Exam 4: Hepatitis
b
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? a. "no immunization is available for hepatitis A, nor are you likely to get the disease" b. "those who have had household or close contact with the patient should receive IgG" c. "all family members should receive the hepatitis A vaccine to prevent or modify the infection" d. "only those individuals who have had sexual contact with the patient should receive immunization"
d
The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response by the nurse is most appropriate? a. "You will need to be tested first; then treatment can be determined." b. "The hepatitis vaccine will provide immunity from this and future exposures." c. "There is nothing you can do since the patient was infectious before admission." d. "An immunoglobulin injection will be given to prevent infection or limit symptoms."
b
The nurse determines that administration of hepatitis B vaccine to a patient has been effective when a specimen of the patients blood reveals a. HBsAg. b. anti-HBs. c. anti-HBc IgG. d. anti-HBc IgM.
c
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? a. spray the house to eliminate infected insects b. tell family members to try to stay away from the client c. ask family members to wash their hands frequently d. disinfect all clothing and eating utensils
b
The nurse identifies a need for further teaching when the patient with hepatitis B makes which statement? a. "I should avoid alcohol completely for at least a year" b. "I must avoid all physical contact with my family until the jaundice is gone" c. "I should use a condom to prevent spread of the disease to my sexual partner" d. "I will need to rest several times a day, gradually increasing my activity as I tolerate it"
a
The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection? a. A caregiver who lives in the same household with the patient b. A friend who delivers meals to the patient and family each week c. A relative with a history of hepatitis A who visits the patient daily d. A child living in the home who received the hepatitis A vaccine 3 months ago
d
The nurse is caring for client recently diagnosed with hepatitis C. In reviewing the client's history, what information will be the most helpful as the nurse develops the teaching plan? The client a. has a history of exercise-induced asthma b. is a scientist and is frequently exposed to multiple chemicals c. traveled to Central America recently and ate uncooked vegetables d. has a known history of sexually transmitted diseases
a
The nurse is developing a plan of care for the client with viral hepatitis. The nurse should instruct the client to a. obtain adequate bed rest b. increase fluid intake c. take antibiotic therapy as prescribed d. drink 240 ml of an electrolyte solution every day
a
The nurse is teaching a client with hepatitis A about preventing transmission of the disease. The nurse should focus teaching on a. proper food handling b. insulin syringe disposal c. alpha-interferon d. use of condoms
b
The nurse should teach the client with hepatitis A to a. limit caloric intake and reduce weight b. increase carbohydrates and protein in the diet c. avoid contact with others and sleep in a separate room d. intensify routine exercise and increase strength
d
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? a. HBV b. HCV c. HDV d. HEV
d
What causes the systemic effects of viral hepatitis? a. toxins produced by the infected liver b. impaired portal circulation from fibrosis c. cholestasis from chemical hepatotoxicity d. complement system activation by antigen-antibody complexes
a
What is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis? a. providing adequate nutritional intake b. promoting strict bed rest during the icteric phase c. providing pain relief without using liver-metabolized drugs d. providing quiet diversional activities during periods of fatigue
d
When a patient is diagnosed with acute hepatitis B, the nurse will plan to teach the patient about a. ways to increase exercise and activity level. b. self-administration of interferon (Intron A). c. side effects of nucleoside and nucleotide analogs. d. measures that will be helpful in improving appetite.
a
When planning care for a client with hepatitis A, the nurse should review laboratory reports for which laboratory values? a. prolonged prothrombin time b. decreased blood glucose level c. elevated serum potassium level d. decreased serum calcium level
d
When teaching the patient with acute hepatitis C (HCV), which statement demonstrates understanding of the disease process? a. "I will use care when kissing my wife to prevent giving it to her." b. "I will need to take adefovir (Hepsera) to prevent chronic HCV." c. "Now that I have had HCV, I will have immunity and not get it again." d. "I will need to be monitored for chronic HCV and other liver problems."
