We
What is the best way to prevent the spread of Hepatitis A?
A- Vaccination
B- Social distancing
C- Hand washing
D- Wearing Gloves
C- hand washing
Your patient comes to the ED with possible exposure to Hep C over the weekend, they are not worried because they are not showing any symptoms- what would your patient teaching be?
A- you are most infectious 1-2 weeks before symptoms onset.
B- you are most contagious when you develop a fever
C- you will die
D- you are most infectious when flu like symptoms start
A- you are most infectious 1-2 weeks before symptoms onset.
What is 2/2/2/2 Rule?
A- 2 does of Hepatitis C vaccine, 2 months apart
B- 2 vaccines to prevent Hep B and Hep D, 2 years apart, 2 years of protection
C- 2 dose of Hep A vaccine, most contagious 2 weeks before s/s, s/s last 2 months
D- 2 doses of Hep B vaccine, one at 2 months, and a year, signs and symptoms last 2 weeks.
C- 2 dose of Hep A vaccine, most contagious 2 weeks before s/s, s/s last 2 months
What is the true test for liver disease?
A- Liver enzymes (AST, ALT, alkaline phosphate)
B- Electrolytes (hyponatremia, hypokalemia)
C- Albumin, bilirubin, and PT
D- CBC, WBC, and BMP
C- Albumin, bilirubin, and PT
You arrive on shift and have four patients, which patient would be your top priority:
A) 24 y/o female diagnosed with hepatitis C
B) A 46 y/o male patient with ascites that is scheduled for a paracentesis at 1100 that has decreased urine output
C) A 55 y/o female patient that needs to start her third day of liver dialysis
D) A 67 y/o male had a band ligation of varices yesterday, his blood pressure has dropped significantly over the last two hours
D) A 67 y/o male had a band ligation of varices yesterday, his blood pressure has dropped significantly
How would you diagnose an acute Hepatitis A infection?
A- Anti-HAV IgM
B- Anti-HBV IgG
C- Anti-HAV IgG
D- Immune Globulin
A- Anti-HAV IgM
Your patient's lab work returns with positive Anti-HBs, what would be the treatment plan for this patient?
A- HBIG
B- Start vaccine series
C- Have them write their will
D- Nothing, this shows immunity from past infection or IV
D- Nothing, this shows immunity from past infection or IV
Your patient tells you that they have a fatty liver, what statement shows they understand this diagnosis?
A- The doctor says I have to lose weight
B- The doctor says it is irreversible so I can continue to live how I want
C- The doctor says it can potentially be reversible if I stop drinking
D- The doctor says I can have two glasses of wine a day.
C- The doctor says it can potentially be reversible if I stop drinking
What order would you question for a needle liver biopsy?
A- ibuprofen given 30 minutes before procedure for pain management
B- type and screen blood
C- coagulation medication
D- have patient empty bladder before procedure
A- ibuprofen for pain management
* have patient lay supine with right arm above head, keep patient on right side position x2hrs.
A liver patient with ascites is at a routine check up, their blood pressure is 110/70, HR is 65, O2 is 98%, bpm is 18, and their temperature is 102F. What do you expect to do for your patient?
A) Prepare for a needle biopsy of the liver to test for liver disease
B) Prepare patient for surgery to band varices
C) Prepare patient for paracentesis to test ascites fluid to determine spontaneous bacterial peritonitis
D) Sit the patient up to move pressure off of their diaphragm to help them breathe
C) Prepare patient for paracentesis to test ascites fluid to determine spontaneous bacterial peritonitis
How is Hepatitis B transmitted? SATA
A- Perinatally
B- Feces
C- Saliva
D- Blood Products
A,C,D
What do you do if you've been exposed to HepA?
