Med Surg TB Chapter 43 Flashcards


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1

A 24-year-old female contracts hepatitis from contaminated food. During the acute (icteric) phase of the patients 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

2

Administration of hepatitis B vaccine to a healthy 18-year-old patient has been effective when a specimen of the patients blood reveals

A) HBsAg.

B) anti-HBs.

C) anti-HBc IgG.

D) anti-HBc IgM.

Answer: B

3

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

4

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

5

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

6

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

7

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

8

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

9

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

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) 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

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: B

12

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 patients bilirubin level decreases.

D) The patient has at least one stool daily.

Answer: A

13

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

14

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

15

A 38-year-old 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) Place the patient on a pressure-relieving mattress.

D) Perform passive range of motion daily.

Answer: C

16

Which finding indicates to the nurse that a patients 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: D

17

To prepare a 56-year-old male patient with ascites for paracentesis, the nurse

A) places the patient on NPO status.

B) assists the patient to lie flat in bed.

C) asks the patient to empty the bladder.

D) positions the patient on the right side.

Answer: C

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: C

19

Which laboratory test result will the nurse monitor when evaluating the effects of therapy for a 62-year-old female patient who has acute pancreatitis?

A) Calcium

B) Bilirubin

C) Amylase

D) Potassium

Answer: C

20

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

A) Nausea and vomiting

B) Hypotonic bowel sounds

C) Abdominal tenderness and guarding

D) Muscle twitching and finger numbness

Answer: D

21

The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of

A) diabetes mellitus.

B) high-protein diet.

C) cigarette smoking.

D) alcohol consumption.

Answer: D

22

The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase)

A) at bedtime.

B) in the morning.

C) with each meal.

D) for abdominal pain

Answer: C

23

The nurse recognizes that teaching a 44-year-old woman following a laparoscopic cholecystectomy has been effective when the patient states which of the following?

A) I can expect yellow-green drainage from the incision for a few days.

B) I can remove the bandages on my incisions tomorrow and take a shower.

C) I should plan to limit my activities and not return to work for 4 to 6 weeks.

D) I will always need to maintain a low-fat diet since I no longer have a gallbladder.

Answer: B

24

The nurse is caring for a 73-year-old man who has cirrhosis. Which data obtained by the nurse during the assessment will be of most concern?

A) The patient complains of right upper-quadrant pain with palpation.

B) The patients 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 patients skin has multiple spider-shaped blood vessels on the abdomen.

Answer: B

25

A 49-year-old female patient with cirrhosis and esophageal varices has a new prescription for propranolol (Inderal). Which finding is the best indicator that the medication has been effective?

A) The patient reports no chest pain.

B) Blood pressure is 140/90 mm Hg.

C) Stools test negative for occult blood.

D) The apical pulse rate is 68 beats/minute

Answer: C

26

Which response by the nurse best explains the purpose of ranitidine (Zantac) for a patient 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: C

27

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

A) Ask the patient about any arm pain.

B) Retake the patients blood pressure.

C) Check the calcium level in the chart.

D) Notify the health care provider immediately.

Answer: C

28

A 67-year-old male patient with acute pancreatitis has a nasogastric (NG) tube to suction and is NPO. 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: D

29

Which assessment finding is of most concern for a 46-year-old woman with acute pancreatitis?

A) Absent bowel sounds

B) Abdominal tenderness

C) Left upper quadrant pain

D) Palpable abdominal mass

Answer: D

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 patients current medication list

Answer: D

31

A 34-year old patient with chronic hepatitis C infection has several medications prescribed. Which medication requires further discussion with the health care provider before administration?

A) Ribavirin (Rebetol, Copegus) 600 mg PO bid

B) Pegylated a-interferon (PEG-Intron, Pegasys) SQ daily

C) Diphenhydramine (Benadryl) 25 mg PO every 4 hours PRN itching

D) Dimenhydrinate (Dramamine) 50 mg PO every 6 hours PRN nausea

Answer: B

32

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

A) 40-year-old with chronic pancreatitis who has gnawing abdominal pain

B) 58-year-old who has compensated cirrhosis and is complaining of anorexia

C) 55-year-old with cirrhosis and ascites who has an oral temperature of 102 F (38.8 C)

D) 36-year-old recovering from a laparoscopic cholecystectomy who has severe shoulder pain

Answer: C

33

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

A) Increase activity level.

B) Maintain adequate nutrition.

C) Establish a stable environment.

D) Identify sources of hepatitis exposure.

Answer: B

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 (BP), heart rate, and respirations.

D) Place the patient in the supine position

Answer: C

35

The nurse is planning care for a 48-year-old woman with acute severe pancreatitis. The highest priority patient outcome is

A) maintaining normal respiratory function.

B) expressing satisfaction with pain control.

C) developing no ongoing pancreatic disease.

D) having adequate fluid and electrolyte balance.

Answer: A

36

The nurse is caring for a 36-year-old 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: C

37

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

A) The patients urine is bright yellow.

B) The patients stools are tan colored.

C) The patient has increased pain after eating.

D) The patient complains of chronic heartburn

Answer: B

38

A 51-year-old woman had an incisional cholecystectomy 6 hours ago. The nurse will place the highest priority on assisting the patient to

A) choose low-fat foods from the menu.

B) perform leg exercises hourly while awake.

C) ambulate the evening of the operative day.

D) turn, cough, and deep breathe every 2 hours.

Answer: D

39

For a patient with cirrhosis, which of the following nursing actions 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) Assisting the patient to choose the diet

Answer: B

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 annually.

Answer: B

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 exam?

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: C

42

A 23-year-old 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: A

43

A 36-year-old female patient is receiving treatment for chronic hepatitis C with pegylated interferon (PEGIntron, Pegasys), ribavirin (Rebetol), and telaprevir (Incivek). Which finding is most important to communicate to the health care provider?

A) Weight loss of 2 lb (1 kg)

B) Positive urine pregnancy test

C) Hemoglobin level of 10.4 g/dL

D) Complaints of nausea and anorexia

Answer: B

44

A nurse is considering which patient to admit to the same room as a patient who had a liver transplant 3 weeks ago and is now hospitalized with acute rejection. 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: D