Nokea
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.
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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 preparing a teaching plan for a young adult patient who is diagnosed with early alcoholic cirrhosis. Which of the following topics is most important to include in patient teaching?
- A. Need to abstain from alcohol
- B. Use of vitamin B supplements
- C. Maintenance of a nutritious diet
- D. Treatment with lactulose
Correct Answer: A
Rationale: The disease progression can be stopped or reversed by alcohol abstinence. The other interventions may be used when cirrhosis becomes more severe to decrease symptoms or complications, but the priority for this patient is to stop the progression of the disease.
The nurse is admitting a patient to the emergency department with pancreatitis who has been vomiting blood. Which of the following actions should the nurse take first?
- A. Insert a large-gauge IV catheter.
- B. Draw blood for coagulation studies.
- C. Check BP, heart rate, and respirations.
- D. Place the patient in the supine position.
Correct Answer: C
Rationale: The nurse's first action should be to determine the patient's hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter also are appropriate. However, the vital signs may indicate the need for more urgent actions. Since aspiration is a concern for this patient, the nurse will need to assess the patient's vital signs and neurological status before placing the patient in the supine position.
Which of the following patients should alert the nurse that screening for hepatitis C should be done?
- A. The patient eats frequent meals in fast-food restaurants.
- B. The patient recently travelled to an undeveloped country.
- C. The patient had a blood transfusion after surgery in 1999.
- D. The patient reports a one-time use of IV drugs 20 years ago.
Correct Answer: D
Rationale: Any patient with a history of IV drug use should be tested for hepatitis C. Blood transfusions given after 1992, when an antibody test for hepatitis C became available, do not pose a risk for hepatitis C. Hepatitis C is not spread by the oral-fecal route and therefore is not caused by contaminated food or by travelling in underdeveloped countries.
The nurse is obtaining a health history from a patient with acute pancreatitis. Which of the following information should the nurse specifically assess when conducting a health history?
- A. Alcohol use
- B. Diabetes mellitus
- C. High-protein diet
- D. Cigarette smoking
Correct Answer: A
Rationale: Alcohol use is one of the most common risk factors for pancreatitis in Canada. In Canada, the most common cause is gallbladder disease (gallstones) followed by alcoholism. Cigarette smoking, diabetes, and high-protein diets are not risk factors.