NR 464 - Exam 1 Questions (BoostGrade)
With Complete Solutions
A 24-year-old female contracts hepatitis from contaminated food. During the
acute (icteric) phase of the patient's illness, the nurse would expect serologic
testing to reveal
a. antibody to hepatitis D (anti-HDV).
b. hepatitis B surface antigen (HBsAg).
c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). - ANSWER d. anti-
hepatitis A virus immunoglobulin M (anti-HAV IgM).
Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM
appears during the acute phase of hepatitis A
A 36-year-old male patient in the outpatient clinic is diagnosed with acute
hepatitis C (HCV) infection. Which action by the nurse is appropriate?
a. Schedule the patient for HCV genotype testing.
b. Administer the HCV vaccine and immune globulin.
c. Teach the patient about ribavirin (Rebetol) treatment.
d. Explain that the infection will resolve over a few months. - ANSWER a.
Schedule the patient for HCV genotype testing.
Genotyping of HCV has an important role in managing treatment and is done
before drug therapy is initiated. Because most patients with acute HCV infection
convert to the chronic state, the nurse should not teach the patient that the HCV
will resolve in a few months. Immune globulin or vaccine is not available for
HCV. Ribavirin is used for chronic HCV infection.
The nurse will plan to teach the patient diagnosed with acute hepatitis B about
a. side effects of nucleotide analogs.
b. measures for improving the appetite
c. ways to increase activity and exercise.
d. administering a-interferon (Intron A). - ANSWER b. measures for improving
the appetite.
,Maintaining adequate nutritional intake is important for regeneration of
hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but
they are not prescribed for acute hepatitis B infection. Rest is recommended.
The nurse administering a-interferon and ribavirin (Rebetol) to a patient with
chronic hepatitis C will plan to monitor for
a. leukopenia.
b. hypokalemia.
c. polycythemia.
d. hypoglycemia. - ANSWER a. leukopenia.
Therapy with ribavirin and a-interferon may cause leukopenia. The other
problems are not associated with this drug therapy.
Which information given by a 70-year-old patient during a health history
indicates to the nurse that the patient should be screened for hepatitis C?
a. The patient had a blood transfusion in 2005.
b. The patient used IV drugs about 20 years ago.
c. The patient frequently eats in fast-food restaurants.
d. The patient traveled to a country with poor sanitation. - ANSWER b. The
patient used IV drugs about 20 years ago.
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 traveling in
underdeveloped countries.
A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has
abnormal liver function studies but serologic testing is negative for viral causes
of hepatitis. Which question by the nurse is most appropriate?
a. "Is there any history of IV drug use?"
b. "Do you use any over-the-counter drugs?"
c. "Are you taking corticosteroids for any reason?"
d. "Have you recently traveled to a foreign country?" - ANSWER b. "Do you use
any over-the-counter drugs?"
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 over-
the-counter drugs such as acetaminophen (Tylenol). 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 data will the nurse monitor in relation to the 4+ pitting edema assessed in
a patient with cirrhosis?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level - ANSWER d. Albumin level
The low oncotic pressure caused by hypoalbuminemia is a major
pathophysiologic factor in the development of edema.
Which topic is most important to include in patient teaching for a 41-year-old
patient diagnosed with early alcoholic cirrhosis?
a. Maintaining good nutrition
b. Avoiding alcohol ingestion
c. Taking lactulose (Cephulac)
d. Using vitamin B supplements - ANSWER b. Avoiding alcohol ingestion
The disease progression can be stopped or reversed by alcohol abstinence.
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with
cirrhosis who has scheduled doses of spironolactone (Aldactone) and
furosemide (Lasix). due. Which action should the nurse take?
a. Administer both drugs.
b. Administer the spironolactone.
c. Withhold the spironolactone and administer the furosemide.
d. Withhold both drugs until discussed with the health care provider. - ANSWER
b. Administer the spironolactone.
Spironolactone is a potassium-sparing diuretic and will help 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.
