Nursing Management: Liver, Pancreas, and Biliary Tract Problem

1. A client contracts hepatitis from contaminated food. During the acute (icteric) phase of the client’s illness, which of the following serological findings should the nurse expect? a. Antibody to hepatitis D virus (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) ANS: D Hepatitis A is transmitted through the oral–fecal route, and antibody to HAV IgM appears during the acute phase of hepatitis A. The client would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. Which of the following findings in a blood specimen indicates that the administration of hepatitis B vaccine to a client has been effective? a. HBsAg b. Anti-HBs c. Anti-HBc IgG d. Anti-HBc IgM ANS: B The presence of surface antibody to HBV (anti-HBs) is a marker of a positive response to the vaccine. The other laboratory values indicate current infection with HBV. DIF: Cognitive Level: Analysis TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance 3. A client in the outpatient clinic is diagnosed with acute hepatitis C virus (HCV) infection. Which of the following actions by the nurse is best? a. Schedule the client for HCV genotype testing. b. Administer immune globulin and the HCV vaccine. c. Instruct the client on ribavirin treatment. d. Teach that the infection will resolve in a few months. ANS: A Genotyping of HCV has an important role in managing treatment and is done before drug therapy is initiated. Since most clients with acute HCV infection convert to the chronic state, the nurse should not teach the client 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. DIF: Cognitive Level: Application TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NURSING MANAGEMENT : LIVER, PANCREAS AND BILIARY TRACT PROBLEMS NU RS IN GT B.CO M 4. The nurse is caring for a client 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 ANS: D 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. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 5. The nurse is caring for a client with chronic hepatitis C who is prescribed combination therapy of -interferon and ribavirin. Which of the following findings should the nurse monitor for the presence of hepatitis C in the client? a. Leukopenia b. Hypokalemia c. Polycythemia d. Hypoglycemia ANS: A Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not associated with this drug therapy. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 6. Which of the following clients should alert the nurse that screening for hepatitis C should be done? a. The client eats frequent meals in fast-food restaurants. b. The client recently travelled to an undeveloped country. c. The client had a blood transfusion after surgery in 1998. d. The client reports a one-time use of IV drugs 20 years ago. ANS: D Any client 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. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance 7. The nurse is caring for a client 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?” NURSINGTB.COM Medical-Surgical Nursing in Canada 4th Edition Lewi Test Bank NU RS IN GT B.CO M c. “Do you use any over-the-counter (OTC) drugs?” d. “Have you recently travelled to a foreign country?” ANS: C The client’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. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 8. The nurse is caring for a client with cirrhosis who has 4+ pitting edema of the feet and legs. Which of the following assessments is priority for the nurse to monitor? a. Hemoglobin b. Temperature c. Activity level d. Albumin ANS: D The low oncotic pressure caused by hypoalbuminemia is a major pathophysiological factor in the development of edema. The other parameters also should be monitored, but they are not directly associated with the client’s current symptoms. DIF: Cognitive Level: Application TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. The nurse is preparing a teaching plan for a young adult client who is diagnosed with early alcoholic cirrhosis. Which of the following topics is most important to include in client teaching? a. Need to abstain from alcohol b. Use of vitamin B supplements c. Maintenance of a nutritious diet d. Treatment with lactulose ANS: A 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 client is to stop the progression of the disease. DIF: Cognitive Level: Application TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. The nurse is caring for a client 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.