A nurse is assisting with the plan of care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan?

Provide periods of rest.

Encourage eating three large meals daily.

Provide a low calorie diet.

Administer acetaminophen for pain.

Answer and Explanation

The Correct Answer is A

A. Provide periods of rest: Rest helps the liver conserve energy and recover from inflammation caused by viral hepatitis. Fatigue is a common symptom, and periods of rest support healing.

B. Encourage eating three large meals daily: Clients with viral hepatitis may have early satiety and nausea, so smaller, frequent meals are preferable to reduce discomfort and support nutrition.

C. Provide a low-calorie diet: Adequate calories are needed to prevent malnutrition; low-calorie diets can worsen fatigue and weight loss.

D. Administer acetaminophen for pain: Acetaminophen is hepatotoxic in high doses and should be avoided or used with caution in clients with liver disease. Non-pharmacologic pain management or safer analgesics may be preferred.

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Correct Answer is D

Explanation

A. Review stress factors that can cause disease exacerbation:Stress management is important for long-term care but does not address immediate physiologic needs during an acute flare.

B. Promote physical mobility: Mobility is beneficial for overall health, but it is not the highest priority during acute exacerbations where fluid and electrolyte imbalances are urgent.

C. Provide emotional support:Emotional support is important, but it does not take precedence over life-sustaining interventions during acute illness.

D. Evaluate fluid and electrolyte levels:Clients with ulcerative colitis exacerbations are at risk of severe dehydration and electrolyte imbalances due to diarrhea. Monitoring and correcting these imbalances takes precedence over other interventions.

A. Measure abdominal girth daily. B. Provide bulk-forming agent. C. Elevate the head of the bed. D. Monitor intake and output every 8 hr.

Correct Answer is A

Explanation

A. Measure abdominal girth daily.Monitoring abdominal girth (often more than once daily if indicated) helps detect increasing distention that suggests worsening obstruction or bowel compromise.

B. Provide bulk-forming agent.Bulk-forming laxatives (fiber agents) are contraindicated in mechanical small bowel obstruction because they can worsen obstruction.

C. Elevate the head of the bed.Not a primary intervention specific to small bowel obstruction; head elevation may assist breathing but does not treat obstruction and can increase risk of aspiration if vomiting-positioning should be individualized.

D. Monitor intake and output every 8 hr.Inadequate frequency. I&O should be monitored more frequently (often hourly or every shift depending on severity) in small bowel obstruction to detect dehydration/electrolyte losses-every 8 hours is insufficient for most obstructed patients.

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A nurse is assisting with the plan of care for a client who has viral hepatitis. Which of the following actions should the nurse include in the plan?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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