Which action should the nurse take to evaluate treatment effectiveness for a
patient who has hepatic encephalopathy?
a. Request that the patient stand on one foot.
b. Ask the patient to extend both arms forward.
c. Request that the patient walk with eyes closed.
d. Ask the patient to perform the Valsalva maneuver. - ANSWER b. Ask the
patient to extend both arms forward.
, Extending the arms allows the nurse to check for asterixis, a classic sign of
hepatic encephalopathy. The other tests might also be done as part of the
neurologic assessment but would not be diagnostic for hepatic encephalopathy.
Which finding indicates to the nurse that lactulose (Cephulac) is effective for a
72-year-old man who has advanced cirrhosis?
a. The patient is alert and oriented.
b. The patient denies nausea or anorexia.
c. The patient's bilirubin level decreases.
d. The patient has at least one stool daily. - ANSWER a. The patient is alert and
oriented.
The purpose of lactulose in the patient with cirrhosis is to lower ammonia levels
and prevent encephalopathy. Although lactulose may be used to treat
constipation, that is not the purpose for this patient. Lactulose will not decrease
nausea and vomiting or lower bilirubin levels.
A 53-year-old patient is being treated for bleeding esophageal varices with
balloon tamponade. Which nursing action will be included in the plan of care?
a. Instruct the patient to cough every hour.
b. Monitor the patient for shortness of breath.
c. Verify the position of the balloon every 4 hours.
d. Deflate the gastric balloon if the patient reports nausea. - ANSWER b. Monitor
the patient for shortness of breath.
The most common complication of balloon tamponade is aspiration pneumonia.
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 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the
esophageal balloon may occlude the airway.
To detect possible complications in a patient with severe cirrhosis who has
bleeding esophageal varices, it is most important for the nurse to monitor
a. bilirubin levels.
b. ammonia levels.
c. potassium levels.
d. prothrombin time. - ANSWER b. ammonia levels.
The protein in the blood in the gastrointestinal (GI) tract will be absorbed and
may result in an increase in the ammonia level because the liver cannot
With Complete Solutions
A 24-year-old female contracts hepatitis from contaminated food. During the
acute (icteric) phase of the patient's illness, the nurse would expect serologic
testing to reveal
a. antibody to hepatitis D (anti-HDV).
b. hepatitis B surface antigen (HBsAg).
c. anti-hepatitis A virus immunoglobulin G (anti-HAV IgG).
d. anti-hepatitis A virus immunoglobulin M (anti-HAV IgM). - ANSWER d. anti-
hepatitis A virus immunoglobulin M (anti-HAV IgM).
Hepatitis A is transmitted through the oral-fecal route, and antibody to HAV IgM
appears during the acute phase of hepatitis A
A 36-year-old male patient in the outpatient clinic is diagnosed with acute
hepatitis C (HCV) infection. Which action by the nurse is appropriate?
a. Schedule the patient for HCV genotype testing.
b. Administer the HCV vaccine and immune globulin.
c. Teach the patient about ribavirin (Rebetol) treatment.
d. Explain that the infection will resolve over a few months. - ANSWER a.
Schedule the patient for HCV genotype testing.
Genotyping of HCV has an important role in managing treatment and is done
before drug therapy is initiated. Because most patients with acute HCV infection
convert to the chronic state, the nurse should not teach the patient that the HCV
will resolve in a few months. Immune globulin or vaccine is not available for
HCV. Ribavirin is used for chronic HCV infection.
The nurse will plan to teach the patient diagnosed with acute hepatitis B about
a. side effects of nucleotide analogs.
b. measures for improving the appetite
c. ways to increase activity and exercise.
d. administering a-interferon (Intron A). - ANSWER b. measures for improving
the appetite.
,Maintaining adequate nutritional intake is important for regeneration of
hepatocytes. Interferon and antivirals may be used for chronic hepatitis B, but
they are not prescribed for acute hepatitis B infection. Rest is recommended.
The nurse administering a-interferon and ribavirin (Rebetol) to a patient with
chronic hepatitis C will plan to monitor for
a. leukopenia.
b. hypokalemia.
c. polycythemia.
d. hypoglycemia. - ANSWER a. leukopenia.
Therapy with ribavirin and a-interferon may cause leukopenia. The other
problems are not associated with this drug therapy.