b
Which finding is normal for a client during the icteric phase of hepatitis A? a. tarry stools b. yellowed sclerae c. shortness of breath d. light, frothy urine
b
Which goal is appropriate for a client with hepatitis A? The client will a. demonstrate a decrease in fluid retention related to ascites b. verbalize the importance of reporting bleeding gums or bloody stools c. limit use of alcohol to 2-3 drinks per week d. restrict activity to within the home to prevent disease transmission
d
Which information given by a patient when the nurse is taking a health history indicates that screening for hepatitis C should be done? a. The patient eats frequent meals in fast-food restaurants. b. The patient recently traveled to an undeveloped country. c. The patient had a blood transfusion after surgery in 1998. d. The patient reports a one-time use of IV drugs 20 years ago.
b
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? a. HAV b. HBV c. HCV d. HEV
c
A client has a positive serologic test for anti-HCV. The nurse should instruct the client a. how to self-administer alpha interferon b. that the HCV will resolve in approximately 3 months c. that a follow up appointment for HCV genotype testing is required d. to take alpha-interferon as prescribed
a
A client has developed hepatitis A after eating contaminated oysters. The nurse assesses the client for which expected assessment finding? a. malaise b. dark stools c. weight gain d. left upper quadrant discomfort
b
A client is diagnosed with viral hepatitis, complaining of "no appetite" and "losing my taste for food." What instruction should the nurse give the client to provide adequate nutrition? a. select foods high in fat b. increase intake of fluids, including juices c. eat a good supper when anorexia is not as severe d. eat less often, preferably only 3 large meals daily
d
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 the most appropriate? a. "your fatigue should be gone by now. We will evaluate you for a secondary infection" b. "your fatigue is an adverse effect of your drug therapy. It will disappear when your treatment regimen is complete" c. "it is important for your to increase your activity level. That will help decrease your fatigue" d. "it is normal for your to feel fatigued. The fatigue should go away in the next 2-4 months"
b
A homeless patient with severe anorexia and fatigue is admitted to the hospital with viral hepatitis. Which patient goal has the highest priority when the nurse is developing the plan of care? a. Increase activity level. b. Maintain adequate nutrition. c. Establish a stable home environment. d. Identify the source of exposure to hepatitis.
a b e
A nurse is teaching a client who has hepatitis B about home care. Which of the following instructions should the nurse include in the teaching? Select all that apply a. limit physical activity b. avoid alcohol c. take acetaminophen for comfort d. wear a mask when in public areas e. eat small frequent meals
d
A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care? a. initiate contact precautions b. weight the client weekly c. measure abdominal girth at the base of the ribcage d. provide a high-calorie, high-carbohydrate diet
c
A patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. What is the most appropriate response by the nurse? a. "only chronic hepatitis C is treatable and primarily with antiviral agents and interferon" b. "there are no specific drug therapies that are effective for treating acute viral hepatitis" c. "lamivudine (Epivir) and interferon both decrease viral load and help prevent complications" d. "no drugs are used for the treatment of viral hepatitis because of the risk of additional liver damage"
a
A patient in the outpatient clinic is diagnosed with acute hepatitis C (HCV) infection. Which action by the nurse is appropriate? a. Schedule the patient for HCV genotype testing. b. Administer immune globulin and the HCV vaccine. c. Instruct the patient on ribavirin (Rebetol) treatment. d. Teach that the infection will resolve in a few months.
b
A patient with acute hepatitis B is being discharged in 2 days. The discharge teaching plan should include instructions to a. avoid alcohol for the first 3 weeks b. use a condom during sexual intercourse c. have family members get an injection of immunoglobulin d. follow a low-protein, moderate-carbohydrate, moderate-fat diet
a
A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that a. pruritis is a common problem with jaundice in this phase b. the patient is most likely to transmit the disease during this phase c. GI symptoms are not as severe in hepatitis A as they are in hepatitis B d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase
a b d
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 a. Administer hepatitis B vaccine. b. Test for antibodies to hepatitis B. c. Teach about interferon therapy. d. Give hepatitis B immune globulin. e. Educate about oral antiviral therapy.
