Adult Health Nursing 6th Edition By kockrow - Test Bank

Christensen: Adult Health Nursing, 6th Edition Chapter 03: Care of the Patient with an Integumentary Disorder Test Bank MULTIPLE CHOICE 1. A patient has generalized macular-papular skin eruptions and complains of severe pruritus from contact dermatitis. When the nurse administers his therapeutic bath, it is important to remember that a. using Burow’s solution helps promote healing. b. rubbing the skin briskly decreases pruritus. c. allowing 20 to 60 minutes to complete the bath will prevent pruritus. d. sterilizing all equipment used will prevent pruritus. ANS: A Pruritus is responsible for most of the discomfort. Wet dressings, using Burow’s solution, help promote the healing process. A cool environment with increased humidity decreases the pruritus. DIF: Cognitive Level: Application REF: Page 79 OBJ: 7 TOP: Pruritus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 2. A patient, age 63, has cancer of the left breast. After a modified radical mastectomy, she has been receiving chemotherapy. Her grandson, who visited a few days ago, now has varicella (chickenpox). The nurse should observe her carefully for signs of a. herpes zoster. b. herpes simplex type I. c. herpes simplex type II. d. impetigo. ANS: A Herpes zoster is caused by the same virus that causes chickenpox (Herpes varicella). The greatest risk occurs to patients who have a lowered resistance to infection, such as those on chemotherapy or large doses of prednisone, in whom the disease could be fatal because of the patient’s compromised immune system. DIF: Cognitive Level: Analysis REF: Pages 72, 74 OBJ: 9 TOP: Chemotherapy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 3. A patient has herpes zoster (shingles). A local antiviral agent, which is useful in delaying the progression of herpetic diseases, was prescribed. This medication is a. lorazepam (Ativan). b. hydroxyzine (Atarax). c. acyclovir (Zovirax). d. hydrocortisone (Solu-Cortef). ANS: C Oral and intravenous acyclovir (Zovirax), when administered early, reduces the pain and duration of the virus. DIF: Cognitive Level: Comprehension REF: Page 72 OBJ: 9 TOP: Anti-infective KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 4. A child has been sent home from school with pruritus and honey-colored crusts on his lower lip and chin. A probable diagnosis would be a. chickenpox. b. impetigo. c. shingles. d. herpes simplex type I. ANS: B Impetigo is seen at all ages, but is particularly common in children. The crust is honey-colored and easily removed. DIF: Cognitive Level: Comprehension REF: Page 76 OBJ: 10 TOP: Infection KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 5. A patient has an erythematous patch of vesicles on her scalp, and she complains of pain and pruritus. A diagnosis of tinea capitis is made. The causative organism is a. bacterium. b. virus. c. worm. d. fungus. ANS: D Tinea capitis is commonly known as ringworm of the scalp. Microsporum audouinii is the major fungal pathogen. DIF: Cognitive Level: Knowledge REF: Page 78 OBJ: 10 TOP: Infection KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 6. A patient, age 46, reports to his physician’s office with urticaria and papules on his hands and arms. He says, “It itches so badly.” In assessing the patient, the nurse should gather data regarding recent a. travel to foreign countries. b. upper respiratory tract infection. c. changes in medication. d. contact with people who have an infectious disease. ANS: C Urticaria is the term applied to the presence of wheals or hives in an allergic reaction commonly caused by drugs, food, insect bites, inhalants, emotional stress, or exposure to heat or cold. DIF: Cognitive Level: Analysis REF: Page 81 OBJ: 8 TOP: Urticaria KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 7. A patient has been receiving penicillin, acetaminophen with codeine, and hydrochlorothiazide for 4 days. He now has a urinary tract infection. A sulfonamide has been prescribed to be taken three times per day. Several hours after the second dose , he complains of pruritus. The nurse observes a generalized erythema and rash. The most appropriate nursing intervention would be to hold a. all medications, and notify the physician of the signs and symptoms. b. the penicillin. c. the acetaminophen with codeine. d. the sulfonamide. ANS: A If a patient develops wheals or hives in an allergic reaction to drugs (urticaria), then all medications should be held. DIF: Cognitive Level: Analysis REF: Page 80 OBJ: 7 TOP: Medication KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 8. A patient has acne vulgaris. When the nurse explains this condition, it is most important to a. stress the importance of strict hygiene. b. discuss the connection of diet and stress. c. explore how this condition is affecting his self-image and lifestyle. d. describe in detail the proper use of prescribed medication. ANS: C The nurse must assess and consider what acne means to a person. Most patients acknowledge that acne affects their self-image. DIF: Cognitive Level: Analysis REF: Page 83 OBJ: 7 TOP: Self-image KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 9. A 30-year-old African American had surgery 6 months ago. Her incisional site is now raised, indurated, and shiny. This tissue growth is most likely a(n) a. angioma. b. keloid. c. melanoma. d. nevus. ANS: B Keloids, which originate in scars, are hard and shiny and are seen more often in African Americans than Caucasians. DIF: Cognitive Level: Knowledge REF: Pages 65, 67, 90, 91, Table 3-1, Figure 3-16 OBJ: 1 TOP: Keloid KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 10. A patient, age 37, sustained partial- and full-thickness burns to 26% of her body surface area. The greatest fluid loss resulting from her burns will usually occur a. within 12 hours after burn trauma. b. 24 to 36 hours after burn trauma. c. 24 to 48 hours after burn trauma. d. 48 to 72 hours after burn trauma. ANS: A In a burn injury, usually the greatest fluid loss occurs within the first 12 hours. DIF: Cognitive Level: Analysis REF: Pages 94-95 OBJ: 14 TOP: Burns KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 11. Most of the deaths from burn trauma