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The nurse is caring for a patient with acute pancreatitis who has a new prescription for parenteral nutrition (PN). Which of the following information is priority to include when monitoring the patient?
- A. Serum potassium
- B. Blood glucose
- C. Serum amylase
- D. Intake and output
Correct Answer: B
Rationale: Blood glucose monitoring is critical in patients with acute pancreatitis receiving PN due to the risk of hyperglycemia from high dextrose content in PN and pancreatic dysfunction. While serum potassium, amylase, and intake/output are important, glucose control is the priority to prevent complications like metabolic imbalances.
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The nurse is caring for a patient with persistent hepatitis C infection who has these
- A. Teach symptoms of variceal bleeding
- B. Review the patient's current medication list.
- C. Draw blood for hepatitis serology testing.
Correct Answer: C
Rationale: Reviewing the patient's current medication list is critical to identify drugs that may exacerbate liver damage or interact with hepatitis C treatments. Teaching about variceal bleeding is not relevant unless the patient has advanced liver disease with portal hypertension. Hepatitis serology is unnecessary since the diagnosis of persistent hepatitis C is already established.
After receiving change-of-shift report, which of the following patients should the nurse assess first?
- A. 50-year-old with persistent pancreatitis who has gnawing abdominal pain
- B. 48-year-old who has compensated cirrhosis and is complaining of anorexia
- C. 45-year-old with cirrhosis and severe ascites who has an oral temperature of 38.8°C (101.8°F)
- D. 36-year-old who is recovering from a laparoscopic cholecystectomy and has severe shoulder pain
Correct Answer: C
Rationale: This patient's history and fever suggest spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.
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.
The nurse is admitting a patient who is homeless and has viral hepatitis with symptoms of severe anorexia and fatigue. Which of the following patient goals should have the highest priority when the nurse is developing the plan of care?
- A. Increase activity level.
- B. Maintain adequate nutrition.
- C. Establish a stable home environment.
- D. Identify the source of exposure to hepatitis.
Correct Answer: B
Rationale: The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as ensuring adequate nutrition. Although the patient's activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.
Which of the following diagnoses is often a misdiagnosis for older-adult patients with liver disease?
- A. Fulminant hepatic failure
- B. Cirrhosis
- C. Dementia
- D. Epstein-Barr virus
Correct Answer: C
Rationale: In older persons with liver disease, hepatic encephalopathy may be misdiagnosed as dementia.