Lewis: Ch 43 Liver Biliary Tract and Pancreas Problems

Question 1

A young adult contracts hepatitis from contaminated food. What should the nurse expect serologic testing to reveal during the acute (icteric) phase of the patient’s illness?

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 1

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. The patient would not have antigen for hepatitis B or antibody for hepatitis D. Anti-HAV IgG would indicate past infection and lifelong immunity.

Question 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.
b. anti-HBs.
c. anti-HBc IgG.
d. anti-HBc IgM.

Answer 2

b. anti-HBs.

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.

Question 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.

Answer 3

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.

Question 4

What topic should the nurse plan to teach the patient diagnosed with acute hepatitis B?

a. Administering α-interferon
b. Measures for improving appetite
c. Side effects of nucleotide analogs
d. Ways to increase activity and exercise

Answer 4

b. Measures for improving 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.

Question 5

The nurse administering -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 5

a. leukopenia.

Therapy with ribavirin and -interferon may cause leukopenia. The other problems are not associated with this drug therapy.

Question 6

Which information from 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.

Answer 6

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.

Question 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. “Have you taken corticosteroids?”
b. “Do you have a history of IV drug use?”
c. “Do you use any over-the-counter drugs?”
d. “Have you recently traveled to another country?”

Answer 7

c. “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.

Question 8

Which focused data should the nurse assess after identifying 4+ pitting edema on a patient who has cirrhosis?

a. Hemoglobin
b. Temperature
c. Activity level
d. Albumin level

Answer 8

d. Albumin level

The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of edema. The other parameters are not directly associated with the patient’s edema.

Question 9

Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

a. Taking lactulose
b. Avoiding all alcohol use
c. Maintaining good nutrition
d. Using vitamin B supplements

Answer 9

b. Avoiding all alcohol use

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 patient is to stop the progression of the disease.

Question 10

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. Withhold both drugs.
b. Administer both drugs.
c. Administer the furosemide.
d. Administer the spironolactone.

Answer 10

d. Administer the spironolactone.

Spironolactone is a potassium-sparing diuretic and will help increase the patient’s potassium level. The furosemide will further decrease the patient’s potassium level and should be held until the nurse talks with the health care provider.

Question 11

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 11

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 be done as part of the neurologic assessment but would not be diagnostic for hepatic encephalopathy.

Question 12

Which finding indicates to the nurse that lactulose is effective for an older adult 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 12

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 or this patient. Lactulose will not decrease nausea and vomiting or lower bilirubin levels.

Question 13

A 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 13

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. Balloons may be deflated briefly every 8 to 12 hours to avoid tissue necrosis, but if only the gastric balloon is deflated, the esophageal balloon may occlude the airway. Balloons are not deflated for nausea.

Question 14

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

a. Bilirubin levels
b. Ammonia levels
c. Potassium levels
d. Prothrombin time

Answer 14

b. Ammonia levels

The protein in the blood in the gastrointestinal tract will be absorbed and may result in an increase in the ammonia level because the liver cannot metabolize protein very well. The prothrombin time, bilirubin, and potassium levels should also be monitored, but they will not be affected by the bleeding episode

Question 15

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

a. Restrict daily dietary protein intake.
b. Reposition the patient every 4 hours.
c. Perform passive range of motion twice daily.
d. Place the patient on a pressure-relief mattress.

Answer 15

d. Place the patient on a pressure-relief mattress.

The pressure-relieving mattress will decrease the risk for skin breakdown for this patient. Adequate dietary protein intake is necessary in patients with ascites to improve oncotic pressure. Repositioning the patient every 4 hours will not be adequate to maintain skin integrity. Passive range of motion will not take the pressure of areas such as the sacrum that are vulnerable to breakdown.

Question 16

Which finding indicates to the nurse that a patient’s transjugular intrahepatic portosystemic shunt (TIPS) placed 3 months ago has been effective?

a. Increased serum albumin level
b. Decreased indirect bilirubin level
c. Improved alertness and orientation
d. Fewer episodes of bleeding varices

Answer 16

d. Fewer episodes of bleeding varices

TIPS is used to lower pressure in the portal venous system and decrease the risk of bleeding from esophageal varices. Indirect bilirubin level and serum albumin levels are not affected by shunting procedures. TIPS will increase the risk for hepatic encephalopathy.

Question 17

How should the nurse prepare a patient with ascites for paracentesis?

a. Place the patient on NPO status.
b. Assist the patient to lie flat in bed.
c. Ask the patient to empty the bladder.
d. Position the patient on the right side.

