Nokea
A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patients treatment, the nurse should anticipate what intervention?
- A. Administration of immune globulins
- B. A regimen of antiviral medications
- C. Rest and watchful waiting
- D. Administration of fresh-frozen plasma (FFP)
Correct Answer: B
Rationale: There is no benefit from rest, diet, or vitamin supplements in HCV treatment. Studies have demonstrated that a combination of two antiviral agents, Peg-interferon and ribavirin (Rebetol), is effective in producing improvement in patients with hepatitis C and in treating relapses. Immune globulins and FFP are not indicated.
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A nurse is caring for a patient with cirrhosis secondary to heavy alcohol use. The nurses most recent assessment reveals subtle changes in the patients cognition and behavior. What is the nurses most appropriate response?
- A. Ensure that the patients sodium intake does not exceed recommended levels.
- B. Report this finding to the primary care provider due to the possibility of hepatic encephalopathy.
- C. Inform the primary care provider that the patient should be assessed for alcoholic hepatitis.
- D. Implement interventions aimed at ensuring a calm and therapeutic care environment.
Correct Answer: B
Rationale: Monitoring is an essential nursing function to identify early deterioration in mental status. The nurse monitors the patients mental status closely and reports changes so that treatment of encephalopathy can be initiated promptly. This change in status is likely unrelated to sodium intake and would not signal the onset of hepatitis. A supportive care environment is beneficial, but does not address the patients physiologic deterioration.
A nurse is caring for a patient with liver failure and is performing an assessment in the knowledge of the patients increased risk of bleeding. The nurse recognizes that this risk is related to the patients inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?
- A. Alterations in glucose metabolism
- B. Retention of bile salts
- C. Inadequate production of albumin by hepatocytes
- D. Inability of the liver to use vitamin K
Correct Answer: D
Rationale: Decreased production of several clotting factors may be partially due to deficient absorption of vitamin K from the GI tract. This probably is caused by the inability of liver cells to use vitamin K to make prothrombin. This bleeding risk is unrelated to the roles of glucose, bile salts, or albumin.
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 nurse is amending a patients plan of care in light of the fact that the patient has recently developed ascites. What should the nurse include in this patients care plan?
- A. Mobilization with assistance at least 4 times daily
- B. Administration of beta-adrenergic blockers as ordered
- C. Vitamin B12 injections as ordered
- D. Administration of diuretics as ordered
Correct Answer: D
Rationale: Use of diuretics along with sodium restriction is successful in 90% of patients with ascites. Beta-blockers are not used to treat ascites and bed rest is often more beneficial than increased mobility. Vitamin B12 injections are not necessary.
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.