Pop Exam 3 Unit 6 EAQ

A patient diagnosed with hepatitis A asks the nurse how this disease may have been contracted. Which answer by the nurse is correct? 1- "You may have consumed foods contaminated with the virus." 2- "If you received a blood transfusion, you may have been exposed." 3- "You may have been exposed if you had unprotected sexual intercourse." 4- "The virus is airborne, so you may have contracted it from an infected person.

1- "You may have consumed foods contaminated with the virus." (Hepatitis A is transmitted through the fecal-oral route and may be contracted by consuming contaminated foods; it is not a blood-borne or airborne virus. Hepatitis B, C, and D can be transmitted by blood transfusions received before 1992. Unprotected sex is a risk factor for hepatitis B and C (although the rate of sexual transmission with hepatitis C is very low in a monogamous relationship, but increases with multiple sex partners). There is no hepatitis virus that is airborne.)

The nurse is providing care to a patient recently diagnosed with cirrhosis of the liver. To prevent further fibrosis of the liver and allow the liver to heal and regenerate, which substances should the nurse tell the patient to avoid? Select all that apply. 1- Alcohol 2- Cigarettes 3- Illicit drugs 4- Fatty foods 5- Acetaminophen

1- Alcohol 2- Cigarettes 3- Illicit drugs 5- Acetaminophen

The serum level of what enzyme is elevated in patients with obstructive jaundice? 1- Alkaline phosphatase 2- Lactate dehydrogenase 3- Alanine aminotransferase 4- Aspartate aminotransferase

1- Alkaline phosphatase (In patients with obstructive jaundice, the serum alkaline phosphatase level is elevated. Levels of serum aspartate aminotransferase, serum alanine aminotransferase, and lactate dehydrogenase are elevated in case of patients with hepatic cell destruction.)

A patient is scheduled to undergo placement of a transjugular intrahepatic portal-systemic shunt (TIPS). The nurse explains that this is placed to prevent which complication? 1- Bleeding esophageal varices 2- Hepatic encephalopathy 3- Malnutrition and vitamin deficiency 4- Spontaneous bacterial peritonitis

1- Bleeding esophageal varices (If ascites cannot be controlled, esophageal varices may occur. Clients may undergo TIPS placement to help drain the fluid from the abdomen into the venous system. This is not performed to reduce the risk of hepatic encephalopathy or bacterial peritonitis, and does not affect nutrition.)

The nurse is caring for a patient with cirrhosis. What factors may lead to hepatic encephalopathy in the patient? Select all that apply. 1- Constipation 2- Low-protein diet 3- Decreased fluid volume 4- Gastrointestinal bleeding 5- Increased serum potassium

1- Constipation 3- Decreased fluid volume 4- Gastrointestinal bleeding (Decreased fluid volume, constipation, and gastrointestinal bleeding may cause hepatic encephalopathy in patients with cirrhosis.)

In caring for a patient who has undergone paracentesis, which changes in the patient's status should be promptly reported to the provider? 1- Decreased blood pressure, increased heart rate 2- Tachypnea, diaphoresis, increased blood pressure 3- Increased blood pressure, increased respiratory rate 4- Increased respiratory rate, increased apical pulse, pallor

1- Decreased blood pressure, increased heart rate (Decreased blood pressure and increased heart rate are indicative of shock. Increased blood pressure, increased respiratory rate, increased apical pulse, pallor, tachypnea, and diaphoresis are all indicative of anxiety on the patient's part.)

What laboratory finding signifies an immune response to liver disease? 1- Elevated serum globulin 2- Elevated serum ammonia 3- Decreased serum albumin 4- Decreased serum total protein

1- Elevated serum globulin (An increase in the serum globulin level indicates an immune response to liver disease. A decrease in serum total protein signifies chronic liver disease, and a decrease in serum albumin signifies severe liver disease. The serum ammonia level is elevated in advanced liver disease or portal-systemic encephalopathy because the liver is unable to detoxify protein byproducts.)

When assessing a patient with hepatitis B, the nurse anticipates which assessment findings? Select all that apply. 1- Itching 2- Brown stool 3- Tea-colored urine 4- Recent influenza infection 5- Right upper quadrant tenderness

1- Itching 3- Tea-colored urine 5- Right upper quadrant tenderness (The urine may be brown, tea-, or cola-colored in patients with hepatitis. Inflammation of the liver may cause right upper quadrant pain. Deposits of bilirubin on the skin, secondary to high bilirubin levels, and jaundice irritate the skin and cause itching. Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored.)