in the emergent phase that require a referral to a burn center result from a. infection. b. dysrhythmias with cardiac arrest. c. hypovolemic shock and renal failure. d. adrenal failure. ANS: A A possible complication that should be addressed at the time of the burn is infection in the wound. DIF: Cognitive Level: Analysis REF: Page 98, Figure 3-24 OBJ: 15 TOP: Burns KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 12. A patient, age 26, is admitted to the burn unit with partial- and full-thickness burns to 20% of his body surface area as well as smoke-inhalation injury. Carbon monoxide intoxication secondary to smoke inhalation is often fatal because carbon monoxide a. binds with hemoglobin in place of oxygen. b. interferes with oxygen intake. c. is a respiratory depressant. d. is a toxic agent. ANS: A Carbon monoxide poisoning is likely if the patient has been in an enclosed area. Carbon monoxide displaces oxygen by binding with the hemoglobin. DIF: Cognitive Level: Analysis REF: Page 97 OBJ: 14 TOP: Burns KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 13. A nurse arrives at an accident scene where the victim has just received an electrical burn. The nurse’s primary concern is a. the extent and depth of the burn. b. the sites of entry and exit. c. the likelihood of cardiac arrest. d. control of bleeding. ANS: C Most electrical burns result in cardiac arrest, and the patient will require CPR or astute cardiac monitoring. DIF: Cognitive Level: Analysis REF: Page 97 OBJ: 10 TOP: Burns KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 14. A patient, age 27, sustained thermal burns to 18% of her body surface area. After the first 72 hours, the nurse will have to observe for the most common cause of burn-related deaths, which is a. shock. b. respiratory arrest. c. hemorrhage. d. infection. ANS: D Infection is the most common complication and cause of death after the first 72 hours. DIF: Cognitive Level: Analysis REF: Page 98 OBJ: 14 TOP: Burns KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe, Effective Care Environment 15. A duodenal ulcer may occur 8 to 14 days after severe burns. Usually, the first symptom is bright red emesis. Which condition matches this description? a. Curling’s ulcer b. Paralytic ileus c. Hypoglycemia d. ICU psychosis syndrome ANS: A Curling’s ulcer is a duodenal ulcer that develops 8 to 14 days after severe burns on the surface of the body. The first sign is usually vomiting of bright red blood. DIF: Cognitive Level: Analysis REF: Page 98 OBJ: 7 TOP: Curling’s ulcer KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 16. A nurse is providing the open method of treatment for a patient who is 52 years old with burns to her lower extremities. It would be important for the nurse to a. change the dressing using good medical asepsis. b. provide an analgesic immediately after the dressing change. c. perform circulation checks every 2 to 4 hours. d. keep the room temperature at 85° F (24.4° C) to prevent chilling. ANS: D Chilling may be controlled by keeping the room temperature at 85° F (24.4° C). DIF: Cognitive Level: Application REF: Page 100 OBJ: 15 TOP: Burn treatment KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 17. The nurse has initiated measures to promote suppuration of a carbuncle. Which assessment would indicate that these measures have been successful? a. The area is erythematous and scaly. b. The area has begun to drain exudate. c. The area is not erythematous or edematous. d. The area has stopped draining exudate. ANS: B Warm soaks two to three times a day can be used to speed the process of suppuration (production of purulent material). Patients should be taught not to touch the exudate. DIF: Cognitive Level: Analysis REF: Page 77 OBJ: 7 TOP: Skin eruptions KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 18. A patient, age 20, is admitted with severe eczema. In planning the care for her, the nurse should plan to a. keep the skin well hydrated. b. change the dressings every day. c. keep the skin clean and dry. d. administer antibiotics for the infection. ANS: A Hydration of the skin is the key to treatment. DIF: Cognitive Level: Application REF: Page 82 OBJ: 7 TOP: Eczema KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 19. The nurse is caring for a 26-year-old patient who was burned 72 hours ago. He has partial-thickness burns to 24% of his body surface area. He begins to excrete large amounts of urine. The nurse should a. slow the IV solution and monitor for burn shock. b. monitor for signs of infection. c. assess for signs of fluid overload. d. raise the foot of the bed and apply blankets. ANS: C As the blood volume increases, the cardiac output increases to increase renal perfusion. The result includes diuresis. However, a great risk for the patient includes fluid overload because of the rapid movement of fluid back into the intravascular space. DIF: Cognitive Level: Analysis REF: Page 95 OBJ: 14 TOP: Burns KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 20. A patient, age 29, is diagnosed with genital herpes. She is receiving acyclovir (Zovirax). Which would indicate a therapeutic response? a. Decrease in pruritus b. Decrease in pain c. Increase in WBC count d. Increase in activity tolerance ANS: B Acyclovir (Zovirax) is an antiviral agent that can alter the course of the disease. DIF: Cognitive Level: Analysis REF: Page 69 OBJ: 7 TOP: Herpes KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 21. A female patient is seen by the school nurse because of flat lesions that are clear in the center with erythematous borders. In assessing a patient for tinea corporis, the nurse would check a. soles of the feet. b. back of the scalp. c. groin area. d. anterior abdomen. ANS: D Tinea corporis is known as ringworm of the body. It occurs on parts of the body with little or no hair. DIF: Cognitive Level: Comprehension REF: Page 78, Figure 3-8 OBJ: 6 TOP: Tinea corporis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 22. A patient has been walking in the woods. He complains of severe pruritus. The nurse notes an erythematous area on his lower legs. The first nursing intervention for dermatitis venenata would be to a. administer Benadryl, 50 mg