A married client with chronic hepatitis C is experiencing nausea, anorexia, and fatigue. During the health history, the client states, "I drink one to two glasses of wine with dinner, and I take St. John's wort for depression." The client admits to taking acetaminophen for frequent headaches. What should the nurse do? Select all that apply.

Instruct the client to increase the protein in his diet and eat less frequently.

Instruct the client that the wine with meals can be beneficial for cardiovascular health

Advise the client to avoid sexual intercourse until hepatitis antibody testing is negative.

Instruct the client to ask the healthcare provider about taking any medications as they may interact with medications the client is currently taking

Encourage the client to obtain sufficient rest.

Answer and Explanation

Correct Answer : D,E

Rationale:

A. This is incorrect because clients with chronic hepatitis C may have impaired liver function. High-protein diets are generally safe unless there is advanced liver disease with hepatic encephalopathy. “Eating less frequently” could worsen anorexia and malnutrition; therefore, individualized dietary guidance from a provider or dietitian is preferred.

B. This is incorrect and unsafe. Alcohol, even in small amounts, is hepatotoxic and can worsen liver inflammation in hepatitis C. The client should be counseled to avoid alcohol entirely.

C. Hepatitis C is transmitted primarily through blood, not casual sexual contact, and antibody testing is not a criterion for resuming sexual activity. Standard precautions and discussion about safe practices may be included, but abstaining until antibody testing is negative is unnecessary.

D. The client is using St. John’s wort and acetaminophen, both of which can interact with other medications or worsen liver function. The nurse should advise consulting the healthcare provider before starting any new medications, including over-the-counter or herbal supplements.

E. Fatigue is a common symptom of chronic hepatitis C. Encouraging adequate rest helps the client conserve energy and promotes overall well-being while managing the illness.

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Correct Answer is D

Explanation

Rationale:

A. This is incorrect because it usually occurs in clients with spinal cord injuries at T6 or above and is triggered by noxious stimuli such as bladder distention or constipation. Its hallmark is sudden, severe hypertension, pounding headache, flushed skin above the lesion, and bradycardia. Since the client in this scenario has hypotension, autonomic dysreflexia is unlikely.

B. This is incorrect because it results from significant blood loss, leading to decreased circulating volume. The body typically compensates with tachycardia and vasoconstriction. The client’s bradycardia is inconsistent with the typical compensatory response to hemorrhagic shock.

C. This is incorrect because it usually presents with sudden shortness of breath, chest pain, tachycardia, hypotension, and hypoxia. While hypotension may occur, bradycardia is uncommon. The client’s low blood pressure with bradycardia and normal respiratory rate points toward a different cause.

D. Neurogenic shock is a type of distributive shock that occurs after a spinal cord injury above T6, including C8, due to loss of sympathetic nervous system control. This causes vasodilation, leading to hypotension, and unopposed parasympathetic activity, causing bradycardia. The client may also have warm, dry skin and relative hypothermia due to impaired thermoregulation, while the respiratory rate may remain normal if the diaphragm is unaffected.

A. Biliary stone disease B. Alcohol abuse C. Cirrhosis D. Hypertriglyceridemia

Correct Answer is A

Explanation

Rationale:

A. Elevated alanine aminotransferase (ALT) above 150 units/L in the context of acute pancreatitis strongly suggests biliary obstruction from gallstones as the cause. ALT is a liver-specific enzyme, and significant elevations often indicate hepatocellular injury due to gallstone migration or blockage of the common bile duct, which can precipitate pancreatitis. This pattern—elevated amylase, lipase, and ALT—is characteristic of biliary pancreatitis.

B. Alcohol-induced pancreatitis usually presents with markedly elevated amylase and lipase, but ALT is typically normal or only mildly elevated. While alcohol is a common cause of pancreatitis, the lab pattern in this client points more toward a biliary etiology.

C. Cirrhosis may cause chronic liver enzyme elevations, but it is not a common direct cause of acute pancreatitis. Acute elevations of pancreatic enzymes (amylase and lipase) are not explained by cirrhosis alone.

D. This can cause pancreatitis, typically when triglyceride levels exceed 1000 mg/dL. Liver enzymes may not be significantly elevated in hypertriglyceridemia-induced pancreatitis. The presence of markedly elevated ALT suggests biliary obstruction rather than a metabolic cause.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While in the emergency department, a client with C8 quadriplegia develops a blood pressure of 80/44 mmHg, pulse of 48 beats per minute, and respiratory rate of 18 breaths per minute. Which condition should the nurse suspect?

Correct Answer is D

Explanation

The nurse assesses a client who presents to the emergency department with acute abdominal pain, an elevated amylase, lipase, and alanine aminotransferase level of 180 units/L. The client is diagnosed with acute pancreatitis. Which cause of pancreatitis should the nurse suspect?

Correct Answer is A

Explanation

A nurse is caring for a client who has cirrhosis of the liver. Which of the following assessment findings require immediate follow-up? Select all that apply.

A student nurse is completing an internship in the emergency department. The student asks the preceptor. "How is emergency department nursing different from other areas of nursing practice? How should the experienced emergency department nurse respond? Select all that apply.

The nurse prepares to administer a dopamine infusion at 4 mcg/kg/min for a client weighing 165 pounds. The nurse has a dopamine solution with a concentration of 400 mg in 250 mL of 5% dextrose. The nurse should set the IV pump to how many millimeters per hour? Round to the nearest tenth.

There has been a car accident involving four vehicles on a remote highway. The nearest emergency department is 15 minutes away. Which victim should be transported by helicopter rather than an ambulance to the nearest hospital?

The nurse changes the subclavian dressing of a client receiving total parenteral nutrition and notes the presence of yellow drainage around the sutures anchoring the catheter. What should the nurse do first?

A nurse is assisting with field triage following a motor-vehicle crash involving a bus with multiple victims. The nurse assesses a child who has an open fracture of the femur. Which action should the nurse take?

A nurse assesses a client who is a possible candidate for a liver transplant for contraindications of a liver transplant. Which findings should the nurse report to the provider? Select all that apply.

The nurse assesses a client with a pleural chest tube inserted to treat a pneumothorax. Which findings require immediate notification to the provider? Select all that apply.