Answer 17

c. Ask the patient to empty the bladder.

The patient should empty the bladder to decrease the risk of bladder perforation during the procedure. The patient would be positioned in Fowler’s position and would not be able to lie flat without compromising breathing. Because no sedation is required for paracentesis, the patient does not need to be NPO.

Question 18

Which finding is most important for the nurse to communicate to the health care provider about a patient who received a liver transplant 1 week ago?

a. Dry palpebral and oral mucosa
b. Crackles at bilateral lung bases
c. Temperature 100.8° F (38.2° C)
d. No bowel movement for 4 days

Answer 18

c. Temperature 100.8° F (38.2° C)

The risk of infection is high in the first few months after liver transplant, and fever is frequently the only sign of infection. The other patient data indicate the need for further assessment or nursing actions and might be communicated to the health care provider, but they do not indicate a need for urgent action.

Question 19

Which laboratory test result will the nurse monitor to evaluate the effects of therapy for a patient who has acute pancreatitis?

a. Lipase
b. Calcium
c. Bilirubin
d. Potassium

Answer 19

a. Lipase

Lipase is elevated in acute pancreatitis. Although changes in the other values may occur, they would not be useful in evaluating whether the prescribed therapies have been effective.

Question 20

Which assessment finding would the nurse need to report most quickly to the health care provider regarding a patient who has acute pancreatitis?

a. Nausea and vomiting
b. Hypotonic bowel sounds
c. Muscle twitching and finger numbness
d. Upper abdominal tenderness and guarding

Answer 20

c. Muscle twitching and finger numbness

Muscle twitching and finger numbness indicate hypocalcemia, which may lead to tetany unless calcium gluconate is administered. Although the other findings should also be reported to the health care provider, they do not indicate complications that require rapid action.

Question 21

What risk factor will the nurse specifically ask about when a patient is being admitted with acute pancreatitis?

a. Diabetes
b. Alcohol use
c. High-protein diet
d. Cigarette smoking

Answer 21

b. Alcohol use

Alcohol use is one of the most common risk factors for pancreatitis in the United States. Cigarette smoking, diabetes, and high-protein diets are not risk factors.

Question 22

What should the nurse teach a patient with chronic pancreatitis is the time to take the prescribed pancrelipase (Viokase)?

a. Bedtime
b. Mealtime
c. When nauseated
d. For abdominal pain

Answer 22

b. Mealtime

Pancreatic enzymes are used to help with digestion of nutrients and should be taken with every meal.

Question 23

The nurse recognizes that teaching a patient following a laparoscopic cholecystectomy has been effective when the patient makes which statement?

a. “I can take a shower and walk around the house tomorrow.”
b. “I need to limit my activities and not return to work for 4 weeks.”
c. “I can expect yellowish drainage from the incision for a few days.”
d. “I will follow a low-fat diet for life because I do not have a gallbladder.”

Answer 23

a. “I can take a shower and walk around the house tomorrow.”

After a laparoscopic cholecystectomy, patients are discharged the same (or next) day and have few restrictions on activities of daily living. Drainage from the incisions would be abnormal, and the patient should be instructed to call the health care provider if this occurs. A low-fat diet may be recommended for a few weeks after surgery but will not be a lifelong requirement.

Question 24

The nurse is caring for a patient who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

a. The patient reports right upper-quadrant pain with palpation.
b. The patient’s hands flap back and forth when the arms are extended.
c. The patient has ascites and a 2-kg weight gain from the previous day.
d. The patient’s abdominal skin has multiple spider-shaped blood vessels.

Answer 24

b. The patient’s hands flap back and forth when the arms are extended.

Asterixis indicates that the patient has hepatic encephalopathy, and hepatic coma may occur. The spider angiomas and right upper quadrant abdominal pain are not unusual for the patient with cirrhosis and do not require a change in treatment. The ascites and weight gain indicate the need for treatment but not as urgently as the changes in neurologic status.

Question 25

A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?

a. The patient reports no chest pain.
b. Blood pressure is 130/80 mm Hg.
c. Stools test negative for occult blood.
d. The apical pulse rate is 68 beats/min.

Answer 25

c. Stools test negative for occult blood.