IM. b. wash area with copious amounts of water. c. apply cool compresses continuously. d. expose area to heat and air. ANS: B In dermatitis venenata (poison oak or ivy), the patient should wash the affected part immediately after contact with the offending allergen. DIF: Cognitive Level: Application REF: Page 80 OBJ: 7 TOP: Pruritus KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 23. The nurse debriding a wound explains the purpose of debridement is to: a. increase the effectiveness of the skin graft. b. prevent infection and promote healing. c. promote suppuration of the wound. d. promote movement in the affected area. ANS: B Débridement is the removal of damaged tissue and cellular debris from a wound or burn to prevent infection and to promote healing. DIF: Cognitive Level: Comprehension REF: Page 99 OBJ: 15 TOP: Burns KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 24. A patient has been admitted to the hospital with burns to his upper chest. The nurse notes singed nasal hairs. It would be important for the nurse to assess this patient frequently for a. decreased activity. b. bradycardia. c. respiratory complications. d. hypertension. ANS: C Signs and symptoms of inhalation injury include singed nasal hairs. Breathing difficulties may take several hours to occur. DIF: Cognitive Level: Analysis REF: Page 95 OBJ: 15 TOP: Burns KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 25. Which may indicate a malignant melanoma in a nevus on a patient’s arm? a. Even coloring of the mole b. Decrease in size of the mole c. Irregular border of the mole d. Symmetry of the mole ANS: C Any change in color, size, or texture and any bleeding or pruritus of a nevus deserves investigation. A malignant melanoma is a cancerous neoplasm in which pigment cells or melanocytes invade the epidermis, dermis, and sometimes the subcutaneous tissue. DIF: Cognitive Level: Knowledge REF: Page 92, Figure 3-18 OBJ: 12 TOP: Melanoma KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 26. A dark-skinned patient has been admitted to the hospital in severe respiratory distress. To determine whether the patient is cyanotic, the nurse uses what knowledge of skin assessment? a. It is not possible to assess color changes in patients with dark skin. b. Cyanosis in patients with dark skin can be seen only in the sclera. c. Cyanosis can be seen in the lips and mucous membranes of patients with dark skin. d. Cyanosis will blanch out with direct pressure to the soles of the feet in dark-skinned patients. ANS: C Assessment of color is more easily made in areas where the epidermis is thin, such as the lips and mucous membrane. DIF: Cognitive Level: Comprehension REF: Pages 67-68, Cultural Considerations OBJ: 6 TOP: Cyanosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 27. A patient developed a severe contact dermatitis of her hands, arms, and lower legs after spending an afternoon picking strawberries. She states that the itching is severe and she cannot keep from scratching. Which instruction by the nurse will be most helpful in managing the pruritus? a. Use cool, wet dressings and baths to promote vasoconstriction. b. Trim the fingernails short to prevent skin damage from scratching. c. Expose the areas to the sun to promote drying and healing of the lesions. d. Wear cotton gloves and cover all other affected areas with clothing to prevent environmental irritation. ANS: A Wet dressings and using Burrow’s solution help promote the healing process. Cold compresses may be applied to decrease circulation to the area (vasoconstriction). DIF: Cognitive Level: Comprehension REF: Page 79 OBJ: 7 TOP: Contact dermatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 28. A patient is a 32-year-old woman whose mother recently died from malignant melanoma. She asks the nurse about what she can do to prevent the development of malignant melanoma in herself and her children. The best response by the nurse includes which information regarding risk factors for melanoma? a. Avoid exposure to the sun and use protective measures when exposure occurs. b. Have all nevi removed. c. Watch for changes in moles, especially on the back. d. There is nothing that prevents malignant melanoma, but it is curable if detected early. ANS: A Encourage the patient to protect skin from the sun by wearing protective clothing including a hat with 4-inch brim, applying sunscreen all over the body, and avoiding the midday sun from 10 am to 4 pm. DIF: Cognitive Level: Application REF: Page 92, NCP 3-2 OBJ: 12 TOP: Melanoma KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance 29. In addition to medication management of systemic lupus erythematosus, which supportive therapy would help control the disease? a. Balanced diet and balance between rest and activity b. Increase in activity to promote mobility c. Exposure to the sun to increase vitamin D absorption d. Increased sodium consumption ANS: A Balanced rest, activity, and diet will support medication management. Limited sunlight exposure is recommended to prevent photosensitivity. SLE often has kidney involvement, which would require reduction of sodium. DIF: Cognitive Level: Analysis REF: Page 29 OBJ: 6 TOP: Systemic lupus erythematosus KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 30. Cellulitis is a potentially serious infection. In adults Staphylococcus aureus can cause which complications? a. Sepsis and meningitis b. Appendicitis and vasculitis c. Tinea pedis and tinea corporis d. Urticaria and psoriasis ANS: A Sepsis, meningitis, and lymphangitis are the most common complications of cellulitis for adults caused by Staphylococcus aureus bacteria. Tinea pedis/corporis are fungal infections. Urticaria and psoriasis are noninfectious skin disorders. DIF: Cognitive Level: Comprehension REF: Page 75 OBJ: 6 TOP: Bacterial disorders of the skin KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity 31. Nursing interventions for treatment of herpes virus infections are: a. Keep the lesions moist to prevent pain. b. Apply cold, moist compresses to lesions. c. Focus on treating symptoms and preventing spread of virus. d. Cleanse lesions with alcohol. ANS: C Rationale: Nursing interventions for treating herpes virus infections