Nokea
A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this client's discharge education?
- A. Use a pill organizer to ensure you take this medication as prescribed.
- B. Transient muscle aching is a common side effect of this medication.
- C. Follow up with your provider in 1 week to test your blood for toxicity.
- D. Take your radial pulse for 1 minute prior to taking this medication.
Correct Answer: A
Rationale: Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.
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An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.)
- A. Policies related to consistent use of Standard Precautions
- B. Hepatitis vaccination mandate for workers in high-risk areas
- C. Implementation of a needleless system for intravenous therapy
- D. Hepatitis B immunity in clients at risk for hepatitis B
- E. Postexposure prophylaxis provided in a timely manner
Correct Answer: A,C,D,E
Rationale: Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided in a timely manner. Hepatitis B immunity in clients does not protect healthcare workers, but ensuring worker immunity through vaccination is critical.
A nurse cares for a client with hepatic portal-systemic encephalopathy (PSE). The client is thin and cachectic in appearance. Which statement best explains the rationale for a low-protein diet?
- A. A low-protein diet will help the liver rest and restore function.
- B. Less protein in the diet will help prevent confusion associated with liver failure.
- C. Increasing dietary protein will help the client gain weight and muscle.
- D. Low dietary protein is needed to prevent fluid overload.
Correct Answer: B
Rationale: A low-protein diet is ordered when serum ammonia levels increase and/or the client shows signs of PSE. A low-protein diet helps reduce excessive breakdown of protein into ammonia by intestinal bacteria. Encephalopathy is caused by excess ammonia. A low-protein diet has no impact on restoring liver function. Increasing dietary protein will cause complications of liver failure and should not be suggested. Increased intravascular protein may help prevent ascites, but clients with liver failure are not able to effectively synthesize dietary protein.
A nurse assesses clients on the medical-surgical unit. Which client is at greatest risk for the development of carcinoma of the liver?
- A. A 25-year-old with a history of blunt liver trauma
- B. A 48-year-old with a history of diabetes mellitus
- C. A 30-year-old who has a history of cirrhosis
- D. An 82-year-old who has chronic malnutrition
Correct Answer: C
Rationale: The risk of contracting a primary carcinoma of the liver is higher in clients with cirrhosis from any cause. Blunt liver trauma, diabetes mellitus, and chronic malnutrition do not increase a person's risk for developing liver cancer.
A nurse cares for a client who is scheduled for a paracentesis. Which intervention should the nurse delegate to an unlicensed assistive personnel (UAP)?
- A. Have the client sign the informed consent form.
- B. Help the client void just before the procedure.
- C. Help the client lie flat in bed on the right side.
- D. Get the client into a chair after the procedure.
Correct Answer: B
Rationale: For safety, the client should void just before a paracentesis. The nurse or the provider should have the client sign the consent form. The proper position for a paracentesis is sitting upright in bed or, alternatively, sitting on the edge of the bed or leaning over a bedside table. The client will be on bed rest after the procedure.
A nurse cares for a client with hepatitis C. The client's brother states, 'I do not want to contract this infection, so I will not go into his room.' How should the nurse respond?
- A. If you wear a gown and gloves, you will not get this virus.
- B. Hepatitis C is not spread through casual contact.
- C. This virus is only transmitted through a fecal specimen.
- D. I can give you an update on your brother's status from here.
Correct Answer: B
Rationale: Although family members may be afraid that they will contract hepatitis C, the nurse should educate the client's family about how the virus is spread. Hepatitis C is spread via blood-to-blood transmission and is associated with illicit IV drug use, needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. Sharing the client's status without consent would violate privacy.