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Which should the nurse explain is the major purpose of the Sengstaken-Blakemore tube (S/B tube)?
- A. Decompress the stomach.
- B. Control esophageal varices bleeding.
- C. A route for tube feedings.
- D. Obtain specimen for gastric analyzing.
Correct Answer: B
Rationale: The major purpose of the S/B tube is to control bleeding by pressure against the vessels in the esophagus. The two balloons of the tube are inflated to put direct pressure on the esophagus and are anchored by the inflated balloon in the stomach. The tube can suction blood from the stomach as well.
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The nurse explains that the use of cyclosporine as an immunosuppressant has been successful in the reduction of rejection of liver transplants because the drug has which benefit?
- A. increases the rate of the regeneration of liver cells.
- B. can overcome complications presented by hepatitis C.
- C. increases blood supply to transplant.
- D. does not suppress bone marrow.
Correct Answer: D
Rationale: Cyclosporine is an immunosuppressant that does not cause bone marrow suppression nor does it impede healing.
A patient with pancreatitis is on nothing by mouth status (NPO). The patient asks the nurse 'Why am I unable to have anything by mouth?'. Which is the best response?
- A. Diagnostic tests depend on you not eating anything.'
- B. The pancreas is stimulated whenever you eat or drink and causes pain.'
- C. Eating causes the need for a bowel movement, which excretes your medication too rapidly.'
- D. Resting your gastrointestinal tract will cure your pancreatitis.'
Correct Answer: B
Rationale: Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered.
What should the nurse monitor in caring for the patient undergoing a paracentesis?
- A. The urinary output
- B. Hypervolemia
- C. Fluid removal over at least 30 minutes
- D. Seizure
Correct Answer: C
Rationale: The fluid removed during a paracentesis is removed over a period of 30 to 90 minutes to prevent sudden changes in blood pressure leading to syncope. The bed should be in a high Fowler's position. Food and fluid restriction is usually not necessary.
The nurse clarifies that deterioration progresses through stages before presenting with liver disease. The first stage is destruction. What is the last stage?
- A. Liver disease
- B. Inflammation
- C. Hepatic insufficiency
- D. Destruction
- E. Fibrotic regeneration
Correct Answer: A
Rationale: Liver deterioration follows a pattern of stages: destruction, inflammation, fibrotic regeneration; hepatic insufficiency then presents as liver disease.
Which is the most appropriate method used by high-risk health workers to prevent hepatitis B?
- A. Hepatitis B vaccine
- B. Diligent hand washing
- C. Wearing protective gear
- D. Hb immune globulin injections
Correct Answer: A
Rationale: The best preventive measure against the contraction of hepatitis B is HBV vaccine.