should focus on treating specific symptoms and preventing spreading of the disease. Lesions should be kept dry. Warm, moist compresses may be applied. DIF: Cognitive Level: Implementation REF: Pages 69, 76 OBJ: 5 TOP: Viral disorders of skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 32. Parasitic skin diseases are identified as pediculosis or scabies. The difference between pediculosis and scabies is a. pediculosis only occurs in poor living conditions. b. scabies only occurs when there is poor hygiene. c. scabies is caused by mites that burrow into the skin. d. lice is caused by mites that attach themselves to bare areas of the skin. ANS: C Scabies is caused by mites that penetrate the skin by burrowing. Pediculosis and scabies occur in any environment or in anyone using good personal hygiene. Lice attach themselves to the shaft of hair follicles. DIF: Cognitive Level: Comprehension REF: Page 89 OBJ: 6 TOP: Parasite disorders of the skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 33. Melanocytes give rise to the pigment melanin which is responsible for skin color. The melanocytes can be found in a. Dermis b. Superficial fascia c. Epidermis d. Loose connective tissue ANS: C A layer in the epidermis contains highly specialized cells called melanocytes. DIF: Cognitive Level: Comprehension REF: Page 60 OBJ: 2 TOP: Structure of the skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity COMPLETION 34. The three major glands of the skin are __________, ___________, and __________. ANS: sudoriferous (sweat), ceruminous, and sebaceous (oil). sudoriferous, ceruminous, sebaceous sweat, ceruminous, oil Sudoriferous glands—sweat glands open into pores on the skin surface and excrete sweat. Ceruminous glands—secrete a waxlike substance called cerumen and are located in the external ear canal. Sebaceous glands—secrete their substance, sebum (an oily secretion), through the hair follicles distributed on the body. DIF: Cognitive Level: Comprehension REF: Page 61 OBJ: 4 TOP: Glands of the skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 35. The most deadly skin cancer is ________________. ANS: melanoma Malignant melanoma is a cancerous neoplasm that invades the epidermis, dermis, and sometimes the subcutaneous tissue. DIF: Cognitive Level: Knowledge REF: Page 92 OBJ: 8 TOP: Tumors of the skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance 36. Place the steps in order for the medical treatment during the emergent phase of burn management from the list below. Place a comma between each answer choice (a, b, c, d, etc.). a. Transport victim to hospital. b. Cover victim with clean cloth or sheet. c. Stop, drop, and roll. d. Remove all now-adherent clothing and jewelry. e. Provide an open airway. f. Control any bleeding. ANS: C, E, F, D, B, A DIF: Cognitive Level: Analysis REF: Page 97 OBJ: 12 TOP: Burns KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 37. Major functions of the skin include: (Select all that apply.) a. excretion of wastes. b. protection. c. vitamin D synthesis. d. temperature regulation. e. prevention of dehydration. ANS: A, B, C, D, E Functions of the skin include protection from the environment (pathogenic organisms, foreign substances, natural barrier against infection), temperature regulation, prevention of dehydration, excretion of waste products, and vitamin D synthesis. DIF: Cognitive Level: Knowledge REF: Page 59, Box 3-1 OBJ: 2 TOP: Functions of the skin KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 38. During primary survey assessment of a burn patient, the nurse checks for early signs of carbon monoxide poisoning, which include: (Select all that apply.) a. dizziness. b. urticaria. c. vomiting. d. headache. e. vertigo. f. unsteady gait. ANS: C, D, F Early signs of carbon monoxide poisoning include headache, nausea, vomiting, and unsteady gait. DIF: Cognitive Level: Knowledge REF: Page 97 OBJ: 14 TOP: Carbon monoxide KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 39. A common diagnostic criterion for identifying systemic lupus erythematosus (SLE) is: (Select all that apply.) a. butterfly rash over nose and cheeks b. photosensitivity. c. severe abdominal pain. d. skin ulcers. e. polyarthralgias and polyarthritis. f. immobility. ANS: A, B, E Butterfly rash on face, sensitivity to sunlight, polyarthralgias and polyarthritis are some of the main criteria leading to the diagnosis of SLE. DIF: Cognitive Level: Knowledge REF: Pages 86-87, Box 3-2 OBJ: 6 TOP: Systemic lupus erythematosus KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 40. Nursing interventions and patient teaching for the treatment of head lice and scabies include: (Select all that apply.) a. clothing, linens, and bath articles thoroughly cleaned in hot water. b. stress nature and transmission of the disease. c. special carbohydrate diet to promote healing. d. complete isolation from the public. ANS: A, B Identify involved contacts while stressing importance of preventing transmission of disease. Washable and cloth items should be cleaned in hot water to prevent reinfection. No special diet is required. Isolation is not necessary once medical management is completed. DIF: Cognitive Level: Application REF: Pages 89-90 OBJ: 7 TOP: Parasitic diseases of the skin KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance MATCHING Match the pathophysiological stage of burns with the greatest concern. a. Freedom from wound infection b. Hypovolemia c. Circulatory overload 41. Stage 1 42. Stage 2 43. Stage 3 41. ANS: B DIF: Cognitive Level: Analysis REF: Page 94 OBJ: 12 TOP: Burns KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance 42. ANS: C DIF: Cognitive Level: Analysis REF: Pages 94, 95 OBJ: 12 TOP: Burns KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance 43. ANS: A DIF: Cognitive Level: Analysis REF: Page 95 OBJ: 12 TOP: Burns KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance Christensen: Adult Health Nursing, 6th Edition Chapter 06: Care of the Patient with a Gallbladder, Liver, Biliary Tract, or Exocrine Pancreatic Disorder Test Bank MULTIPLE CHOICE 1. Which abnormal lab value would be found in a patient with a pathological condition of the liver? a. Hemoglobin b. Alkaline