Nokea
A 34-year-old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the healthcare provider before administration?
- A. Ribavirin (Rebetol, Copegus) 600 mg PO bid
- B. Pegylated α-interferon (PEG-Intron, Pegasys) SQ weekly
- C. Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching
- D. Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea
Correct Answer: B
Rationale: The correct answer is B: Pegylated α-interferon (PEG-Intron, Pegasys) SQ weekly. Pegylated α-interferon is typically administered once weekly, not daily. Therefore, this medication requires further discussion with the healthcare provider before administration to ensure the correct dosing frequency. Ribavirin, choice A, is appropriate for chronic hepatitis C treatment. Choices C and D, Diphenhydramine and Dimenhydrinate, are commonly used for symptomatic relief in patients with hepatitis C and do not require further discussion with the healthcare provider in this context.
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To palpate the liver during a head-to-toe physical assessment, the nurse should
- A. put pressure on the biopsy site using a sandbag
- B. elevate the head of the bed to facilitate breathing
- C. place the patient on the right side with the bed flat
- D. check the patient's post-biopsy coagulation studies
Correct Answer: C
Rationale: To palpate the liver effectively during a head-to-toe physical assessment, the patient should be positioned on the right side with the bed flat. This position helps to splint the biopsy site and allows for proper palpation of the liver. Elevating the head of the bed has no direct relevance to palpating the liver. Checking coagulation studies is done before the biopsy and is unrelated to palpation. Putting pressure on the biopsy site using a sandbag is not an appropriate way to facilitate liver palpation as it does not provide the necessary support and stabilization needed for the procedure.
To detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices, it is most important for the nurse to monitor
- A. bilirubin levels.
- B. ammonia levels.
- C. potassium levels.
- D. prothrombin time.
Correct Answer: B
Rationale: In a patient with severe cirrhosis and bleeding esophageal varices, monitoring ammonia levels is crucial. Severe liver dysfunction impairs the metabolism of protein in the GI tract, leading to increased ammonia levels. Elevated ammonia levels can result in hepatic encephalopathy, a serious complication. Monitoring bilirubin levels is important for assessing liver function and jaundice but may not directly reflect the risk of complications from bleeding esophageal varices. Potassium levels are important but not the most critical in this scenario. Prothrombin time is essential for evaluating coagulation status but does not directly relate to the risk of complications from bleeding esophageal varices in this patient.
A man is receiving heparin subcutaneously. The patient has dementia and lives at home with a part-time caretaker. The nurse is most concerned about which side effect of heparin?
- A. Back Pain
- B. Fever and Chills
- C. Risk for Bleeding
- D. Dizziness
Correct Answer: C
Rationale: The correct answer is 'Risk for Bleeding.' A patient with dementia may have impaired judgment and may be prone to falls or injuries, increasing the risk of bleeding while on heparin therapy. Monitoring for signs of bleeding is crucial in this situation. Choice A, 'Back Pain,' is not a common side effect of heparin. Choice B, 'Fever and Chills,' is not a typical side effect of heparin but may indicate other underlying conditions. Choice D, 'Dizziness,' is not a common side effect of heparin and is not the primary concern in this scenario.
Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?
- A. Advise limiting alcohol intake to 1 drink daily
- B. Schedule for liver cancer screening every 6 months
- C. Initiate administration of the hepatitis C vaccine series
- D. Monitor anti-hepatitis B surface antigen (anti-HBs) levels annually
Correct Answer: B
Rationale: Patients diagnosed with chronic hepatitis B are at a higher risk for developing liver cancer. Therefore, it is essential to schedule them for liver cancer screening every 6 to 12 months to detect any potential malignancies at an early stage. Advising patients to limit alcohol intake is crucial as alcohol can exacerbate liver damage; thus, patients with chronic hepatitis B are advised to completely avoid alcohol. Administering the hepatitis C vaccine is irrelevant for a patient diagnosed with chronic hepatitis B since it is a different virus. Monitoring anti-hepatitis B surface antigen (anti-HBs) levels annually is not necessary as the presence of anti-HBs indicates a past hepatitis B infection or vaccination, and it does not require regular monitoring.
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?
- A. Dry palpebral and oral mucosa
- B. Crackles at bilateral lung bases
- C. Temperature 100.8?F (38.2?C)
- D. No bowel movement for 4 days
Correct Answer: C
Rationale: The correct answer is the patient's temperature of 100.8°F (38.2°C). In a patient who received a liver transplant 1 week ago, a fever is a significant finding that should be promptly communicated to the health care provider. Post-transplant patients are at high risk of infections, and fever can often be the initial indicator of an underlying infectious process. The other findings listed in choices A, B, and D are important and should be addressed, but they do not take precedence over a potential infection post-liver transplant. Dry palpebral and oral mucosa may indicate dehydration, crackles at bilateral lung bases may suggest fluid overload or infection, and no bowel movement for 4 days could indicate a bowel obstruction or ileus. However, in the context of a recent liver transplant, an elevated temperature is the most concerning and requires immediate attention to rule out infection.