Which information obtained by the nurse in the clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

Choice A reason:
Monitoring for signs of dehydration is essential because Mr. Carter's symptoms (fatigue, nausea, and jaundice) and laboratory results indicate acute hepatitis A, which can cause significant fluid loss due to nausea and reduced oral intake. Assessing hydration status ensures timely intervention to prevent complications such as hypovolemia. Additionally, high bilirubin levels and elevated liver enzymes suggest hepatic dysfunction, which may impair the body's ability to maintain fluid balance.
Choice B reason:
Educating Mr. Carter on proper hand hygiene is crucial to prevent the transmission of hepatitis A, which is highly contagious and spreads via the fecal-oral route. Since Mr. Carter has recently traveled to an area with poor sanitation, providing education on hygiene practices is an immediate priority to protect others. Proper handwashing with soap and clean water significantly reduces the risk of spreading the infection.
Choice C reason:
Encouraging a high-protein diet to repair liver damage is not appropriate during the acute phase of hepatitis A. Protein metabolism requires significant liver function, which is impaired in Mr. Carter’s case due to elevated ALT and AST levels. Emphasizing adequate hydration and balanced nutrition (without overloading the liver with protein) is more suitable. Dietary recommendations for hepatitis A focus on small, frequent meals and avoiding foods that burden liver function.
Choice D reason:
Administering intravenous antibiotics is unnecessary because hepatitis A is a viral infection, not bacterial. Antibiotics do not address viral infections and would not benefit Mr. Carter’s recovery. Supportive care, including hydration, rest, and symptom management, is the mainstay of treatment for viral hepatitis A.
Choice E reason:
Advising rest and limiting physical activity is vital to support Mr. Carter’s recovery. Fatigue and jaundice indicate that his liver is under significant strain, and rest helps reduce metabolic demands on the liver, allowing it to heal more effectively. Light activity may be reintroduced as symptoms improve, but physical exertion should be avoided during the acute phase.
Choice F reason:
Educating the patient about the need for lifelong hepatitis A vaccination is unnecessary because recovery from hepatitis A usually provides lifelong immunity. Vaccination is more relevant for individuals who are at risk and have not been exposed to the virus. Mr. Carter’s current care plan should focus on managing the acute phase of the disease and preventing transmission to others.

Choice A reason: Cardiac dysrhythmias are not the primary concern in a patient with acute cholecystitis. Although severe pain can lead to stress on the cardiovascular system, it is not the main priority in this scenario. Hypotension can be a concern due to dehydration from vomiting, but pain management is addressed more comprehensively under fluid and electrolyte balance and infection control.
Choice B reason: Wound dehiscence is not relevant in this case as the patient has not undergone surgery yet. Fluid and electrolyte imbalance and hypotension are important considerations due to the patient’s nausea and vomiting, but wound dehiscence does not apply to her current state of care.
Choice C reason: The inadequate diet is a consideration due to the patient's inability to eat or drink, and hypotension is a risk due to dehydration. However, wound dehiscence is still not relevant since the patient has not had a surgical procedure yet. Preventing an inadequate diet is part of the broader management but not the immediate priority.
Choice D reason: Infection, fluid and electrolyte imbalance, and pain are the most relevant concerns for a patient with acute cholecystitis. The nasogastric tube and IV fluids are vital for managing her dehydration and electrolyte imbalances. The patient's high pain level (9/10) indicates severe discomfort that must be managed effectively. Additionally, with the insertion of a nasogastric tube and the risk of cholecystitis-related complications, preventing infection is a key priority.