phosphatase c. pH 5.0 d. Ca– 125 ANS: B Liver enzyme tests are AST, ALT, LDH, alkaline phosphatase, and gamma GT. DIF: Cognitive Level: Analysis REF: Pages 232, 244 OBJ: 2 TOP: Diagnostic procedures KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 2. The patient has cirrhosis of the liver and an albumin/globulin ratio of 0.9 g/dL. The normal ratio is 1.2 to 2.2 g/dL. In collecting objective data for her, the nurse would probably note which outstanding clinical sign? a. Jaundice b. Edema c. Pruritus d. Pallor ANS: B Low serum albumin levels result also from excessive loss of albumin into urine or into third-space volumes, causing ascites or edema. DIF: Cognitive Level: Analysis REF: Page 232 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 3. An essential nursing measure to prevent peritonitis after a paracentesis is a. thoroughly cleansing the skin of the abdominal wall. b. examining ascites for bacteria. c. providing oral or intravenous fluids. d. maintaining sterile technique during the procedure. ANS: C An incision is made in the skin, and a hollow trocar cannula, or catheter, is passed through the incision and into the cavity. Thoroughly cleansing the skin of the abdominal wall is done prior to the procedure. DIF: Cognitive Level: Application REF: Page 238 OBJ: 3 TOP: Paracentesis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 4. Because vitamin K is malabsorbed in the presence of cirrhosis, which laboratory value would be elevated? a. Hemoglobin b. Hematocrit c. Prothrombin time d. White blood cell count ANS: C The cirrhotic liver cannot absorb vitamin K or produce the clotting factors VII, IX, and X. This causes the patient with cirrhosis to have bleeding tendencies. Prothrombin time measures clotting time. DIF: Cognitive Level: Analysis REF: Pages 237, 241 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 5. A patient was scheduled for a laparoscopic cholecystectomy, but complications developed and he underwent an open cholecystectomy with a T-tube inserted into the common bile duct. The purpose of the T-tube is to a. decompress the duct and relieve pain caused by stimulation the sphincter of Oddi. b. improve diaphragmatic expansion and prevention of atelectasis. c. shorten postoperative recovery and hasten the healing process. d. keep the duct open and allow drainage of the bile until edema resolves. ANS: D If the stones are in the common bile duct and edema is present, a biliary drainage tube, or T-tube, will be inserted to keep the duct open and allow drainage of the bile until the edema resolves. DIF: Cognitive Level: Comprehension REF: Page 250, Figure 6-8 OBJ: 3 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 6. If the patient has a T-tube in place after a cholecystectomy, the best nursing intervention would be to a. open the T-tube to air so that it will drain freely. b. position and secure the drainage bag at the abdominal level. c. make certain that the tube is tightly taped to the patient near the nipple. d. irrigate the T-tube with normal saline to ensure the free flow of bile. ANS: B The nurse will be responsible for the care of the T-tube if one is placed. The drainage bag for the T-tube is placed below the level of the common bile duct to prevent the reflux of bile. The bag must be positioned so the tube is not kinked, or bile cannot drain from the liver. Normally T-tubes are not irrigated. DIF: Cognitive Level: Application REF: Pages 250-251, Figure 6-8 OBJ: 3 TOP: Cholecystectomy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 7. After the physician has performed a liver biopsy, the nursing interventions would usually include a. allowing the patient to get up to use the bathroom if he desires. b. keeping the patient on the right side for minimum of 2 hours. c. taking vital signs every 4 hours. d. keeping the patient on the left side for minimum of 4 hours. ANS: B Keep the patient lying on the right side for minimum of 2 hours to splint puncture site. It compresses the liver capsule against the chest wall to decrease the risk of hemorrhage or bile leak. DIF: Cognitive Level: Application REF: Page 234 OBJ: 2 TOP: Liver biopsy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 8. The patient, age 56, has cirrhosis of the liver with severe ascites. The nurse is assisting the physician in the procedure to remove this fluid from his abdominal cavity. This procedure is called an a. abdominal paracephalus. b. abdominal paracentesis. c. abdominal paradentium. d. abdominal perimetrium. ANS: B Paracentesis is a temporary method of removing fluid by withdrawing fluid from the abdominal cavity by either gravity or vacuum. DIF: Cognitive Level: Comprehension REF: Page 238 OBJ: 3 TOP: Ascites KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 9. The nurse realizes that the patient requires additional teaching about an esophagoscopy after the patient states a. “Right after the test, I want breakfast with black coffee.” b. “The instrument will be put down my throat.” c. “I haven’t had anything to eat or drink since 9 PM last night.” d. “My doctor said I could have medicine to relax me before the test.” ANS: A After the procedure, keep the patient NPO until the gag reflex returns. DIF: Cognitive Level: Analysis REF: Page 236 OBJ: 2 TOP: Diagnostic procedures KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 10. Patients with hepatitis A, B, C, D, or E typically are instructed to a. drink alcohol in moderation. b. participate in an exercise program. c. eat a diet low in carbohydrates and high in fat. d. take vitamin B, C, and K supplements. ANS: D If the patient is dehydrated, intravenous fluids will be given, with supplements of vitamin C for healing, vitamin B complex to assist with the damaged liver’s ability to absorb fat-soluble vitamins, and vitamin K to combat prolonged coagulation time. DIF: Cognitive Level: Application REF: Page 245 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 11. Which findings would the nurse expect in a patient with acute pancreatitis? a. Temperature greater than 102° F (40° C) b. Blood pressure (systolic) greater than 130 mm Hg c. Heart rate less than 60 beats per minute d. Abdominal pain that increases with lying down ANS: D This pain is usually