Chapter 43: Liver, Pancreas, and Biliary Tract Problems Lewis: Medical-Surgical Nursing, 10th Edition

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 p