that, when the damage caused by cirrhosis blocks the blood flow through the liver, it can lead to which complication(s)? (select all that apply.) a. Portal hypertension b. Decrease in metabolic processes of the liver c. Decrease in clotting factors d. Increase in ascites e. Decrease in aldosterone

ABCD

A patient has reported to the clinic with concerns about contracting hepatitis A from her boyfriend. What response by the nurse is most appropriate? a. "If you are having unprotected sexual intercourse with your partner, there is a relatively high risk for hepatitis A." b. "Hepatitis A is not transmitted as a result of close contact with an infected individual." c. "Hepatitis A transmission is associated with contact with infected body fluids." d. "Hepatitis A is relatively uncommon in our country and seen more in underdeveloped countries."

B

A 20-year-old college student who has not been immunized against hepatitis B virus (HBV) comes to the clinic and reports that he has been exposed to hepatitis B. The nurse anticipates that the health care provider will likely recommend which treatment? a. A prescription for a broad-spectrum antibiotic b. A prescription for an antiviral agent c. The first of the three immunizations for HBV d. An injection of hepatitis B immune globulin (HBIG)

D

Fecal-oral transmission, acute onset

HAV

Transmission by contact with blood and body fluids, perinatal transmission from mother to infant

HBV

Most likely to lead to cirrhosis

HCV

Coexists with HBV

HDV

Prevalent in less developed countries

HEV

The nurse reinforces that the immunization for HBV is believed to provide _____ immunity.

LIFELONG/LIFETIME

The nurse explains that bile salts deposited in the skin cause jaundice and also cause _____.

PRURITUS

A nurse is caring for a patient who is 4 hours postoperative after a laparoscopic cholecystectomy. The patient reports abdominal fullness and mild discomfort. After verifying that the patient's vital signs are stable, what action is most important for the nurse to take next? a. Ambulate the patient. b. Notify the charge nurse. c. Position the patient in high Fowler. d. Administer the ordered PRN analgesic.

A

In caring for a patient with hepatitis B, a nurse would employ which precautions? a. Standard Precautions b. Strict isolation c. Contact Precautions d. Surgical asepsis

A

The nurse is aware that a definitive diagnosis of cirrhosis is made based on the results of which diagnostic or laboratory test? a. Liver biopsy b. Elevated aspartate aminotransferase (AST) c. Elevated alanine aminotransferase (ALT) d. Elevated lactate dehydrogenase (LDH)

A

The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient? a. Instruct the patient to sit and lean forward. b. Monitor intake and output. c. Monitor laboratory values and note changes. d. Check blood glucose values frequently.

A

The nurse is caring for a patient with esophageal varices with a new order for vasopressin (Pitressin). The nurse reviews the patient's history and notes that the patient's comorbidities include coronary artery disease (CAD), type 2 diabetes, gastroesophageal reflux disease (GERD), and fibromyalgia. The nurse should immediately notify the physician about which component of the patient's history? a. CAD b. Diabetes mellitus (DM) type 2 c. GERD d. Fibromyalgia.

A

The nurse points out to a patient recently diagnosed with hepatitis B virus (HBV) that the virus is found which type(s) of body fluid(s) or secretions? (select all that apply.) a. Semen b. Vaginal secretions c. Sweat d. Breast milk e. Human feces

ABDE

The nurse caring for a patient recently admitted with acute pancreatitis. Which action(s) should the nurse include in the daily assessments? (select all that apply.) a. Auscultate bowel sounds. b. Carefully evaluate amount of food eaten each meal. c. Measure abdominal girth. d. Monitor for effectiveness of pain control. e. Monitor urine output.

