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The patient's cirrhosis of the liver has also caused a dilation of the veins of the lower esophagus secondary to portal hypertension, resulting in the development of which complication?
- A. esophageal varices.
- B. diverticulosis.
- C. Crohn disease.
- D. esophageal reflux (GERD).
Correct Answer: A
Rationale: Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension.
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Which medical intervention and management system controls the bleeding of esophageal varices?
- A. Transfusions
- B. Sengstaken-Blakemore (S/B) tube
- C. Band ligation
- D. Cryotherapy
- E. Portacaval shunt
- F. Large doses of vitamin B12
Correct Answer: B,C,E
Rationale: Band ligation, insertion of the tube, and various shunting surgeries are helpful in stopping the hemorrhage. Transfusions, cryotherapy, and water-soluble vitamins are not beneficial.
Hepatitis D is usually seen as a coinfection with
Correct Answer: hepatitis B
Rationale: Hepatitis D is usually seen as a coinfection with hepatitis B.
Viral hepatitis may be treated at home. Which should be taught to the patient's family?
- A. Clothes should be laundered separately with hot water.
- B. Personal items and drinking glasses should not be shared.
- C. Articles soiled with feces do not require extra care.
- D. Hands need to be thoroughly washed after toileting.
- E. Contaminated items may be disposed of with regular trash.
Correct Answer: A,B,D
Rationale: For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly.
Which nursing intervention should be completed immediately after the health care provider has performed a needle liver biopsy?
- A. Assisting to ambulate for the bathroom
- B. Keeping the patient on the right side for a minimum of 2 hours
- C. Taking vital signs every 4 hours
- D. Keeping the patient on the left side for a minimum of 4 hours
Correct Answer: B
Rationale: Keep the patient lying on the right side with a rolled towel against the puncture site for minimum of 2 hours to splint the puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. Vital signs are taken every 15 minutes for 30 minutes, then every 30 minutes for 2 hours.
The nurse caring for a patient who has had an open cholecystectomy with a T Tube will take which action?
- A. open the T tube to the air so that it will drain freely.
- B. position and secure the drainage bag at mid-chest level.
- C. place the collection bag so the tube is not kinked.
- D. irrigate the T tube with normal saline to ensure the free flow of bile.
Correct Answer: C
Rationale: The T tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T tubes are not irrigated.