MSN Exam for Hepatitis

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1) Tony has diagnosed with hepatitis A. The information from the health history that is most likely linked to hepatitis A is:

  1. Exposed with arsenic compounds at work
  2. Working as local plumber
  3. Working at hemodialysis clinic
  4. Dish washer in restaurants

2) Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward signs and symptoms related to Hepatitis that may develop. The one that should be reported immediately to the physician is:

  1. Restlessness
  2. Yellow urine
  3. Nausea
  4. Clay- colored stools

3) A female client with hepatitis C develops liver failure and GI hemorrhage. The blood products that would most likely bring about hemostasis in the client are:

  1. whole blood and albumin.
  2. platelets and packed red blood cells.
  3. fresh frozen plasma and whole blood.
  4. cryoprecipitate and fresh frozen plasma.

4) Which of the following factors can cause hepatitis A?

  1. Contact with infected blood
  2. Blood transfusions with infected blood
  3. Eating contaminated shellfish
  4. Sexual contact with an infected person

5) A client is suspected of having hepatitis. Which diagnostic test result will assist in confirming this diagnosis?

  1. Elevated hemoglobin level
  2. Elevated serum bilirubin level
  3. Elevated blood urea nitrogen level
  4. Decreased erythrocycle sedimentation rate

6) In the United States, nurses performing invasive procedures need to be up-to-date with their immunizations, particularly

  1. hepatitis B.
  2. hepatitis E.
  3. hepatitis A.
  4. hepatitis C.

7) Which of the following Vitamins is not stored in the Liver?

  1. Vitamin A
  2. Vitamin B
  3. Vitamin C
  4. Vitamin D

8) Tiffany Black is diagnosed with type A hepatitis. What special precautions should the nurse take when caring for this patient?

  1. Put on a mask and gown before entering the patient’s room.
  2. Wear gloves and a gown when removing the patient’s bedpan.
  3. Prevent the droplet spread of the organism.
  4. Use caution when bringing food to the patient.

9) Which of the following symptoms during the icteric phase of viral hepatitis should the nurse expect the client to inhibit?

  1. Watery stool
  2. Yellow sclera
  3. Tarry stool
  4. Shortness of breath

10) A female client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

  1. place the client in a private room.
  2. wear a mask when handling the client’s bedpan.
  3. wash the hands after touching the client.
  4. wear a gown when providing personal care for the client.

11) Which of the following is not a specific element of Hepatitis C?

  1. Vaccine available
  2. May be transmitted with sexual contact
  3. Inflammation of the liver
  4. Lifetime carrier

12) Van Fajardo is a 55 year old who was admitted to the hospital with newly diagnosed hepatitis. The nurse is doing a patient teaching with Mr. Fajardo. What kind of role does the nurse assume?

  1. talker
  2. teacher
  3. thinker
  4. doer

13) An infant is brought to the health care clinic for three immunizations at the same time. The nurse knows that hepatitis B, DPT, and Haemophilus influenzae type B immunizations should:

  1. Be drawn in the same syringe and given in one injection.
  2. Be mixed and inject in the same sites.
  3. Not be mixed and the nurse must give three injections in three sites.
  4. Be mixed and the nurse must give the injection in three sites.

14) A female client who has just been diagnosed with hepatitis A asks, “How could I have gotten this disease?” What is the nurse’s best response?

  1. “You may have eaten contaminated restaurant food.”
  2. “You could have gotten it by using I.V. drugs.”
  3. “You must have received an infected blood transfusion.”
  4. “You probably got it by engaging in unprotected sex.”

15) A client is hospitalized with hepatitis A. Which of the client’s regular medications is contraindicated due to the current illness?

  1. Prilosec (omeprazole)
  2. Synthroid (levothyroxine)
  3. Premarin (conjugated estrogens)
  4. Lipitor (atorvastatin)

16) A mother brought her child in the health center for hepatitis B vaccination in a series. The mother informs the nurse that the child missed an appointment last month to have the third hepatitis B vaccination. Which of the following statements is the appropriate nursing response to the mother?

  1. “I will examine the child for symptoms of hepatitis B”
  2. “Your child will start the series again”
  3. “Your child will get the next dose as soon as possible”
  4. “Your child will have a hepatitis titer done to determine if immunization has taken place.”

17) A male client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

  1. severe abdominal pain radiating to the shoulder.
  2. anorexia, nausea, and vomiting.
  3. eructation and constipation.
  4. abdominal ascites.

18) For prevention of hepatitis A, you decided to conduct health education activities. Which of the following is IRRELEVANT?

  1. Use of sterile syringes and needles
  2. Safe food preparation and food handling by vendors
  3. Proper disposal of human excreta and personal hygiene
  4. Immediate reporting of water pipe leaks and illegal water connections

19) Dr. Smith has determined that the client with hepatitis has contracted the infection form contaminated food. The nurse understands that this client is most likely experiencing what type of hepatitis?

  1. Hepatitis A
  2. Hepatitis B
  3. Hepatitis C
  4. Hepatitis D

20) In caring for a client with acute viral hepatitis, which task should be delegated to the nursing assistant?

  1. Empty the bedpan while wearing gloves.
  2. Suggest diversional activities.
  3. Monitor dietary preferences.
  4. Reports signs and symptoms of jaundice.

21) A patient with chronic hepatitis C has been receiving interferon alfa-2a (Roferon-A) injections for the last month. Which information gathered during a visit in the home to conduct an interview and physical assessment is most important to communicate to the physician?

  1. The patient has chronic nausea and vomiting
  2. The patient is giving the medication by the IM route to her lateral thigh.
  3. The patient has a temperature of 99.7o F orally.
  4. The patient complains of chronic fatigue, muscle aches, and anorexia.

