Nokea
A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, which of the following serological findings should the nurse expect?
- A. Antibody to hepatitis D virus (anti-HDV)
- B. Hepatitis B surface antigen (HBsAg)
- C. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG)
- D. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
Correct Answer: D
Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.
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The nurse is providing discharge instructions to a patient following a laparoscopic cholecystectomy. Which of the following patient statements indicate that the teaching has been effective?
- A. I can remove the bandages on my incisions tomorrow and take a shower.
- B. I can expect some yellow-green drainage from the incision for a few days.
- C. I should plan to limit my activities and not return to work for 4-6 weeks.
- D. I will always need to maintain a low-fat diet since I no longer have a gallbladder.
Correct Answer: A
Rationale: After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions. Patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.
The nurse is caring for a patient with cirrhosis and esophageal varices who has a new prescription for propranolol. Which of the following assessment findings is the best indicator that the medication has been effective?
- A. The apical pulse rate is 68 beats/minute.
- B. Stools test negative for occult blood.
- C. The patient denies complaints of chest pain.
- D. Blood pressure is less than 140/90 mm Hg.
Correct Answer: B
Rationale: Since the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.
A patient in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection. Which of the following actions by the nurse is best?
- A. Schedule the patient for HCV genotype testing.
- B. Administer immune globulin and the HCV vaccine.
- C. Instruct the patient on ribavirin treatment.
- D. Teach that the infection will resolve in a few months.
Correct Answer: A
Rationale: Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most patients with acute HCV infection convert to a persistent state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for persistent HCV infection.
The health care provider plans a paracentesis for a patient with ascites caused by liver cancer. Which of the following actions should the nurse implement to prepare the patient for the procedure?
- A. Place the patient on NPO status
- B. Assist the patient to lie flat in bed.
- C. Ask the patient to empty the bladder.
- D. Position the patient on the right side.
Correct Answer: C
Rationale: The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler's position and would not be able to lie flat without compromising breathing. Since no sedation is required for paracentesis, the patient does not need to be NPO.
Which of the following nursing actions should be included in the plan of care for a patient who is being treated for bleeding esophageal varices with balloon tamponade using a device such as a Blakemore tube?
- A. Monitor the patient for shortness of breath.
- B. Encourage the patient to cough every 4 hours.
- C. Deflate the gastric balloon every 12 hours.
- D. Verify the position of the balloon every 6 hours.
Correct Answer: A
Rationale: A common complication of balloon tamponade is occlusion of the airway by the balloon, so it is important to monitor the patient's respiratory status. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8-12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.