Nokea
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.
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The nurse is planning care for a patient with acute severe pancreatitis. Which of the following patient outcomes is priority?
- A. Expressing satisfaction with pain control
- B. Developing no ongoing pancreatic problems
- C. Maintaining normal respiratory function
- D. Having adequate fluid and electrolyte balance
Correct Answer: C
Rationale: Respiratory failure can occur as a complication of acute pancreatitis, and maintenance of adequate respiratory function is the priority goal. The other outcomes also would be appropriate for the patient.
The nurse is caring for a patient with persistent hepatitis C who is prescribed combination therapy of ?±-interferon and ribavirin. Which of the following findings should the nurse monitor for the presence of hepatitis C in the patient?
- A. Leukopenia
- B. Hypokalemia
- C. Polycythemia
- D. Hypoglycemia
Correct Answer: A
Rationale: Therapy with ribavirin and ?±-interferon may cause leukopenia. The other problems are not associated with this drug therapy.
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 data obtained by the nurse during the assessment of a patient with cirrhosis is of most concern?
- A. The patient's hands flap back and forth when the arms are extended.
- B. The patient has ascites and a 2-kg weight gain from the previous day.
- C. The patient's skin has multiple spider-shaped blood vessels on the abdomen.
- D. The patient complains of right upper-quadrant pain with abdominal palpation.
Correct Answer: A
Rationale: The asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain do indicate the need for treatment but not as urgently as the changes in neurological status.
The nurse is assessing a patient who had a liver transplant a week previously and obtains the following data. Which of the following findings is most important to communicate to the health care provider?
- A. Dry lips and oral mucosa
- B. Crackles at both lung bases
- C. Temperature 38.2°C (100.8°F)
- D. Pain at the incision site
Correct Answer: B
Rationale: Crackles at both lung bases may indicate pulmonary edema or infection, which are serious complications post-liver transplant requiring immediate attention. Dry lips, fever, and incisional pain are also concerning but less urgent unless accompanied by other critical symptoms.