ACDE

The nurse is speaking with a patient who has concerns about the development of cholelithiasis. The nurse correctly includes which risk factors for the condition? (select all that apply.) a. Obesity b. Daily exercise regimen c. Diabetes mellitus (DM) d. Taking cholesterol-lowering drugs e. Mexican American ethnicity

ACDE

The nurse caring for a patient with acute pancreatitis assesses a bluish tinge around the patient's umbilicus. The nurse recognizes that this finding likely results from which underlying problem? a. Increased amylase b. Retroperitoneal hemorrhage. c. Inflammatory response to a pseudocyst d. Ascites

B

The nurse is caring for a patient who underwent a cholecystectomy 3 days ago. Which assessment finding best indicates to the nurse that the bile flow is no longer obstructed from entering the bowel? a. Excessive flatus b. Dark brown stool c. Dark urine d. Increased appetite

B

The nurse is caring for a patient with cirrhosis. The nurse is educating the patient about nutritional implications related to his diagnosis. Which statement indicates that the nurse's teaching has been successful? a. "I should eat lots of sweet potatoes and carrots for vitamin A." b. "I should choose proteins like cottage cheese and quinoa instead of chicken." c. "I should eat oysters and shellfish for a good source of copper." d. "I should eat red meat and dark, leafy vegetables to boost my iron stores."

B

The nurse is planning skin care of the patient with ascites. Which actions should the nurse include? (select all that apply.) a. Bathe the patient in hot water. b. Apply emollients to decrease itching. c. Closely trim the patient's fingernails. d. Change the patient's position every 1 to 2 hours. e. Coach the patient in deep-breathing exercises.

BCD

A patient with advanced cirrhosis develops esophageal varices. The nurse anticipates that this complication will be addressed by which type of medication(s)? (select all that apply.) a. Vasodilators b. Intravenous (IV) vasopressin (Pitressin) c. IV iron d. Beta blockers e. Vitamin K

BDE

The nurse is caring for a patient being treated for new onset of gallstones. The patient asks the nurse if he will have to have surgery. How should the nurse respond? a. "You will have to have surgery if you continue to have gallstones." b. "Tell me more about your concern." c. "Treatment for gallstones may include diet modification and weight loss, medications, or surgery." d. "You need to ask the doctor about your concerns."

C

The nurse is caring for a patient diagnosed with gallstones who requires a cholecystectomy. The patient is upset and asks the nurse why he cannot have lithotripsy instead. Which response is most appropriate for the nurse to make? a. "Is there a reason that you want to have lithotripsy?" b. "Your doctor decides which procedure will be best." c. "Gallstones are usually treated with surgery. Tell me more about your concerns." d. "I understand that you are upset. Would you like to speak with a chaplain?"

C

The nurse is caring for a patient with cholelithiasis who is scheduled to undergo a cholescintigraphy (HIDA scan). Which statement accurately describes the purpose of the HIDA scan? a. To visualize the location of gallstones b. To assess amounts of inflammation and swelling c. To diagnose abnormal contraction of the gallbladder d. To assess composition of gallstones

C

The nurse is caring for a patient with cirrhosis. Which assessment finding warrants the nurse's immediate attention? a. Shiny, tight abdomen b. Yellow sclera c. Confusion d. Paired horizontal bands on the fingernails

C

The physician has prescribed rifaximin (Xifaxan) for a patient with cirrhosis. The patient questions why he must take this medication. Which response by the nurse is most appropriate? a. Rifaximin (Xifaxan) helps prevent infection. b. Rifaximin (Xifaxan) helps reduce straining during a bowel movement. c. Rifaximin (Xifaxan) kills intestinal flora. d. Rifaximin (Xifaxan) aids in reducing ascites.

C

The nurse is caring for a patient admitted with suspected acute viral hepatitis. Which laboratory value would best support this diagnosis? a. Decreased aspartate aminotransferase (AST) b. Decreased alanine aminotransferase (ALT) c. Decreased gamma-glutamyl transpeptidase (GGT) d. Increased prothrombin time

D

The nurse is caring for a patient with hepatitis. The nurse explains that jaundice occurs in conjunction with hepatitis based on which underlying pathophysiology? a. Liver ischemia in hepatitis causes jaundice. b. Increased bile production by the enlarged Kupffer cells causes jaundice. c. The hepatitis virus destroys red blood cells and causes jaundice. d. Hepatitis causes liver congestion that obstructs bile flow.

D

The nurse is providing discharge teaching for a patient who underwent a laparoscopic cholecystectomy. Which statement indicates that the nurse's teaching has been successful? a. "I should call my doctor if I have any pain." b. "I should be able to go back to work tomorrow." c. "I should avoid fatty foods for a few weeks." d. "I should let these Steri-Strips fall off on their own."

D