d
College freshman are participating in a study abroad program. When teaching them about hepatitis B, the nurse should instruct the students on the need for a. water sanitation b. single dormitory rooms c. vaccination for hepatitis D d. safe sexual practices
b
During the incubation period of viral hepatitis, what should the nurse expect the patient to report? a. dark urine and easy fatigability b. no symptoms except diagnostic results c. anorexia and right upper quadrant discomfort d. constipation or diarrhea with light-colored stools
d
Following a needle stick, what is used as prophylaxis against HBV? a. interferon b. HBV vaccine c. hepatitis B immune globulin (HBIG) d. hepatitis B immune globulin (HBIG) and HBV vaccine
Regenerate
Hepatitis After resolution of an acute infection, liver cells can ____________. If no complications occur, the liver can resume its normal appearance and function
Fibrosis
Hepatitis Chronic viral hepatitis can be insidious and silent, causing persistent and continual destruction of infected hepatocytes. Over time scar tissue can develop, which leads to __________ and compromised liver function.
Hepatocytes
Hepatitis During acute viral hepatitis, large numbers of infected __________ are destroyed. The destruction of ___________ leads to a wide range of liver-related dysfunction
Hepatitis C
Hepatitis This type of hepatitis can result in both acute illness as well as chronic infection. The most common causes of outbreaks are among injection drug users and HIV-positive men who have sex with men. The majority of patients usually develop chronic infection. However, because symptoms are generally mild, most people are unaware of their infection
Hepatitis B
Hepatitis This type of hepatitis is a blood-borne pathogen that can cause either acute or chronic hepatitis. Perinatal transmission is the most common mode of transmission. It can be transmitted perinatally, percutaneously (IV drug use), or via small cuts on mucosal surfaces and exposure to infectious blood, blood products, or other body fluids
Hepatitis D
Hepatitis This type of hepatitis is a defective single-stranded RNA virus that cannot survive on its own and requires hepatitis B to replicate. It can cause a spectrum of illnesses ranging from an asymptomatic chronic carrier state to acute liver failure
Hepatitis A
Hepatitis This type of hepatitis is a self-limiting infection that can cause a mild flu-like illness and jaundice. It is transmitted primarily through the fecal-oral route. Poor hygiene, improper food handling, crowded situations, and poor sanitary conditions are contributing factors
Hepatitis E
Hepatitis This type of hepatitis is transmitted by the fecal-oral route. The usual mode of transmission is drinking contaminated water
Detoxification
Hepatitis ______________ and processing of drugs, hormones, and metabolites may also be disrupted
Convalescent
Hepatitis: Clinical Manifestations As jaundice fades, the ___________ phase begins. During this period, patients typically experience malaise and easy fatigability.
Clay
Hepatitis: Clinical Manifestations If conjugated bilirubin cannot pass into the intestines from the liver because of obstruction or inflammation of the bile ducts, the stools will be light or ______ colored
Encephalopathy
Hepatitis: Clinical Manifestations In patients with severe liver damage, hepatic _____________ is a potentially life threatening spectrum of neurologic, psychiatric, and motor disturbances. It results from the liver's inability to remove toxins from the blood
Bilirubin Bile Biliary
Hepatitis: Clinical Manifestations Jaundice, a yellowish discoloration of body tissues, results from an alteration in normal __________ metabolism or disruption of the flow of ______ into the hepatic or _______ duct
Coagulation
Hepatitis: Clinical Manifestations Manifestations of chronic hepatitis include anemia and ____________ problems (easy bruising and bleeding)
Acute
Hepatitis: Clinical Manifestations Many patients with _________ hepatitis may have no symptoms. However, others may have intermittent anorexia, lethargy, N/V, low-grade fever, skin rashes, diarrhea, or constipation, malaise, fatigue, myalgias, and right upper quadrant pain
Acute
Hepatitis: Clinical Manifestations Occasionally _______ liver failure may occur. Manifestations include encephalopathy, GI bleeding, DIC, fever with leukocytosis, renal manifestations, ascites, edema, hypotension, respiratory failure, bacterial infections, thrombocytopenia, and coagulopathies
2
Hepatitis: Clinical Manifestations Patients with hepatitis are most infectious ______ weeks before the start of their symptoms
Salts
Hepatitis: Clinical Manifestations Pruritus sometimes accompanies jaundice. It occurs as a result of the accumulation of bile ______ beneath the skin
Icteric Anicteric
Hepatitis: Clinical Manifestations The patient in the acute phase of hepatitis may be _________ (jaundiced) or __________
Darker
Hepatitis: Clinical Manifestations The urine may appear _________ because of excess bilirubin being excreted by the kidneys.