Because the purpose of β-blocker therapy for patients with esophageal varices is to decrease the risk for bleeding from esophageal varies, the best indicator of the effectiveness for propranolol is the lack of blood in the stools. Although propranolol is used to treat hypertension, angina, and tachycardia, the purpose for use in this patient is to decrease the risk for bleeding from esophageal varices.

Question 26

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient who was admitted with bleeding esophageal varices?

a. The medication will reduce the risk for aspiration.
b. The medication will inhibit development of gastric ulcers.
c. The medication will prevent irritation of the enlarged veins.
d. The medication will decrease nausea and improve the appetite.

Answer 26

c. The medication will prevent irritation of the enlarged veins.

Esophageal varices are dilated submucosal veins. The therapeutic action of H2-receptor blockers in patients with esophageal varices is to prevent irritation and bleeding from the varices caused by reflux of acid gastric contents. Although ranitidine does decrease the risk for peptic ulcers, reduce nausea, and help prevent aspiration pneumonia, these are not the primary purposes for H2-receptor blockade in this patient.

Question 27

When taking the blood pressure (BP) on the right arm of a patient who has severe acute pancreatitis, the nurse notices carpal spasms of the patient’s right hand. Which action should the nurse take next?

a. Ask the patient about any arm pain.
b. Retake the patient’s blood pressure.
c. Check the calcium level in the chart.
d. Notify the health care provider immediately.

Answer 27

c. Check the calcium level in the chart.

The patient with acute pancreatitis is at risk for hypocalcemia, and the assessment data indicate a positive Trousseau’s sign. The health care provider should be notified after the nurse checks the patient’s calcium level. There is no indication that the patient needs to have the BP rechecked or that there is any arm pain.

Question 28

A patient with acute pancreatitis is NPO and has a nasogastric (NG) tube to suction. Which information obtained by the nurse indicates that these therapies have been effective?

a. Bowel sounds are present.
b. Grey Turner sign resolves.
c. Electrolyte levels are normal.
d. Abdominal pain is decreased.

Answer 28

d. Abdominal pain is decreased.

NG suction and NPO status will decrease the release of pancreatic enzymes into the pancreas
and decrease pain. Although bowel sounds may be hypotonic with acute pancreatitis, the presence of bowel sounds does not indicate that treatment with NG suction and NPO status has been effective. Electrolyte levels may be abnormal with NG suction and must be replaced by appropriate IV infusion. Although Grey Turner sign will eventually resolve, it would not be appropriate to wait for this to occur to determine whether treatment was effective

Question 29

Which assessment finding is of most concern for a patient with acute pancreatitis?

a. Absent bowel sounds
b. Abdominal tenderness
c. Left upper quadrant pain
d. Palpable abdominal mass

Answer 29

d. Palpable abdominal mass

A palpable abdominal mass may indicate the presence of a pancreatic abscess, which will require rapid surgical drainage to prevent sepsis. Absent bowel sounds, abdominal tenderness, and left upper quadrant pain are common in acute pancreatitis and do not require rapid action to prevent further complications.

Question 30

Which action will be included in the care for a patient who has recently been diagnosed with asymptomatic nonalcoholic fatty liver disease (NAFLD)?

a. Teach symptoms of variceal bleeding.
b. Draw blood for hepatitis serology testing.
c. Discuss the need to increase caloric intake.
d. Review the patient’s current medication list.

Answer 30

d. Review the patient’s current medication list.

Some medications can increase the risk for NAFLD, and they should be discontinued. NAFLD is not associated with hepatitis, weight loss is usually indicated, and variceal bleeding would not be a concern in a patient with asymptomatic NAFLD.

Question 31

A patient with chronic hepatitis B infection has several medications prescribed. Which medication order requires clarification with the health care provider before administration?

a. Tenofovir (Viread) orally once daily
b. Adefovir (Hepsera) orally once daily
c. Entecarvir (Baraclude) orally once daily
d. Pegylated α-interferon (Pegasys) orally once daily

Answer 31

d. Pegylated α-interferon (Pegasys) orally once daily

Pegylated α-interferon is administered subcutaneously, not orally. The medications are all appropriate for a patient with chronic hepatitis B infection.

Question 32

During change-of-shift report, the nurse learns about the following four patients. Which patient requires assessment first?

a. A 58-yr-old patient who has compensated cirrhosis and reports anorexia
b. A 40-yr-old patient with chronic pancreatitis who has gnawing abdominal pain
c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)
d. A 36-yr-old patient recovering from a laparoscopic cholecystectomy who has severe shoulder pain

Answer 32

c. A 55-yr-old patient with cirrhosis and ascites who has an oral temperature of 102° F (38.8° C)

This patient’s history and fever suggest possible spontaneous bacterial peritonitis, which would require rapid assessment and interventions such as antibiotic therapy. The clinical manifestations for the other patients are consistent with their diagnoses and do not indicate complications are occurring.

