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Which of the following actions should be included in the plan of care for a patient who has recently been diagnosed with asymptomatic non-alcoholic fatty liver disease (NAFLD)?
- 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 essential to identify potential hepatotoxic drugs and manage risk factors like diabetes or hyperlipidemia, which are associated with NAFLD progression. Teaching about variceal bleeding is irrelevant for asymptomatic NAFLD, as varices are a complication of advanced liver disease. Hepatitis serology is not indicated unless viral hepatitis is suspected.
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The nurse is caring for a patient with cirrhosis who has scheduled doses of spironolactone and furosemide and has a serum potassium level of 3.2 mmol/L. Which of the following actions should the nurse take?
- A. Give both drugs as scheduled
- B. Administer the spironolactone
- C. Administer the furosemide and withhold the spironolactone
- D. Withhold both drugs until talking with the health care provider.
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic and will help to increase the patient's potassium level. The nurse does not need to talk with the doctor before giving the spironolactone, although the health care provider should be notified about the low potassium value. The furosemide will further decrease the patient's potassium level and should be held until the nurse talks with the health care provider.
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.
The nurse is caring for a patient with cirrhosis and esophageal varices who has a new prescription for propranolol. Which of the following assessment findings is the best indicator that the medication has been effective?
- A. The apical pulse rate is 68 beats/minute.
- B. Stools test negative for occult blood.
- C. The patient denies complaints of chest pain.
- D. Blood pressure is less than 140/90 mm Hg.
Correct Answer: B
Rationale: Since the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varices, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.
The nurse is caring for a patient following an incisional cholecystectomy for cholelithiasis. Which of the following actions is priority for the nurse to implement?
- A. Patient education about low-fat food choices.
- B. Perform leg exercises hourly while awake.
- C. Ambulate the evening of the operative day.
- D. Turn, cough, and deep breathe every 2 hours.
Correct Answer: D
Rationale: Postoperative nursing care for incisional cholecystectomy is the same as general postoperative nursing care. Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions also are important to implement but are not as high a priority as ensuring adequate ventilation.
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.