Immune Globulin within 2 weeks of exposure for persons who do not have anti-HAV antibodies. Should also start vaccine to give active immunity
Which of the following can harm the liver? SATA
A- Tylenol
B- Rifampin
C- Statin drugs
D- Fatty foods
E- High cholesterol
A- Tylenol
B- Rifampin
C- Statin drugs
D- Fatty foods
E- High cholesterol
A- varices
B- jaundice
C- ascites
D- heart complications
A- varices
Which order would you question for a patient with ascites and portal hypertension. His vitals are: bp- 90/63, HR- 66, BMP- 18, O2- 98%.
A) Lasix 20 mg, 500 ml NS, Cetriaxone 1 g IVPB
B) Pantoprazole, Octreotide, propranolol
C) Aldactone, Albumin, Samsca
D) Propanolol, Octreotide, Albumin and Samsca
A) Lasix 20 mg, 500 ml NS, Cetriaxone 1 g IVPB
You patient asks what Ribavirin is and why they are taking it, you explain:
A) This is an antiretroviral that will destroy hepatitis B infection.
B) This is a nucleoside that will slow down hepatitis B DNA replication
C) This will stop RNA replication of hepatitis C
D) This will destroy Hepatitis D cells, stopping replication.
B) This is a nucleoside that will slow down hepatitis B DNA replication
Which results would show an active Hep B infection in a patient? SATA
A- anti-HBc IgG
B- HBeAg
C- Anti-HBc IgM
D- HBsAg
E- Anti- HBs
A- anti-HBc IgG
B- HBeAg
D- HBsAg
Your HIV+ patient is getting their routine blood checks, what diagnostic result would be indicate an infection? Why is this combination worse?
A- anti-HCV antibody
B- HCV RNA
C- HCV Cx5
B- HCV RNA- increase risk for cirrohsis
Which teaching to your patient with esophageal/gastric varices about irritants is not correct?
A- NSAIDs, Tylenol, and statins are irritants and should be avoided.
B- Carrots and tortilla chips can cause trauma to varices
C- Heavy lifting and exercise can lessen the strain on the varices
D- coughing, sneezing, and straining can cause increased esophageal pressure
C- Heavy lifting and exercise can lessen the strain on the varices
A patient's son brought him into the ED after his father started to have slurred speech, and was showing some violent behaviors. The patient has a history of liver disease with recent black, tarry stools, abdominal pain, and lethargy. His H & H is low, his Na+- 130, K+- 3.3. What would be the primary concern and how do you fix it?
A) Hepatorenal Syndrome, need to give albumin and fluids.
B) Hepatic encephalopathy, need to reduce ammonia with lactulose, control bleed, and start neomycin.
C) Low sodium delirium, replace sodium
D) Portal hypertension is causing blood to back up into esophagus and spleen, collateral circulation is needed.
B) Hepatic encephalopathy, need to reduce ammonia with lactulose, control bleed, and start neomycin.
Describe how Hep B vaccine is given
3 doses
1st dose within 12 hours of birth
2nd dose 4 weeks later (1 month old)
3rd dose 5 months later (6 months old)
What would you expect the treatment be for chronic HCV?
A- Immune modulators: Pegylated a-interferon
B- let the virus run it's course
C- Combo Therapy: Harvoni
D- Direct Acting Antivirals- Protease inhibition (Telaprevir PO, Boceprevir PO)
D- Direct Acting Antivirals- Protease inhibition (Telaprevir PO, Boceprevir PO)- 12 week course with 95% cure rate
Which of the following orders would you question for your liver patient?
A- Vitamin B
B- Potassium
C- Aspirin
D- Vitamin K
C- Aspirin
A- ascites is causing too much pressure on the lungs, apply O2
B- varices have ruptured, emergency- stop the bleed
C- emergency, GI bleeding
D- Patient is likely having a reaction from bad seafood.
B- varices have ruptured, emergency- stop the bleed
How does the diet of a patient with hepatic encephalopathy differ from a patient with liver failure?
A) low protein vs high protein
B) fluid restriction vs pushing fluids
C) vitamin K vs no vitamin K
D) electrolyte deficient vs too much electrolytes
A) low protein vs high protein