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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.
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The nurse is caring for a patient with acute pancreatitis who has a new prescription for parenteral nutrition (PN). Which of the following information is priority to include when monitoring the patient?
- A. Serum potassium
- B. Blood glucose
- C. Serum amylase
- D. Intake and output
Correct Answer: B
Rationale: Blood glucose monitoring is critical in patients with acute pancreatitis receiving PN due to the risk of hyperglycemia from high dextrose content in PN and pancreatic dysfunction. While serum potassium, amylase, and intake/output are important, glucose control is the priority to prevent complications like metabolic imbalances.
The nurse is caring for a patient who is admitted with an abrupt onset of jaundice, nausea, and abnormal liver function studies. Serological testing is negative for viral causes of hepatitis. Which of the following questions by the nurse is best?
- A. Is there any history of IV drug use?
- B. Are you taking corticosteroids for any reason?
- C. Do you use any over-the-counter (OTC) drugs?
- D. Have you recently travelled to a foreign country?
Correct Answer: C
Rationale: The patient's symptoms, lack of antibodies for hepatitis, and the abrupt onset of symptoms suggest toxic hepatitis, which can be caused by commonly used OTC drugs such as acetaminophen. Travel to a foreign country and a history of IV drug use are risk factors for viral hepatitis. Corticosteroid use does not cause the symptoms listed.
Which of the following nursing actions is a priority when the nurse is caring for a patient with pancreatic cancer?
- A. Offer high-calorie, high-protein dietary choices.
- B. Offer psychological support for anxiety or depression.
- C. Educate about the need to avoid scratching pruritic areas.
- D. Administer prescribed opioids to relieve pain as needed.
Correct Answer: D
Rationale: Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to education, or manage anxiety or depression.
Which of the following nursing actions should be included in the plan of care for a patient who is being treated for bleeding esophageal varices with balloon tamponade using a device such as a Blakemore tube?
- A. Monitor the patient for shortness of breath.
- B. Encourage the patient to cough every 4 hours.
- C. Deflate the gastric balloon every 12 hours.
- D. Verify the position of the balloon every 6 hours.
Correct Answer: A
Rationale: A common complication of balloon tamponade is occlusion of the airway by the balloon, so it is important to monitor the patient's respiratory status. In addition, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Coughing increases the pressure on the varices and increases the risk for bleeding. Balloon position is verified after insertion and does not require further verification. The esophageal balloon is deflated every 8-12 hours to avoid necrosis, but if the gastric balloon is deflated, the esophageal balloon may occlude the airway.
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.