Nokea
A group of nurses have attended an inservice on the prevention of occupationally acquired diseases that affect healthcare providers. What action has the greatest potential to reduce a nurses risk of acquiring hepatitis C in the workplace?
- A. Disposing of sharps appropriately and not recapping needles
- B. Performing meticulous hand hygiene at the appropriate moments in care
- C. Adhering to the recommended schedule of immunizations
- D. Wearing an N95 mask when providing care for patients on airborne precautions
Correct Answer: A
Rationale: HCV is bloodborne. Consequently, prevention of needlestick injuries is paramount. Hand hygiene, immunizations and appropriate use of masks are important aspects of overall infection control, but these actions do not directly mitigate the risk of HCV.
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A patient with liver disease has developed jaundice; the nurse is collaborating with the patient to develop a nutritional plan. The nurse should prioritize which of the following in the patients plan?
- A. Increased potassium intake
- B. Fluid restriction to 2 L per day
- C. Reduction in sodium intake
- D. High-protein, low-fat diet
Correct Answer: C
Rationale: Patients with ascites require a sharp reduction in sodium intake. Potassium intake should not be correspondingly increased. There is no need for fluid restriction or increased protein intake.
A participant in a health fair has asked the nurse about the role of drugs in liver disease. What health promotion teaching has the most potential to prevent drug-induced hepatitis?
- A. Finish all prescribed courses of antibiotics, regardless of symptom resolution.
- B. Adhere to dosing recommendations of OTC analgesics.
- C. Ensure that expired medications are disposed of safely.
- D. Ensure that pharmacists regularly review drug regimens for potential interactions.
Correct Answer: B
Rationale: Although any medication can affect liver function, use of acetaminophen (found in many over-the-counter medications used to treat fever and pain) has been identified as the leading cause of acute liver failure. Finishing prescribed antibiotics and avoiding expired medications are unrelated to this disease. Drug interactions are rarely the cause of drug-induced hepatitis.
A patient with a liver mass is undergoing a percutaneous liver biopsy. What action should the nurse perform when assisting with this procedure?
- A. Position the patient on the right side with a pillow under the costal margin after the procedure.
- B. Administer 1 unit of albumin 90 minutes before the procedure as ordered.
- C. Administer at least 1 unit of packed red blood cells as ordered the day before the scheduled procedure.
- D. Confirm that the patients electrolyte levels have been assessed prior to the procedure.
Correct Answer: A
Rationale: Immediately after a percutaneous liver biopsy, assist the patient to turn onto the right side and place a pillow under the costal margin. Prior administration of albumin or PRBCs is unnecessary. Coagulation tests should be performed, but electrolyte analysis is not necessary.
A patient with end-stage liver disease has developed hypervolemia. What nursing interventions would be most appropriate when addressing the patients fluid volume excess? Select all that apply.
- A. Administering diuretics
- B. Administering calcium channel blockers
- C. Implementing fluid restrictions
- D. Implementing a 1500 kcal/day restriction
- E. Enhancing patient positioning
Correct Answer: A,C,E
Rationale: Administering diuretics, implementing fluid restrictions, and enhancing patient positioning can optimize the management of fluid volume excess. Calcium channel blockers and caloric restriction do not address this problem.
A patient who has undergone liver transplantation is ready to be discharged home. Which outcome of health education should the nurse prioritize?
- A. The patient will obtain measurement of drainage from the T-tube.
- B. The patient will exercise three times a week.
- C. The patient will take immunosuppressive agents as required.
- D. The patient will monitor for signs of liver dysfunction.
Correct Answer: C
Rationale: The patient is given written and verbal instructions about immunosuppressive agent doses and dosing schedules. The patient is also instructed on steps to follow to ensure that an adequate supply of medication is available so that there is no chance of running out of the medication or skipping a dose. Failure to take medications as instructed may precipitate rejection. The nurse would not teach the patient to measure drainage from a T-tube as the patient wouldn't go home with a T-tube. The nurse may teach the patient about the need to exercise or what the signs of liver dysfunction are, but the nurse would not stress these topics over the immunosuppressive drug regimen.