Question 33

Which goal has the highest priority in the plan of care for a 26-yr-old patient who was admitted with viral hepatitis, has severe anorexia and fatigue, and is homeless?

a. Increase activity level.
b. Maintain adequate nutrition.
c. Establish a stable environment.
d. Identify source of hepatitis exposure.

Answer 33

b. Maintain adequate nutrition.

The highest priority outcome is to maintain nutrition because adequate nutrition is needed for hepatocyte regeneration. Finding a home for the patient and identifying the source of the infection would be appropriate activities, but they do not have as high a priority as ensuring adequate nutrition. Although the patient’s activity level will be gradually increased, rest is indicated during the acute phase of hepatitis.

Question 34

Which action should the nurse in the emergency department take first for a new patient who is vomiting blood?

a. Insert a large-gauge IV catheter.
b. Draw blood for coagulation studies.
c. Check blood pressure and heart rate.
d. Place the patient in the supine position.

Answer 34

c. Check blood pressure and heart rate.

The nurse’s first action should be to determine the patient’s hemodynamic status by assessing vital signs. Drawing blood for coagulation studies and inserting an IV catheter are also appropriate. However, the vital signs may indicate the need for more urgent actions. Because aspiration is a concern for this patient, the nurse will need to assess the patient’s vital signs and neurologic status before placing the patient in a supine position.

Question 35

The nurse is planning care for a patient with acute severe pancreatitis. What is the highest priority patient outcome?

a. Having fluid and electrolyte balance
b. Maintaining normal respiratory function
c. Expressing satisfaction with pain control
d. Developing no ongoing pancreatic disease

Answer 35

b. Maintaining normal respiratory function

Respiratory failure can occur as a complication of acute pancreatitis and maintenance of adequate respiratory function is the priority goal. The other outcomes would also be appropriate for the patient.

Question 36

The nurse is caring for a patient with pancreatic cancer. Which nursing action is the highest priority?

a. Offer psychologic support for depression.
b. Offer high-calorie, high-protein dietary choices.
c. Administer prescribed opioids to relieve pain as needed.
d. Teach about the need to avoid scratching any pruritic areas.

Answer 36

c. Administer prescribed opioids to relieve pain as needed.

Effective pain management will be necessary in order for the patient to improve nutrition, be receptive to teaching, or manage anxiety or depression.

Question 37

Which assessment information will be most important for the nurse to report to the health care provider about a patient who has acute cholecystitis?

a. The patient’s urine is bright yellow.
b. The patient’s stools are tan colored.
c. The patient reports chronic heartburn.
d. The patient has increased pain after eating.

Answer 37

b. The patient’s stools are tan colored.

Tan or gray stools indicate biliary obstruction, which requires rapid intervention to resolve. The other data are not unusual for a patient with this diagnosis, although the nurse would also report the other assessment information to the health care provider.

Question 38

A patient had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to:

a. perform leg exercises hourly while awake.
b. ambulate the evening of the operative day.
c. turn, cough, and deep breathe every 2 hours.
d. choose preferred low-fat foods from the menu.

Answer 38

c. turn, cough, and deep breathe every 2 hours.

Postoperative nursing care after a cholecystectomy focuses on prevention of respiratory complications because the surgical incision is high in the abdomen and impairs coughing and deep breathing. The other nursing actions are also important to implement but are not as high a priority as ensuring adequate ventilation.

Question 39

For a patient who has cirrhosis, which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP)?

a. Assessing the patient for jaundice
b. Providing oral hygiene after a meal
c. Palpating the abdomen for distention
d. Teaching the patient the prescribed diet

Answer 39

b. Providing oral hygiene after a meal

Providing oral hygiene is within the scope of UAP. Assessments and assisting patients to choose therapeutic diets are nursing actions that require higher level nursing education and scope of practice and would be delegated to licensed practical/vocational nurses (LPNs/VNs) or RNs.

Question 40

Which action will the nurse include in the plan of care for a patient who has been diagnosed with chronic hepatitis B?

a. Advise limiting alcohol intake to 1 drink daily.
b. Schedule for liver cancer screening every 6 months.
c. Initiate administration of the hepatitis C vaccine series.
d. Monitor anti-hepatitis B surface antigen (anti-HBs) levels.

