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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.
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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.
A patient contracts hepatitis from contaminated food. During the acute (icteric) phase of the patient's illness, which of the following serological findings should the nurse expect?
- A. Antibody to hepatitis D virus (anti-HDV)
- B. Hepatitis B surface antigen (HBsAg)
- C. Anti-hepatitis A virus immunoglobulin G (anti-HAV IgG)
- D. Anti-hepatitis A virus immunoglobulin M (anti-HAV IgM)
Correct Answer: D
Rationale: Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.
The nurse is providing discharge instructions to a patient following a laparoscopic cholecystectomy. Which of the following patient statements indicate that the teaching has been effective?
- A. I can remove the bandages on my incisions tomorrow and take a shower.
- B. I can expect some yellow-green drainage from the incision for a few days.
- C. I should plan to limit my activities and not return to work for 4-6 weeks.
- D. I will always need to maintain a low-fat diet since I no longer have a gallbladder.
Correct Answer: A
Rationale: After a laparoscopic cholecystectomy, the patient will have Band-Aids in place over the incisions. Patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.
The nurse is caring for a patient who has advanced cirrhosis and is receiving lactulose. Which of the following findings by the nurse indicates that the medication is effective?
- A. The patient is alert and oriented.
- B. The patient denies nausea or anorexia.
- C. The patient's bilirubin level decreases.
- D. The patient has at least one stool daily.
Correct Answer: A
Rationale: The purpose for lactulose in the patient with cirrhosis is to lower ammonia levels and prevent encephalopathy. Although lactulose may be used to treat constipation, that is not the purpose for this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.
Which of the following actions should the nurse implement to evaluate the effectiveness of treatment for a patient who has hepatic encephalopathy?
- A. Request that the patient stand on one foot.
- B. Ask the patient to extend both arms to the front.
- C. Instruct the patient to perform the Valsalva manoeuvre.
- D. Have the patient walk a few steps with the eyes closed.
Correct Answer: B
Rationale: Extending the arms allows the nurse to check for asterixis, a classic sign of hepatic encephalopathy. The other tests also might be done as part of the neurological assessment but would not be diagnostic for hepatic encephalopathy.