Chapter 43: Liver, Pancreas, and Biliary Tract
Problems Lewis: Medical-Surgical Nursing, 10th
Edition
MULTIPLE CHOICE
1. A young adult 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).
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 patient 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: Apply (application) REF: 980
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been
effective when the patient’s blood specimen reveals
a.
HBsAg. c. anti-HBc IgG.
b.
anti-HBs. 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: Apply (application) REF: 980
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
3. A 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.
ANS: A
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.
DIF: Cognitive Level: Apply (application) REF: 980
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse will plan to teach the patient diagnosed with acute hepatitis B about
, a.
administering -interferon
b.
side effects of nucleotide analogs.
c.
measures for improving the appetite.
d.
ways to increase activity and exercise.
ANS: C
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: Apply (application) REF: 980
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
5. The nurse administering -interferon and ribavirin (Rebetol) to a patient with
chronic hepatitis C will plan to monitor for
a.
leukopenia. c. polycythemia.
b.
hypokalemia. 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: Apply (application) REF: 981
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. Which information given by a 70-yr-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.
ANS: B
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.
DIF: Cognitive Level: Apply (application) REF: 976
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
7. A 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 appropriate?
a.
“Do you have a history of IV drug use?”
b.
“Do you use any over-the-counter drugs?”
c.
“Have you used corticosteroids for any reason?”
d.
“Have you recently traveled to a foreign country?”
ANS: B
Problems Lewis: Medical-Surgical Nursing, 10th
Edition
MULTIPLE CHOICE
1. A young adult 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).
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 patient 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: Apply (application) REF: 980
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. The nurse evaluates that administration of hepatitis B vaccine to a healthy patient has been
effective when the patient’s blood specimen reveals
a.
HBsAg. c. anti-HBc IgG.
b.
anti-HBs. 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: Apply (application) REF: 980
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance
3. A 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.
ANS: A
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.
DIF: Cognitive Level: Apply (application) REF: 980
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. The nurse will plan to teach the patient diagnosed with acute hepatitis B about
, a.
administering -interferon
b.
side effects of nucleotide analogs.
c.
measures for improving the appetite.
d.
ways to increase activity and exercise.
ANS: C
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: Apply (application) REF: 980
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
5. The nurse administering -interferon and ribavirin (Rebetol) to a patient with
chronic hepatitis C will plan to monitor for
a.
leukopenia. c. polycythemia.
b.
hypokalemia. 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: Apply (application) REF: 981
TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
6. Which information given by a 70-yr-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.
ANS: B
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.
DIF: Cognitive Level: Apply (application) REF: 976
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
7. A 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 appropriate?
a.
“Do you have a history of IV drug use?”
b.
“Do you use any over-the-counter drugs?”
c.
“Have you used corticosteroids for any reason?”
d.
“Have you recently traveled to a foreign country?”
ANS: B