decreased by flexing the trunk, by leaning forward from a sitting position, or by assuming the fetal position. It is increased by eating or lying down. Low-grade fever may be present. DIF: Cognitive Level: Analysis REF: Page 253 OBJ: 3 TOP: Pancreatitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 12. Flapping tremor (asterixis) is seen in a patient with a. Crohn’s disease. b. hepatic encephalopathy. c. cancer of the stomach. d. candidiasis. ANS: B Asterixis is a hand flapping tremor in which the patient stretches out an arm and hyperextends the wrist with the fingers separated, relaxed, and extended. This occurs in the patient with hepatic encephalopathy. DIF: Cognitive Level: Analysis REF: Page 240 OBJ: 3 TOP: Asterixis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 13. The patient’s cirrhosis of the liver has also caused a dilation of the veins of her lower esophagus secondary to vessel hypertension, resulting in her developing the complications of: a. Varices b. Diverticulosis c. Crohn’s disease d. Achalasia cyst ANS: A Esophageal varices (a complex of longitudinal, tortuous veins at the lower end of the esophagus) enlarge and become edematous as the result of portal hypertension. DIF: Cognitive Level: Analysis REF: Page 238 OBJ: 3 TOP: Cirrhosis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 14. As a result of cirrhosis of the liver, the patient’s condition deteriorates and he slips into a hepatic coma. The nurse would anticipate increasing levels of: a. Amylase b. Ammonia c. Thrombocytes d. Bilirubin ANS: B Hepatic encephalopathy is a type of brain damage caused by liver disease and consequent ammonia intoxication. Ammonia is the breakdown product of protein. DIF: Cognitive Level: Analysis REF: Page 240 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 15. When a patient has hepatic encephalopathy, medications often administered to relieve toxic blood chemistry include: a. vasopressin, Capoten. b. milk of magnesia, Metamucil. c. neomycin, lactulose. d. HydroDIURIL. ANS: C The buildup of ammonia can be prevented with the use of lactulose (Chronulac) and neomycin. Preventing the buildup of ammonia will prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestine. DIF: Cognitive Level: Application REF: Page 240, Table 6-1 OBJ: 3 TOP: Encephalopathy KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 16. The new operative procedure gaining in popularity for the removal of the gallbladder, if there is no cholecystitis or choledocholithiasis, is a(n) a. laparoscopic cholecystectomy. b. cholangiography. c. open cholecystectomy. d. choledochostomy. ANS: A The most recently developed operative procedure, which is now the most common treatment for cholecystitis and cholelithiasis, is done by way of endoscopy. It is called laparoscopic cholecystectomy and uses laser cautery to remove the gallbladder. DIF: Cognitive Level: Knowledge REF: Page 250 OBJ: 8 TOP: Laparoscopic cholecystectomy KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 17. In preparation for a cholecystography, the nurse asks if the patient has eaten since midnight. This is done to determine a. if the patient is hungry. b. drug allergies. c. the accuracy of the test. d. fat intake tolerance. ANS: C The following factors are necessary for adequate dye concentration: ingestion of the correct number of dye tablets, adequate absorption of the dye, abstinence from food the morning of the exam, uptake for the portal system and excretion of the dye by the liver, patency of the cystic duct, and concentration of the dye within the gallbladder. DIF: Cognitive Level: Application REF: Page 232 OBJ: 2 TOP: Diagnostic procedures KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 18. The nurse assesses a patient with cholecystitis. Which pain description is typical of biliary colic? a. Substernal, radiating to the left shoulder and arm b. Epigastric, radiating to the back c. Right upper abdomen, radiating to the back or right shoulder d. Left upper abdomen, radiating to the jaw and neck ANS: C It localizes in the right upper quadrant epigastric region. The pain radiates around the mid torso to the right scapular area. DIF: Cognitive Level: Analysis REF: Page 249 OBJ: 3 TOP: Cholecystitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 19. The nurse can prevent the transmission of hepatitis A by avoiding a. direct contact through fecal matter, contaminated food, or contaminated water. b. contaminated blood transfusion. c. sexual contact and contaminated needles. d. droplet inhalation. ANS: A Hepatitis A virus is transmitted when a person puts something in his or her mouth that is contaminated with fecal material (called fecal-oral transmission). Teach patients the importance of good hand washing after the bathroom or changing a diaper, as well as proper food preparation, to prevent the spread of HAV. DIF: Cognitive Level: Application REF: Page 243, Box 6-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Safe, Effective Care Environment 20. Infection control is necessary in all areas of the health care setting. Which would be most appropriate in the prevention of hepatitis B in high-risk health workers? a. Hepatitis B vaccine b. Maintaining enteric isolation technique c. Wearing protective gear d. HBIG injections ANS: A People identified as being at high risk for developing hepatitis B should be vaccinated if they are not already immune. These people include health care personnel. DIF: Cognitive Level: Knowledge REF: Pages 243-244, Safety Alert! OBJ: 5 TOP: Hepatitis B KEY: Nursing Process Step: Planning MSC: NCLEX: Safe, Effective Care Environment 21. The major focus of nursing intervention for the patient with pancreatitis is a. fluid replacement. b. electrolyte imbalance. c. establishing suction. d. controlling pain. ANS: D The presence and location of pain are important to determine, as well as what aggravates or relieves the pain. Nursing Intervention: Administer medications as prescribed and monitor relief. DIF: Cognitive Level: Analysis REF: Page 254 OBJ: 3 TOP: Pancreatitis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 22. A patient states that he returned from a 2-week camping trip a few days ago. He complains of nausea and