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The nurse is caring for a patient who has had a transjugular intrahepatic portosystemic shunt (TIPS) placement. Which of the following indicate that the procedure has been effective?
- A. Lower indirect bilirubin level
- B. Increase in serum albumin level
- C. Decrease in episodes of variceal bleeding
- D. Improvement in alertness and orientation
Correct Answer: C
Rationale: TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.
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The nurse is educating a patient with persistent pancreatitis about the prescribed pancrelipase. At which time would the nurse recommend taking the drug?
- A. Bedtime
- B. With every meal
- C. Upon arising in the morning
- D. As soon as abdominal pain starts
Correct Answer: B
Rationale: Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal or snacks.
The nurse is preparing a teaching plan for a young adult patient who is diagnosed with early alcoholic cirrhosis. Which of the following topics is most important to include in patient teaching?
- A. Need to abstain from alcohol
- B. Use of vitamin B supplements
- C. Maintenance of a nutritious diet
- D. Treatment with lactulose
Correct Answer: A
Rationale: The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.
The nurse is admitting a patient to the emergency department with pancreatitis who has been vomiting blood. Which of the following actions should the nurse take first?
- A. Insert a large-gauge IV catheter.
- B. Draw blood for coagulation studies.
- C. Check BP, heart rate, and respirations.
- D. Place the patient in the supine position.
Correct Answer: C
Rationale: The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter also are appropriate. However, the vital signs may indicate the need for more urgent actions. Since aspiration is a concern for this patient, the nurse will need to assess the patient's vital signs and neurological status before placing the patient in the supine position.
The nurse is caring for a patient who is diagnosed with acute hepatitis B. Which of the following information should the nurse include in the teaching plan?
- A. Ways to increase exercise and activity level
- B. Self-administration of ?±-interferon
- C. Adverse effects of nucleoside and nucleotide analogs
- D. Measures that will be helpful in improving appetite
Correct Answer: D
Rationale: Maintaining adequate nutritional intake is important for regeneration of hepatocytes. Interferon and antivirals may be used for persistent hepatitis B, but they are not prescribed for acute hepatitis B infection. Rest is recommended.
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.