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After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching?
- A. Some medications have been known to cause hepatitis A.
- B. I may have been exposed when we ate shrimp last weekend.
- C. I was infected with hepatitis A through a recent blood transfusion.
- D. My infection with Epstein-Barr virus can co-infect me with hepatitis A.
Correct Answer: B
Rationale: The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection, not a co-infection with hepatitis A.
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A nurse delegates hygiene care for a client who has advanced cirrhosis to an unlicensed nursing personnel (UAP). Which statements should the nurse include when delegating this task to the UAP? (Select all that apply.)
- A. Apply lotion to the client's dry skin areas.
- B. Use a basin with warm water to bathe the client.
- C. For oral care, use a soft toothbrush.
- D. Provide supplemental warm water for gargles.
- E. Bathe with antibacterial and water-based soaps.
Correct Answer: A,C,D
Rationale: Clients with advanced cirrhosis often have pruritus. Lotion will help decrease itchiness from dry skin. A soft toothbrush should be used to prevent gum bleeding, and the client's nails should be trimmed short to prevent scratching. Clients should use cool, not warm, water on their skin and should not use excessive amounts of soap.
A nurse obtains a clients health history at a community health clinic. Which statement alerts the nurse to a possible health threat to the client?
- A. I drink two glasses of red wine each week.
- B. I take a lot of Tylenol for my arthritis pain.
- C. I have a cousin who died of liver cancer.
- D. I got a hepatitis vaccine before traveling.
Correct Answer: B
Rationale: Acetaminophen (Tylenol) can cause liver damage if taken in large amounts. Clients should be taught not to exceed 4000 mg/day of acetaminophen. The nurse should teach the client about this limitation and should explain other drug options with the client to manage his or her arthritis pain. Two glasses of wine each week, a cousin with liver cancer, and the hepatitis vaccine do not place the client at risk for a liver disorder, and therefore do not require any health teaching.
A nurse cares for a client who has chronic cirrhosis from substance abuse. The client states, 'All of my family hates me.' How should the nurse respond?
- A. You should make peace with your family.
- B. This is not unusual. My family hates me too.
- C. You should find a friend or recovery group for support.
- D. You must attend Alcoholics Anonymous.
Correct Answer: C
Rationale: Clients who have chronic cirrhosis may have alienated relatives over the years because of substance abuse. The nurse should assist the client to identify a friend, neighbor, or person in his or her recovery group for support. Suggesting that the client make peace with family may not be possible and is not client-centered. Sharing personal experiences or mandating attendance at Alcoholics Anonymous is not appropriate.
After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the client's understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for further teaching?
- A. I should drink bottled water during my travels.
- B. I will not eat off others' plates or share utensils.
- C. I should eat plenty of fresh fruits and vegetables.
- D. I will wash my hands frequently and thoroughly.
Correct Answer: C
Rationale: The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, not sharing plates, glasses, or eating utensils, and frequent handwashing are good ways to prevent illness.
An emergency room nurse assesses a client after a motor vehicle crash. The nurse notices a steering wheel imprint across the client's chest. Which action should the nurse take?
- A. Ask the client where he or she was sitting during the crash.
- B. Assess the client by gently palpating the abdomen for tenderness.
- C. Notify the laboratory to draw blood for blood type and crossmatch.
- D. Develop a handwashing plan to prevent infection.
Correct Answer: B
Rationale: The liver is often injured by a steering wheel in a motor vehicle crash. Because the client's chest was marked by the steering wheel, the nurse should perform an abdominal assessment. Assessing the client's position in the crash is not needed because of the steering wheel imprint. The client may or may not need a blood transfusion. A handwashing plan is not relevant to this situation.