22) You obtain these assessment data while completing as admission for a patient with a history of a liver transplant who is receiving cyclosporine (Sandimmune), prednisone (Deltasone), and mycophenolate (CellCept) to suppress immune function. Which one will be of most concern?

  1. The patient’s gums appear very pink and swollen.
  2. The patient’s blood glucose is increased to 162 mg/dL
  3. The patient has a non-tender swelling above the clavicle.
  4. The patient has 1+ pitting edema in the feet and ankles.
Answers and Rationales
  1. B. Working as local plumber . Hepatitis A is primarily spread via fecal-oral route. Sewage polluted water may harbor the virus.
  2. D. Clay- colored stools . Clay colored stools are indicative of hepatic obstruction
  3. D. cryoprecipitate and fresh frozen plasma. The liver is vital in the synthesis of clotting factors, so when it’s diseased or dysfunctional, as in hepatitis C, bleeding occurs. Treatment consists of administering blood products that aid clotting. These include fresh frozen plasma containing fibrinogen and cryoprecipitate, which have most of the clotting factors. Although administering whole blood, albumin, and packed cells will contribute to hemostasis, those products aren’t specifically used to treat hemostasis. Platelets are helpful, but the best answer is cryoprecipitate and fresh frozen plasma.
  4. C. Eating contaminated shellfish. Hepatitis A can be caused by consuming contaminated water, milk, or food — especially shellfish from contaminated water. Hepatitis B is caused by blood and sexual contact with an infected person. Hepatitis C is usually caused by contact with infected blood, including receiving blood transfusions.
  5. B. Elevated serum bilirubin level . Laboratory indicators of hepatitis include elevated liver enzyme levels, elevated serum bilirubin levels, elevated erythrocyte sedimentation rates, and leukopenia. An elevated blood urea nitrogen level may indicate renal dysfunction. A hemoglobin level is unrelated to this diagnosis.
  6. A. hepatitis B. Hepatitis B is transmitted through contact with infected blood or plasma.
  7. C. Vitamin C
  8. B. Wear gloves and a gown when removing the patient’s bedpan.The nurse should wear gloves and a gown when removing the patient’s bedpan because the type A hepatitis virus occurs in stools. It may also occur in blood, nasotracheal secretions, and urine. Type A hepatitis isn’t transmitted through the air by way of droplets. Special precautions aren’t needed when feeding the patient, but disposable utensils should be used.
  9. B. Yellow sclera . Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy.
  10. C. wash the hands after touching the client. To maintain enteric precautions, the nurse must wash the hands after touching the client or potentially contaminated articles and before caring for another client. A private room is warranted only if the client has poor hygiene — for instance, if the client is unlikely to wash the hands after touching infective material or is likely to share contaminated articles with other clients. For enteric precautions, the nurse need not wear a mask and must wear a gown only if soiling from fecal matter is likely.
  11. A. Vaccine available 
  12. B. teacher . The nurse will assume the role of a teacher in this therapeutic relationship. The other roles are inappropriate in this situation.
  13. C. Not be mixed and the nurse must give three injections in three sites. Immunization should never be mixed together in a syringe, thus necessitating three separate injections in three sites. Note: some manufacturers make a premixed combination of immunization that is safe and effective.
  14. A. “You may have eaten contaminated restaurant food.” Hepatitis A virus typically is transmitted by the oral-fecal route — commonly by consuming food contaminated by infected food handlers. The virus isn’t transmitted by the I.V. route, blood transfusions, or unprotected sex. Hepatitis B can be transmitted by I.V. drug use or blood transfusion. Hepatitis C can be transmitted by unprotected sex.
  15. D. Lipitor (atorvastatin) . Lipid-lowering agents are contraindicated in the client with active liver disease. Answers A, B, and C are incorrect because they are not contraindicated in the client with active liver disease.
  16. C. “Your child will get the next dose as soon as possible”  Continuity is essential to promote active immunity and give hepatitis B lifelong prophylaxis. Optimally, the third vaccination is given 6 months after the first.
  17. B. anorexia, nausea, and vomiting. Hallmark signs and symptoms of hepatitis A include anorexia, nausea, vomiting, fatigue, and weakness. Abdominal pain may occur but doesn’t radiate to the shoulder. Eructation and constipation are common in gallbladder disease, not hepatitis A. Abdominal ascites is a sign of advanced hepatic disease, not an early sign of hepatitis A.
  18. A. Use of sterile syringes and needles. Hepatitis A is transmitted through the fecal oral route. Hepatitis B is transmitted through infected body secretions like blood and semen.
  19. A. Hepatitis A . Hepatitis A is transmitted by the fecal-oral route via contaminated food or infected food handlers. Hepatitis B, C, and D are transmitted most commonly via infected blood or body fluids.
  20. A. Empty the bedpan while wearing gloves. The nursing assistant should use infection control precautions for the protection of self, employees, and other clients. Planning and monitoring are RN responsibilities. While the nursing assistants can report valuable information, they should not be responsible for signs and symptoms that can be subtle or hard to detect, such as skin changes. Focus: Delegation
  21. A. The patient has chronic nausea and vomiting . Nausea and vomiting are common adverse effects of interferon alfa-2a, but continued vomiting should be reported to the physician because dehydration may occur. The medication may be given by either the subcutaneous or intramuscular route. Flu-like symptoms such as a mild temperature elevation, headache, muscle aches, and anorexia are common after initiating therapy but tend to decrease over time.
  22. C. The patient has a non-tender swelling above the clavicle. Patients taking immunosuppressive medications are at increased risk for development of cancer. A non-tender swelling or lump may indicate the patient has lymphoma. The other data indicate that the patient is experiencing common side effects of the immunosuppressive medications.

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