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A patient is being discharged after a liver transplant and the nurse is performing discharge education. When planning this patients continuing care, the nurse should prioritize which of the following risk diagnoses?
- A. Risk for Infection Related to Immunosuppressant Use
- B. Risk for Injury Related to Decreased Hemostasis
- C. Risk for Unstable Blood Glucose Related to Impaired Gluconeogenesis
- D. Risk for Contamination Related to Accumulation of Ammonia
Correct Answer: A
Rationale: Infection is the leading cause of death after liver transplantation. Pulmonary and fungal infections are common; susceptibility to infection is increased by the immunosuppressive therapy that is needed to prevent rejection. This risk exceeds the threats of injury and unstable blood glucose. The diagnosis of Risk for Contamination relates to environmental toxin exposure.
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A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply.
- A. Immunization
- B. Use of standard precautions
- C. Consumption of a vitamin-rich diet
- D. Annual vitamin K injections
- E. Annual vitamin B12 injections
Correct Answer: A,B
Rationale: People who are at high risk, including nurses and other health care personnel exposed to blood or blood products, should receive active immunization. The consistent use of standard precautions is also highly beneficial. Vitamin supplementation is unrelated to an individuals risk of HBV.
A 55-year-old female patient with hepatocellular carcinoma (HCC) is undergoing radiofrequency ablation. The nurse should recognize what goal of this treatment?
- A. Destruction of the patients liver tumor
- B. Restoration of portal vein patency
- C. Destruction of a liver abscess
- D. Reversal of metastasis
Correct Answer: A
Rationale: Using radiofrequency ablation, a tumor up to 5 cm in size can be destroyed in one treatment session. This technique does not address circulatory function or abscess formation. It does not allow for the reversal of metastasis.
A previously healthy adults sudden and precipitous decline in health has been attributed to fulminant hepatic failure, and the patient has been admitted to the intensive care unit. The nurse should be aware that the treatment of choice for this patient is what?
- A. IV administration of immune globulins
- B. Transfusion of packed red blood cells and fresh-frozen plasma (FFP)
- C. Liver transplantation
- D. Lobectomy
Correct Answer: C
Rationale: Liver transplantation carries the highest potential for the resolution of fulminant hepatic failure. This is preferred over other interventions, such as pharmacologic treatments, transfusions, and surgery.
A patient with a diagnosis of cirrhosis has developed variceal bleeding and will imminently undergo variceal banding. What psychosocial nursing diagnosis should the nurse most likely prioritize during this phase of the patients treatment?
- A. Decisional Conflict
- B. Deficient Knowledge
- C. Death Anxiety
- D. Disturbed Thought Processes
Correct Answer: C
Rationale: The sudden hemorrhage that accompanies variceal bleeding is intensely anxiety-provoking. The nurse must address the patients likely fear of death, which is a realistic possibility. For most patients, anxiety is likely to be a more acute concern than lack of knowledge or decisional conflict. The patient may or may not experience disturbances in thought processes.
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.