Which information given by a 70-year-old patient during a health history
indicates to the nurse that the patient should be screened for hepatitis C?
a. The patient had a blood transfusion in 2005.
b. The patient used IV drugs about 20 years ago.
c. The patient frequently eats in fast-food restaurants.
d. The patient traveled to a country with poor sanitation. - ANSWER b. The
patient used IV drugs about 20 years ago.
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 traveling in
underdeveloped countries.
A 55-year-old patient admitted with an abrupt onset of jaundice and nausea has
abnormal liver function studies but serologic testing is negative for viral causes
of hepatitis. Which question by the nurse is most appropriate?
a. "Is there any history of IV drug use?"
b. "Do you use any over-the-counter drugs?"
c. "Are you taking corticosteroids for any reason?"
d. "Have you recently traveled to a foreign country?" - ANSWER b. "Do you use
any over-the-counter drugs?"
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 over-
the-counter drugs such as acetaminophen (Tylenol). 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 data will the nurse monitor in relation to the 4+ pitting edema assessed in
a patient with cirrhosis?
a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level - ANSWER d. Albumin level
The low oncotic pressure caused by hypoalbuminemia is a major
pathophysiologic factor in the development of edema.
Which topic is most important to include in patient teaching for a 41-year-old
patient diagnosed with early alcoholic cirrhosis?
a. Maintaining good nutrition
b. Avoiding alcohol ingestion
c. Taking lactulose (Cephulac)
d. Using vitamin B supplements - ANSWER b. Avoiding alcohol ingestion
The disease progression can be stopped or reversed by alcohol abstinence.
A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with
cirrhosis who has scheduled doses of spironolactone (Aldactone) and
furosemide (Lasix). due. Which action should the nurse take?
a. Administer both drugs.
b. Administer the spironolactone.
c. Withhold the spironolactone and administer the furosemide.
d. Withhold both drugs until discussed with the health care provider. - ANSWER
b. Administer the spironolactone.
Spironolactone is a potassium-sparing diuretic and will help 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.
Which action should the nurse take to evaluate treatment effectiveness for a
patient who has hepatic encephalopathy?
a. Request that the patient stand on one foot.
b. Ask the patient to extend both arms forward.
c. Request that the patient walk with eyes closed.
d. Ask the patient to perform the Valsalva maneuver. - ANSWER b. Ask the
patient to extend both arms forward.
, Extending the arms allows the nurse to check for asterixis, a classic sign of
hepatic encephalopathy. The other tests might also be done as part of the
neurologic assessment but would not be diagnostic for hepatic encephalopathy.
Which finding indicates to the nurse that lactulose (Cephulac) is effective for a
72-year-old man who has advanced cirrhosis?
a. The patient is alert and oriented.
b. The patient denies nausea or anorexia.
c. The patient's bilirubin level decreases.
d. The patient has at least one stool daily. - ANSWER a. The patient is alert and
oriented.
The purpose of lactulose in the patient with cirrhosis is to lower ammonia levels
and prevent encephalopathy. Although lactulose may be used to treat
constipation, that is not the purpose for this patient. Lactulose will not decrease
nausea and vomiting or lower bilirubin levels.
A 53-year-old patient is being treated for bleeding esophageal varices with
balloon tamponade. Which nursing action will be included in the plan of care?
a. Instruct the patient to cough every hour.
b. Monitor the patient for shortness of breath.
c. Verify the position of the balloon every 4 hours.
d. Deflate the gastric balloon if the patient reports nausea. - ANSWER b. Monitor
the patient for shortness of breath.
The most common complication of balloon tamponade is aspiration pneumonia.
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 to 12 hours to avoid necrosis, but if the gastric balloon is deflated, the
esophageal balloon may occlude the airway.
To detect possible complications in a patient with severe cirrhosis who has
bleeding esophageal varices, it is most important for the nurse to monitor
a. bilirubin levels.
b. ammonia levels.
c. potassium levels.
d. prothrombin time. - ANSWER b. ammonia levels.
The protein in the blood in the gastrointestinal (GI) tract will be absorbed and
may result in an increase in the ammonia level because the liver cannot