When providing community education, the nurse emphasizes that which group should receive immunization for hepatitis B? 1- Men who prefer sex with men 2- Patients who work with shellfish 3- Patients traveling to a third-world country 4- Patients with elevations of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)

1- Men who prefer sex with men (Men who prefer sex with men are at increased risk for hepatitis B, which is spread by the exchange of blood and body fluids during sexual activity. Consuming raw or undercooked shellfish may cause hepatitis A, not hepatitis B. Travel to third-world countries exposes the traveler to contaminated water and risk for hepatitis A; hepatitis B is not of concern, unless the patient is exposed to blood and body fluids during travel. Patients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B)

When assessing a patient for possible liver dysfunction, the nurse notices round, pinpoint, red-purple lesions on the patient's skin. What term should the nurse use to document such lesions? 1- Petechiae 2- Ecchymosis 3- Telangiectases 4- Spider angioma

1- Petechiae (The term petechiae is used for round, pinpoint, red-purple lesions. Ecchymoses are large purple, blue, or yellow patches. Telangiectases and spider angioma are terms used for vascular lesions with a red center and radiating branches.)

The nurse is caring for a patient who has liver trauma as a result of a motor vehicle crash. What sign/symptom, if present in the patient, would prompt the nurse to suspect internal hemorrhage and hypovolemic shock? 1- Tachypnea 2- Bradycardia 3- Hot, dry skin 4- Hypertension

1- Tachypnea (Liver is a highly vascular organ. Hepatic trauma can cause massive blood loss. Tachypnea is an indicator of hemorrhage and hypovolemic shock in patients with liver trauma. Other indicators include hypotension rather than hypertension, and tachycardia rather than bradycardia. The skin is cool and clammy with excessive sweating.Liver is a highly vascular organ. Hepatic trauma can cause massive blood loss. Tachypnea is an indicator of hemorrhage and hypovolemic shock in patients with liver trauma. Other indicators include hypotension rather than hypertension, and tachycardia rather than bradycardia. The skin is cool and clammy with excessive sweating.)

Which factors may lead to the development of hepatic encephalopathy in a patient with cirrhosis? Select all that apply. 1 Diarrhea 2 Hypokalemia 3 Hypertension 4 High-protein diet 5 Hypermagnesemia 6 Gastrointestinal bleeding

2 Hypokalemia 4 High-protein diet 6 Gastrointestinal bleeding (The development of hepatic encephalopathy is believed to be the result of the shunting of portal venous blood into the central circulation so that the liver is bypassed. A buildup of ammonia and gamma aminobutyric acid (GABA) is the result. Factors that may precipitate hepatic encephalopathy include a high-protein diet, infections, hypovolemia, hypokalemia, and constipation. GI bleeding that causes a large protein load in the intestine, and medications such as hypnotics, opioids, sedatives, analgesics, and diuretics also contribute to encephalopathy. Diarrhea, hypertension, and hypermagnesemia are not known to be contributing factors for hepatic encephalopathy.)

When caring for a patient with portal hypertension, the nurse assesses for which potential complications? Select all that apply. 1- Fever 2- Ascites 3- Hematuria 4- Hemorrhoids 5- Esophageal varices

2- Ascites 4- Hemorrhoids 5- Esophageal varices (Portal hypertension results from increased resistance to or obstruction (blockage) of the flow of blood through the portal vein and its branches. The blood meets resistance to flow and seeks collateral (alternative) venous channels around the high-pressure area. Veins become dilated in the esophagus (esophageal varices), rectum (hemorrhoids), and abdomen (ascites due to excessive abdominal [peritoneal] fluid). Hematuria may indicate insufficient production of clotting factors in the liver and decreased absorption of vitamin K. Fever indicates an inflammatory process.)

Which is an important institutional measure that a hospital should take to prevent the transmission of hepatitis B (HBV) to health care workers? 1- Provide immunoglobulin injections within 14 days of exposure to the virus. 2- Develop a hospital-wide needleless system for delivery of medications. 3- Provide information about HBV transmission to at-risk employees. 4- Reinforce Standard Precautions procedures among all hospital employees.

2- Develop a hospital-wide needleless system for delivery of medications. (Needlesticks are the leading cause of HBV exposure among health care workers, so eliminating needles would make a huge impact on preventing transmission of the disease. Providing immunoglobulin injections, providing HBV information, and reinforcing Standard Precautions may all be done as well, but are not as important as the implementation of needleless systems.)

Which activity by the nurse will best relieve symptoms associated with ascites? 1- Administering oxygen 2- Elevating the head of the bed 3- Monitoring serum albumin levels 4- Administering intravenous fluids

2- Elevating the head of the bed (The best action by the nurse caring for a client with ascites is to elevate the head of the bed. The enlarged abdomen of ascites limits respiratory excursion. Fowler's position will increase excursion and reduce shortness of breath.The client may need oxygen, but first the nurse would raise the head of the bed to improve respiratory excursion and oxygenation. Monitoring serum albumin levels will detect anticipated decreased levels associated with cirrhosis and hepatic failure but does not relieve the symptoms of ascites. Administering IV fluids will contribute to fluid volume excess and fluid shifts into the peritoneal cavity, worsening ascites.)

What is a feature of hepatic abscess? 1- Mortality rates of hepatic abscesses are low. 2- Right upper abdominal pain is a common manifestation. 3- Symptoms of amebic hepatic abscess are usually sudden. 4- Multiple hepatic abscesses are often found simultaneously

2- Right upper abdominal pain is a common manifestation. (One of the common manifestations of a hepatic abscess is right upper abdominal pain. Symptoms of amebic hepatic abscess develop slowly. The mortality or death rate due to hepatic abscess is usually high. Both pyogenic and amebic hepatic abscesses are usually solitary. There may occasionally be multiple pyogenic abscesses in the same person.)

