12 Questions
A nurse on a medical-surgical unit is admitting a client who has hepatitis B with ascites. Which of the following actions should the nurse include in the plan of care?
Provide a high-calorie, high-carbohydrate diet.
A nurse is caring for a client who has advanced cirrhosis with worsening hepatic encephalopahy. Which of the following is an expected assessment finding? (Select all that apply.)
A. Anorexia B. Change in orientation C. Asterixis D. Ascites E. Fetor hepaticus
B,C,E
A nurse is caring for a client who has cirrhosis. Which of the following medications can the nurse expect to administer to this client? (Select all that apply.)
A. Diuretic B. Beta-blocking agent C. Opioid analgesic D. Lactulose (Cephulac) E. Sedative
A,B,D
A nurse is teaching a client who has hepatitis B about home care. Which of the following should the nurse include in the teaching? (Select all that apply.)
A. Limit physical activity. B. Avoid alcohol. C. Take acetaminophen for comfort. D. Wear a mask when in public places. E. Eat small frequent meals.
A,B,E
A nurse is assessing a client who has been taking prednisone following an exacerbation of inflammatory bowel disease (IBD). Which of the following assessment findings is the highest priority?
Client reports having a sore throat.
A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching?
“I will plan to limit fiber in my diet.”
A nurse is completing discharge teaching to a client who has Crohn’s disease. Which of the following should be included in the teaching?
Drink canned protein supplements.
The nurse recognizes the prevention of which complication as the primary rationale for initiating total parenteral nutrition at a slow rate?
Hyperglycemia
The nurse recognizes that education for patients receiving infusion therapy should include which information? (Select all that apply)
A. precautions for preventing infection B. Signs and symptoms to report C. Manufacturer of the IVAD D. Purpose of infusion therapy E. Calculation of infusion rates
A,B,D
Elevated ammonia levels can lead to hepatic encephalopathy. Which provider order best reduces this risk in patients with cirrhosis?
Restrict protein intake
A nurse is planning care for a client who has a new prescription for total parenteral nutrition (TPN). Which of the following interventions should be included in the plan of care? (Select all that apply.)
A. Obtain a capillary blood glucose four times daily. B. Administer prescribed medications through a secondary port on the TPN IV tubing. C. Monitor vital signs three times during the 12-hr shift. D. Change the TPN IV tubing every 24 hr. E. Ensure a daily aPTT is obtained.
A,C,D
A nurse is caring for a client who is receiving TPN solution. It has been 24 hr since the current bag of solution was hung, and 400 mL remains to infuse. Which of the following is the appropriate action for the nurse to take?
Remove the current bag and hang a new bag.
Study Notes
Hepatitis B and Cirrhosis
- A client with hepatitis B and ascites requires a plan of care that includes actions to manage ascites and prevent complications.
- Expected assessment findings for a client with advanced cirrhosis and worsening hepatic encephalopathy include anorexia, change in orientation, asterixis, and fetor hepaticus.
- Medications that may be administered to a client with cirrhosis include diuretics, beta-blocking agents, lactulose, and opioid analgesics.
Home Care and Teaching
- A client with hepatitis B should be taught to limit physical activity, avoid alcohol, and eat small, frequent meals.
- The client should not be advised to take acetaminophen for comfort or wear a mask in public places.
Ulcerative Colitis and Crohn's Disease
- A client with ulcerative colitis who understands the teaching will recognize the importance of adhering to the medication regimen and avoiding stress.
- Discharge teaching for a client with Crohn's disease should include instructions on how to manage the condition, including dietary changes and stress management.
Total Parenteral Nutrition (TPN)
- The primary rationale for initiating TPN at a slow rate is to prevent complications, such as refeeding syndrome.
- Education for patients receiving infusion therapy should include precautions for preventing infection, signs and symptoms to report, and the purpose of infusion therapy.
- Elevated ammonia levels can lead to hepatic encephalopathy, and lactulose may be prescribed to reduce this risk.
- When planning care for a client with a new prescription for TPN, the nurse should include interventions such as obtaining regular blood glucose levels, administering medications through a secondary port, and monitoring vital signs frequently.
- When a client is receiving TPN solution, the nurse should change the IV tubing every 24 hours and ensure a daily aPTT is obtained.
Medication Administration
- A client with inflammatory bowel disease who is taking prednisone should be assessed for signs of adrenal insufficiency, such as fatigue, weakness, and dizziness.
- The nurse should prioritize assessment findings related to adrenal insufficiency over other findings.
TPN Administration
- If a client is receiving TPN solution and 400 mL remains to infuse after 24 hours, the nurse should discard the remaining solution and hang a new bag.
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