Answer 40

b. Schedule for liver cancer screening every 6 months.

Patients with chronic hepatitis are at higher risk for development of liver cancer and should be screened for liver cancer every 6 to 12 months. Patients with chronic hepatitis are advised to completely avoid alcohol. There is no hepatitis C vaccine. Because anti-HBs is present whenever there has been a past hepatitis B infection or vaccination, there is no need to regularly monitor for this antibody.

Question 41

A patient born in 1955 had hepatitis A infection 1 year ago. According to Centers for Disease
Control and Prevention (CDC) guidelines, which action should the nurse include in care when the patient is seen for a routine annual physical examination?
a. Start the hepatitis B immunization series.
b. Teach the patient about hepatitis A immune globulin.
c. Ask whether the patient has been screened for hepatitis C.
d. Test for anti-hepatitis-A virus immune globulin M (anti-HAV-IgM).

Answer 41

c. Ask whether the patient has been screened for hepatitis C.

Current CDC guidelines indicate that all patients who were born between 1945 and 1965 should be screened for hepatitis C because many persons who are positive have not been diagnosed. Although routine hepatitis B immunization is recommended for infants, children, and adolescents, vaccination for hepatitis B is recommended only for adults at risk for blood-borne infections. Because the patient has already had hepatitis A, immunization, and anti-HAV IgM levels will not be needed.

Question 42

A patient has been admitted with acute liver failure. Which assessment data are most important for the nurse to communicate to the health care provider?

a. Asterixis and lethargy
b. Jaundiced sclera and skin
c. Elevated total bilirubin level
d. Liver 3 cm below costal margin

Answer 42

a. Asterixis and lethargy

The patient’s findings of asterixis and lethargy are consistent with grade 2 hepatic encephalopathy. Patients with acute liver failure can deteriorate rapidly from grade 1 or 2 to grade 3 or 4 hepatic encephalopathy and need early transfer to a transplant center. The other findings are typical of patients with hepatic failure and would be reported but would not indicate a need for an immediate change in the therapeutic plan.

Question 43

A 36-yr-old female patient is receiving treatment for chronic hepatitis B with pegylated interferon (Pegasys). Which finding is important to communicate to the health care provider to suggest a change in therapy?

a. Nausea and anorexia
b. Weight loss of 2 lb (1 kg)
c. Positive urine pregnancy test
d. Hemoglobin level of 10.4 g/dL

Answer 43

c. Positive urine pregnancy test

Because ribavirin is teratogenic, the medication will need to be discontinued immediately. Anemia, weight loss, and nausea are common adverse effects of the prescribed regimen and may require actions such as patient teaching, but they would not require immediate cessation of the therapy.

Question 44

A nurse is considering which patient to admit to the same room as a patient who is hospitalized with acute rejection 3 weeks after a liver transplant. Which patient would be the best choice?

a. Patient who is receiving chemotherapy for liver cancer
b. Patient who is receiving treatment for acute hepatitis C
c. Patient who has a wound infection after cholecystectomy
d. Patient who requires pain management for chronic pancreatitis

Answer 44

d. Patient who requires pain management for chronic pancreatitis

The patient with chronic pancreatitis does not present an infection risk to the immunosuppressed patient who had a liver transplant. The other patients either are at risk for infection or currently have an infection, which will place the immunosuppressed patient at risk for infection.

Question 45

In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen’s sign. Indicate the area in the accompanying figure where the nurse will assess for this change.

a. 1
b. 2
c. 3
d. 4

Answer 45

c. 3

The area around the umbilicus should be indicated. Cullen’s sign consists of ecchymosis around the umbilicus. Cullen’s sign occurs because of seepage of bloody exudates from the inflamed pancreas and indicates severe acute pancreatitis.

Question 46

After an unimmunized person is exposed to hepatitis B through a needle-stick injury, which actions will the nurse plan to take? (Select all that apply.)

a. Administer hepatitis B vaccine.
b. Test for antibodies to hepatitis B.
c. Teach about α-interferon therapy.
d. Give hepatitis B immune globulin.
e. Explain options for oral antiviral therapy.

Answer 46

a. Administer hepatitis B vaccine.
b. Test for antibodies to hepatitis B.
d. Give hepatitis B immune globulin.

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.