Skin
Hepatitis: Clinical Manifestations _______ manifestations may include spider angiomas, palmar erythema, and gynecomastia. Some patients have splenomegaly, hepatomegaly, or cervical lymph node enlargement
HCV
Hepatitis: Clinical Manifestations ________ infection is more likely than HBV to become chronic, as many patients with chronic _______ infection develop chronic liver disease, cirrhosis, portal hypertension, and liver cancer
Ascites
Hepatitis: Clinical Manifestations _________, a common manifestation of hepatitis, is the accumulation of excess fluid in the peritoneal cavity. Fluid accumulates due to reduced protein levels in the blood, which reduces the plasma oncotic pressure
Cirrhosis
Hepatitis: Clinical Manifestations __________ is generally an irreversible condition that can increase one's risk for liver dysfunction, portal hypertension, and primary liver cancer
Biopsy
Hepatitis: Diagnostic Studies A liver ________ is not indicated in acute hepatitis unless the diagnosis is in doubt
Immunocompromised
Hepatitis: Diagnostic Studies HCV RNA testing may be used for _____________________ patients. Because of altered or delayed antibody response to HCV, these patients may not have detectable antibody levels even though they are infected with HCV
Antigen Antibody
Hepatitis: Diagnostic Studies The only definitive way to distinguish among the various types of viral hepatitis is by testing the patient's blood for the specific _______ or ________
Genotype
Hepatitis: Diagnostic Studies Viral __________ testing is done in patients undergoing drug therapy for HBV or HVC infection
Suppress
Hepatitis: Interprofessional Care Current drug therapies for chronic HBV do not eradicate the virus but ________ viral replication and prevent complications of hepatitis B
B
Hepatitis: Interprofessional Care If a healthcare personnel is caring for a patient with hepatitis ____ and is exposed, such as through a needle stick, they should wash their hands with soap and water and can be given the hepatitis ____ immunoglobulin in addition to the vaccine
Flu-Like
Hepatitis: Interprofessional Care The most common complication patients experience when taking any class of interferons is _________ symptoms.
Nutrition
Hepatitis: Interprofessional Care There is no specific treatment for acute viral hepatitis. Most patients can be managed at home. Emphasis is on providing adequate __________ and measures to rest the body and assist the liver to regenerate and repair
Harvoni
Hepatitis: Interprofessional Care This medication is used to treat those with chronic hepatitis C. It is important for the nurse to ensure the patient understands that they should never miss a dose
HCV
Hepatitis: Interprofessional Care Treatment of chronic hepatitis ______ is individualized and based on the genotype of the _____, severity of liver disease, and presence of other health problems. Treatment primarily includes the use of direct-acting antivirals, which block proteins needed for _____ replication
Nucleoside Nucleotide
Hepatitis: Interprofessional Care ___________ and ______________ analogs inhibit viral DNA replication. They do not prevent all viral reproduction, but they can substantially lower the amount of viruses in the body
Interferon
Hepatitis: Interprofessional Care ______________ is a naturally occurring immune protein made by the body during an infection to recognize and respond to pathogens. It has antiviral, antiproliferative, and immune-modulating effects
a
In the care of a client with acute viral hepatitis, which task should be delegated to unlicensed assistive personnel (UAP)? a. Emptying the bedpan while wearing gloves b. Playing games or engaging the client in diversional activities c. Monitoring dietary preferences d. Reporting signs and symptoms of jaundice