anorexia and dark urine. What additional information would assist in diagnosing hepatitis A? a. Exposure to blood b. Recent ingestion of raw fish c. History of intravenous drug use d. Multiple sex partners ANS: B Hepatitis A spreads by direct contact through the oral-fecal route, usually by food and water contaminated with feces. DIF: Cognitive Level: Analysis REF: Page 243, Box 6-1 OBJ: 5 TOP: Hepatitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 23. What instructions should the patient receive before undergoing a paracentesis? a. NPO 12 hours before procedure b. Empty bladder before procedure c. Strict bed rest after procedure d. Empty bowel before procedure ANS: B When paracentesis is done, the nurse must have the patient void immediately before the procedure to prevent puncture of the bladder. DIF: Cognitive Level: Comprehension REF: Page 238 OBJ: 8 TOP: Cirrhosis KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 24. Carefully monitoring the patient for signs that may indicate the development of pancreatitis (abdominal pain, nausea, and vomiting) is essential after a(n) a. colonoscopy. b. endoscopic retrograde cholangiopancreatography (ERCP). c. upper GI series. d. Schilling test. ANS: B Assess for signs and symptoms of pancreatitis, which is the most common ERCP complication. These signs and symptoms include increasingly intense abdominal pain, nausea, vomiting, and diminished or absent bowel sounds. DIF: Cognitive Level: Analysis REF: Page 236 OBJ: 2 TOP: Diagnostic procedures KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 25. A patient has been admitted with right upper quadrant pain. Which would most likely be a source of her pain? a. Spleen b. Ovaries c. Gallbladder d. Pancreas ANS: C The pain of acute cholecystitis (inflammation of the gallbladder) is abrupt and localizes in the right upper quadrant epigastric region. DIF: Cognitive Level: Comprehension REF: Page 249 OBJ: 3 TOP: Biliary tract disorders KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 26. A family member of a patient asks the nurse about the protein-restricted diet ordered because of advanced liver disease with hepatic encephalopathy. What statement by the nurse would best explain the purpose of the diet? a. “The liver cannot rid the body of ammonia that is made by the breakdown of protein in the digestive system.” b. “The liver heals better with a high-carbohydrate diet rather than with a diet high in protein.” c. “Most people have too much protein in their diets. The amount in this diet is better for liver healing.” d. “Because of portal hypertension, the blood flows around the liver, and ammonia made from protein collects in the brain, causing hallucinations.” ANS: A The patient with hepatic encephalopathy is on a very low-protein to no-protein diet. The goal of management of hepatic encephalopathy is the reduction of ammonia formation in the intestines. DIF: Cognitive Level: Analysis REF: Pages 240-241, Nursing Diagnoses box OBJ: 8 TOP: Cirrhosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 27. Which would be a major nursing concern to monitor postoperatively in a patient who has had a liver transplant? a. Drainage b. Serum electrolytes c. Infection d. Urinary retention ANS: C A critical aspect of nursing care following liver transplantation is monitoring for infection. DIF: Cognitive Level: Analysis REF: Pages 245-246 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 28. Which medication would the nurse expect the physician to order postoperatively for a patient who has had a liver transplant? a. Phenergan b. Zofran c. Aspirin d. Cyclosporine ANS: D Cyclosporine is an effective immunosuppressant drug. The use of cyclosporine has been a major factor in the success rates of liver transplantation. It does not cause bone marrow suppression and does not impede wound healing. DIF: Cognitive Level: Application REF: Page 248, Nursing Diagnoses box OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 29. A nursing diagnosis of: Knowledge, deficient, related to relationship of infection to nutritional needs is critical because: a. The body requires more protein intake to fight infection. b. The body does not absorb nutrients effectively postoperatively. c. The body does not require more calories postoperatively. d. The body requires more parenteral nutrients postoperatively. ANS: A In addition to the relationship of infection and nutrition, the nurse may need to teach preoperative and postoperative procedures if the patient requires percutaneous or open surgical drainage. DIF: Cognitive Level: Application REF: Page 231 OBJ: 7 TOP: Nursing diagnosis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 30. Which serum test would a physician order if jaundice was suspected? a. Cardiac enzymes b. Liver enzymes c. Total bilirubin d. Complete blood count ANS: C Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin. This yellow discoloration is recognized when the total serum bilirubin exceeds 2.5 mg/dL. DIF: Cognitive Level: Knowledge REF: Page 253 OBJ: 4 TOP: Jaundice KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 31. Which factors are most commonly associated with pancreatitis? a. Coronary artery disease b. Alcoholism and biliary tract disease c. Cirrhosis d. History of myocardial infarction ANS: B Alcoholism and biliary tract disease are the two factors most commonly associated with pancreatitis. DIF: Cognitive Level: Knowledge REF: Page 254 OBJ: 3 TOP: Pancreatitis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 32. A patient with pancreatitis is NPO. The patient asks the nurse why he is unable to have anything by mouth. The best response would be a. “The reason you are unable to have anything by mouth is because the physician must examine you.” b. “The pancreas is stimulated whenever you eat or drink and may aggravate your condition.” c. “The pancreas is to be removed surgically. This is the reason you are unable to eat or drink.” d. “The reason you are unable to have anything by mouth is because of diagnostic exams the physician might order.” ANS: B Food and fluids are withheld to avoid stimulating pancreatic activity, and IV fluids are administered. DIF: Cognitive Level: Analysis REF: Page 254 OBJ: 3 TOP: