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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.
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A patient in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection. Which of the following actions by the nurse is best?
- A. Schedule the patient for HCV genotype testing.
- B. Administer immune globulin and the HCV vaccine.
- C. Instruct the patient on ribavirin treatment.
- D. Teach that the infection will resolve in a few months.
Correct Answer: A
Rationale: Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most patients with acute HCV infection convert to a persistent state, the nurse should not teach the patient that the HCV will resolve in a few months. Immune globulin or vaccine is not available for HCV. Ribavirin is used for persistent HCV infection.
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.
After an unimmunized individual is exposed to hepatitis B through a needle-stick injury, which of the following actions should the nurse plan to take?
- A. Administer hepatitis B vaccine.
- B. Test for antibodies to hepatitis B.
- C. Teach about ?±-interferon therapy.
- D. Give hepatitis B immune globulin.
- E. Educate about oral antiviral therapy.
Correct Answer: A,B,D
Rationale: The recommendations for hepatitis B exposure include both vaccination and immune globulin administration. In addition, baseline testing for hepatitis B antibodies will be needed. Interferon and oral antivirals are not used for hepatitis B prophylaxis.
The nurse is caring for a patient with severe cirrhosis who has an episode of bleeding esophageal varices. Which of the following laboratory tests should the nurse monitor to detect possible complications of the bleeding episode?
- A. Bilirubin
- B. Ammonia
- C. Potassium
- D. Prothrombin time
Correct Answer: B
Rationale: The blood in the gastrointestinal (GI) tract will be absorbed as protein and may result in an increase in ammonia level because the liver cannot metabolize protein well. The prothrombin time, bilirubin, and potassium levels also should be monitored, but these will not be affected by the bleeding episode.
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.