A patient with hepatic encephalopathy may require which dietary or pharmacologic therapy to help decrease serum ammonia levels? 1- Nonabsorbable antibiotics given for long-term therapy 2- Trial of lactulose to increase the excretion of ammonia 3- Diet high in carbohydrates and protein with moderate fats 4- Diet low in protein and moderate in fats and carbohydrates

2- Trial of lactulose to increase the excretion of ammonia (Lactulose can be used with hepatic encephalopathy to increase the excretion of ammonia through the stools. To help minimize serum ammonia, patients may be started on a moderate protein, fat, and carbohydrate diet. High protein increases ammonia and low protein does not provide enough protein for healing. Nonabsorbable antibiotics may be used, but are given short-term only.)

Which patient statement causes the nurse to suspect that the patient has stage I hepatic encephalopathy? 1- "I am unable to recognize people." 2- "I feel numb when I should feel pain." 3- "I am unable to sleep during the night." 4- "I am unable to move my hands freely."

3- "I am unable to sleep during the night." (Hepatic encephalopathy is a complex cognitive syndrome which occurs due to liver failure and cirrhosis. Sleep pattern disturbances are a manifestation of stage I hepatic encephalopathy. Disorientation and an inability to recognize people are present in stage II hepatic encephalopathy. Muscle rigidity affecting mobility and numbness are characteristic of stage III hepatic encephalopathy.)

Which problem for a client with cirrhosis takes priority? 1- Insufficient knowledge related to the prognosis of the disease process 2- Discomfort related to the progression of the disease process 3- Potential for injury related to hemorrhage 4- Inadequate nutrition related to an inability to tolerate usual dietary intake

3- Potential for injury related to hemorrhage (Potential for injury related to hemorrhage is the priority patient problem because this complication could be life-threatening. Insufficient knowledge, discomfort, and inadequate nutrition are not priorities because these issues are not immediately life-threatening.)

The nurse administers lactulose (Evalose) to a client with cirrhosis for which purpose? 1- Provides enzymes necessary to digest dairy products 2- Reduces portal pressure 3- Promotes gastrointestinal (GI) excretion of ammonia 4- Decreases GI bleeding

3- Promotes gastrointestinal (GI) excretion of ammonia (Lactulose reduces serum ammonia levels by excreting ammonia through the GI tract. Lactase is the enzyme that digests dairy. The mechanism of action of lactulose is not to reduce portal pressure. Lactulose does not affect bleeding.)

Which vitamin may be especially important for a patient who is alcoholic with liver disease? 1- Folate 2- Niacin 3- Thiamine 4- Vitamin D

3- Thiamine (Thiamine is commonly deficient in patients who are alcoholics, due to alcohol withdrawal, although all vitamins should be given to patients with liver disease because the liver eventually becomes unable to store vitamins.)

Which statement by a client with cirrhosis indicates that further instruction is needed about the disease? 1- "Cirrhosis is a chronic disease that has scarred my liver." 2- "The scars on my liver create problems with blood circulation." 3- "Because of the scars on my liver, blood clotting and blood pressure are affected." 4- "My liver is scarred, but the cells can regenerate themselves and repair the damage."

4- "My liver is scarred, but the cells can regenerate themselves and repair the damage." (Although cells and tissues will attempt to regenerate, this will result in permanent scarring and irreparable damage. Cirrhosis is a chronic condition that leaves scars on the liver. Permanent scars form in response to attempts by the cells to regenerate and create problems in blood circulation moving through the liver. Liver scarring will create problems with blood clotting, cholesterol levels, and blood pressure, as well as with the metabolism of drugs and toxins.)

When providing discharge teaching to a client with cirrhosis, it is essential for the nurse to emphasize avoidance of which of these? 1- Vitamin K-containing products 2- Potassium-sparing diuretics 3- Nonabsorbable antibiotics 4- Nonsteroidal anti-inflammatory drugs (NSAIDs)

4- Nonsteroidal anti-inflammatory drugs (NSAIDs) (Clients who have cirrhosis should not take NSAIDs because they may predispose to bleeding. The client with cirrhosis is prone to bleeding; vitamin K can decrease bleeding, so it is not necessary to restrict this in the diet. Potassium-sparing diuretics are used to reduce ascites. Nonabsorbable antibiotics are used to decrease ammonia levels.)

Which individual has the greatest risk for developing hepatitis A? 1- Health care worker 2- Intravenous drug user 3- Client receiving hemodialysis 4- Person who consumes raw oysters

4- Person who consumes raw oysters (Undercooked or raw shellfish from contaminated waters and food handled by those who have not washed their hands thoroughly are at risk for hepatitis A. Intravenous drug users, those undergoing hemodialysis, and health care workers are more at risk for hepatitis B or C, which is spread by blood or body fluids.)