Pancreatitis KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity 33. The nurse explains that morphine contraindicated in the patient with pancreatitis because: a. Demerol (meperidine) is less expensive. b. Tylenol is more effective at managing this type of pain. c. Morphine may cause spasms of the sphincter of Oddi. d. These patients do not experience pain. ANS: C A common complaint is constant, severe pain; in such cases, meperidine (Demerol) PCA is often administered. Morphine may cause spasms of the sphincter of Oddi. DIF: Cognitive Level: Knowledge REF: Page 254 OBJ: 3 TOP: Pancreatitis KEY: Nursing Process Step: Intervention MSC: NCLEX: Physiological Integrity 34. Which factors may increase a patient’s risk of developing cancer of the pancreas? a. Diet high in carbohydrates and dairy products b. Cardiovascular disease and glaucoma c. Tea and cola consumption d. Cigarette smokers and people with diabetes mellitus ANS: D The cause of cancer of the pancreas is unknown, but it is diagnosed more often in cigarette smokers, people exposed to chemical carcinogens, and people with diabetes mellitus and pancreatitis. DIF: Cognitive Level: Knowledge REF: Page 256 OBJ: 3 TOP: Cancer of the pancreas KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 35. Which assessment would indicate possible gallbladder disease in an older adult? a. Dull pain in the right upper quadrant region b. Changes in color of urine or stool c. Distention of veins in upper part of body d. Aching muscles and tenderness in the liver ANS: B The incidence of cholelithiasis increases with aging. Assess older adults for history of changes in stool or urine color. Cirrhosis of the liver may cause distention in veins in upper part of body. DIF: Cognitive Level: Knowledge REF: Page 256 OBJ: 1 TOP: Cancer of the pancreas KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 36. In preparing the patient for a paracentesis, the nurse must be sure a. the patient is NPO for 12 hours before the procedure. b. the patient is lying flat in bed for the procedure. c. the fluid is removed over at least 30 minutes. d. oral liquids and a light meal are given the evening after the procedure. ANS: C The fluid removed during a paracentesis is removed over a period of 30 to 90 minutes to prevent sudden changes in blood pressure leading to syncope. The bed should be in a high Fowler’s position. Food and fluid restriction is usually not necessary. DIF: Cognitive Level: Analysis REF: Page 238 OBJ: 3 TOP: Cancer of the pancreas KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity 37. A patient with a T-tube for an open cholecystectomy has resumed oral intake. The T-tube is clamped 2 hours before meals and unclamped 2 hours after meals to aid in the digestion of fat. During the time the tube is clamped the patient complains of abdominal pain and nausea. The best intervention would be to a. notify the physician. b. unclamp the tube immediately. c. increase the IV fluids. d. change the T-tube dressing. ANS: B While the tube is clamped, the patient may show signs of abdominal pain, nausea, vomiting, etc. Unclamp the tube immediately allow for drainage and relief of both nausea and pain. DIF: Cognitive Level: Analysis REF: Page 252 OBJ: 2 TOP: Cancer of the pancreas KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity MULTIPLE RESPONSE 38. What are the indications for a liver transplant? (Select all that apply.) a. Congenital biliary abnormalities b. Hepatic malignancy c. Chronic hepatitis d. Cirrhosis due to alcoholism e. Gallbladder disease ANS: A, B, C Indications for liver transplantation include congenital biliary abnormalities, inborn errors of metabolism, hepatic malignancy (confined to the liver), sclerosing cholangitis, and chronic end-stage liver disease. DIF: Cognitive Level: Comprehension REF: Page 245 OBJ: 7 TOP: Liver transplant KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 39. Esophageal varices can rupture as a result of increases in abdominal venous pressure. Which would increase the abdominal venous pressure? (Select all that apply.) a. Coughing b. Swallowing c. Vomiting d. Performing the Valsalva maneuver ANS: A, C, D Coughing, vomiting and performing the Valsalva maneuver will increase abdominal venous pressure. DIF: Cognitive Level: Comprehension REF: Pages 238-239 OBJ: 7 TOP: Esophageal varices KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 40. Dietary teaching for a patient who is treated conservatively for cholecystitis is necessary to keep the patient comfortable. Which foods should be avoided? (Select all that apply.) a. Peanut butter b. Grilled chicken c. Rice and pasta d. Bananas, apples, oranges e. Whole milk f. Glazed chocolate doughnuts ANS: A, E, F Peanut butter, nuts, chocolate, whole milk, fried foods, and cream and other fatty foods should be avoided. DIF: Cognitive Level: Comprehension REF: Page 252 OBJ: 1 TOP: Cholecystitis and cholelithiasis KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity 41. Viral hepatitis may be treated at home. Teach the patient’s family: (Select all that apply.) a. Clothes should be laundered separately with hot water. b. Personal items and drinking glasses should not be shared. c. Articles soiled with feces do not require extra care. d. Hands need to be thoroughly washed after toileting. e. Contaminated items may be disposed of with regular trash. ANS: A, B, D For the patient with viral hepatitis being cared for in the home, the family needs to be taught necessary precautions. Clothes should be laundered separately with hot water. Personal items used by the patient should not be shared. Articles soiled with feces must be disinfected. Any contaminated items should be disposed of properly. DIF: Cognitive Level: Implementation REF: Page 247 OBJ: 6 TOP: Hepatitis KEY: Nursing Process Step: Analysis MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control COMPLETION 42. ___________ is a condition characterized by yellowing of the sclera and the skin. ANS: Jaundice Jaundice is the discoloration of body tissues caused by abnormally high blood levels of bilirubin. DIF: Cognitive Level: Knowledge REF: Pages 237, 241 OBJ: 4 TOP: Jaundice KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity