Tuberculosis

1. True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium

tuberculosis and it only affects the lungs.
 False
Rationale: tuberculosis is a contagious bacterial infection caused by mycobacterium
tuberculosis that affects the lungs AND other systems of the body like the joints,
kidneys, brain, spine, liver etc
2. A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place
the patient in ___________________ precautions and will always wear
_____________________ when providing patient care?
 airborne, respirator
rationale: A patient with ACTIVE TB is contagious. The bacterium, mycobacterium
tuberculosis which causes TB, is so small that it can stay suspended in the air for hours
to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In
addition, a special mask must be worn called a respirator (also referred to as an N95
mask…..a surgical mask does NOT work with this condition)
3. Which statement is correct regarding mycobacterium tuberculosis?
 It is known as being an aerobic type of bacteria
Rationale: Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high
in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an
acid-fast smear it will turn BRIGHT RED.
4. Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During
transport to endoscopy, the patient will need to wear?
 No special PPE is needed
Rationale: Patients with a latent tuberculosis infection are NOT contagious. Therefore,
no special PPE is needed for the patient during transport. HOWEVER, if the patient had
ACTIVE tuberculosis they would need to wear a surgical mask during transport.
5. You are assessing your newly admitted patients who are all presenting with atypical signs and
symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the
patients are being monitored and tested for the disease. Select all the risk factors below that
increases a patient’s risk for developing tuberculosis:
 Inmate
 IV drug user
 HIV
RATIONALE: Remember from our lecture we discussed the risk factors for developing TB
and to remember them I said remember the mnemonic “TB Risk”. It stands for tight
living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line
(homeless), refugee (especially in high risk countries), immune system issue such as HIV,
substance abusers (IV drugs or alcohol), Kids less than the age of 5….all these are risk
factors.
6. Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements
that reflect this condition:
 The patient will have a positive tuberculin skin test or IGRA test
  The patient is not contagious and will have no signs and symptoms.”
RATIONALE: he patient WILL need medical treatment to prevent this case of LBTI from
developing into an active TB infection later on. The patient will NOT have an abnormal
chest x-ray or a positive sputum test. This is only in active TB
7. A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection.
The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she
received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician’s order below
would require the nurse to ask the doctor for an order clarification?
 PPD (Mantoux test)
Rationale: Patients who have received the BCG vaccine will have a false positive on a
PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to
prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the
person has already been exposed to the bacteria via vaccine and will have a false
positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test.
8. You’re teaching a group of long-term care health givers about the signs and symptoms of
tuberculosis. What signs and symptoms will you include in your education?
 Night sweats
 Hemoptysis
 Chills
 Fever
 Chest pain
RATIONALE: The answers are B, D, E, F, and G. Option A is wrong because a cough
should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the
patient will experience weight LOSS (not gain).
9. A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know
that:
 The patient will need a chest x-ray and sputum culture to confirm the test results before
treatment is provided.
Rationale: A positive PPD result does NOT necessarily mean the patient has an active
infection of TB. The patient will need a chest x-ray and sputum culture to determine if
mycobacterium tuberculosis is present and then treatment will be based on those
results. The IGRA test does NOT differentiate between LTBI or an active TB infection.
Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB.
10. A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to
the office in _________ so the results can be interpreted?
 48-72 hours
RATIONALE: The patient should report back in 48-72 hours. If they fail to, the test must
be repeated.
11. A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has
arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
 10 mm induration
Rationale: 15 mm induration is positive in ALL people regardless of health history or risk
factors. However, for patients who are homeless (living in homeless shelter) and are IV
drug users, a 10 mm or more is considered positive.
12. The physician orders an acid-fast bacilli sputum culture smear on a patient with possible
tuberculosis. How will you collect this?
 Collect 3 different sputum specimens on 3 different days
RATIONALE: This is how an AFB sputum culture is collected.
13. A patient receiving medical treatment for an active tuberculosis infection asks when she can
starting going out in public again. You respond that she is no longer contagious when:
 She has 3 negative sputum cultures
 Her signs and symptoms improve
 She has been on tuberculosis medications for about 3 weeks
RATIONALE: hese are all criteria for when a patient with active TB can return to public
life (school, work, running errands). Until then they are still contagious and must stay
home in isolation.
14. As the nurse you know that one of the reasons for an increase in multi-drug-resistant
tuberculosis is:
 Noncompliance due to duration of medication treatment needed
Rationale: Patients must be on medication treatment for about 6-12 months (depending
on the type of TB the patient has). This leads to noncompliant issues. DOT (directly
observed therapy) is now being instituted so compliance is increased. This is where a
public health nurse or a trained DOT worker will deliver the medication and watch the
patient swallow the pill until treatment is complete.
15. Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big
toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you
anticipated the doctor will order?
 Uric acid level
Rationale: This medication can increase uric acid levels which can lead to gout. The
patient’s signs and symptoms are classic findings in a gout attack.
16. You note your patient’s sweat and urine is orange. You reassure the patient and educate him
that which medication below is causing this finding?
 Rifampin
Rationale: This medication will cause body fluids to turn orange.
17. A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to
assess the patient’s?
 Vision
Rationale: This medication can cause inflammation of the optic nerve. Therefore, it is
very important the nurse asks the patient about their vision. If the patient has blurred
vision or reports a change in colors, the MD must be notified immediately.
18. A patient taking Isoniazid (INH) should be monitored for what deficiency?
 Vitamin B6
Rationale: This medication can lead to low Vitamin B6 levels. Most patients will take a
supplement of B6 while taking this medication.
19. A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician?
 The patient has ringing in their ears.
Rationale: This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is
alarming if the patient reports ringing in their ears, which could represent ototoxicity.
20. Tuberculosis causative factor
 mycobacerium tuberculosis ( acid fast bacteria)
21. Assessment of Tuberculosis
 FEVER
 WEIGHT LOSS
 BLOOD TINGED SPUTUM
 ANOREXIA
 NIGHT SWEATS
 INFECTION IS CAUSED BY INHALATION OF DROPLETS THAT CONTAIN THE TUBERCULOSIS
BACTERIA, (MYCOBACTERIUM TUBERCULOSIS)
22. used to treat people who have tuberculosis. Treatment of tuberculosis usually includes the
administration of
 Antitubercular Drugs
23. PUMONARY TUBERCULOSIS is an
 airborne infection

DIAGNOSTIC TEST:

1. Mantoux Skin Test. Purified Protien Derivative (PPD)

CHECK WITHIN 48 TO 72 HOURS. AN AREA OF INDURATION MEASURING 10 MM OR
MORE IN DIAMETER IS INTERPRETED AS A SIGNIFICANT INDICATOR OF TB. FURTHER TESTS WILL
THEN BE CONDUCTED.

AN INDURATION OF MORE THAN 5 MM IN A HIV PATIENT MEANS EXPOSURE TO TB.

2. Smear and culture (Sterile Sputum Specimen)

MAKE SURE TO OBTAIN BEFORE PATIENT HAD BREAKFAST
TO OBTAIN A SPUTUM: INSTRUCT CLIENT TO TAKE A DEEP BREATH AND THEN COUGH.

TREATMENT:
 ISONIAZID (INH) WITH STREPTOMYCIN FOR 9 MONTH TO 1 YEAR OR MORE.
 RIFAMPIN AND PYRAZINIMIDE (PZA) MAY ALSO BE USED.
 A PRIVATE ROOM WITH APPROPRIATE AIR HANDLING AND VENTILATION IS IMPORTANT
TO DECREASE THE RISK OF ADMISSION.
Sputum Test: Confirms the diagnosis of Tuberculosis
Three negative sputum test is usually necessary in order to be considered non- infectious.

24. are the first-line drugs to treat tuberculosis.

 Isoniazid and Rifampin
25. The right forearm of a client who had a purified protein derivative (PPD) test for tuberculosis is
reddened and raised about 3mm where the test was given. This PPD would be read as having
which of the following results?
 Negative
 Rationale: This test would be classed as negative. A 5 mm raised area would be a
positive result if a client was HIV+ or had recent close contact with someone diagnosed
with TB. Indeterminate isn't a term used to describe results of a PPD test. If the PPD is
reddened and raised 10mm or more, it's considered positive according to the CDC.
26. A client with primary TB infection can expect to develop which of the following conditions?
 A positive skin test
Rationale: A primary TB infection occurs when the bacillus has successfully invaded the
entire body after entering through the lungs. At this point, the bacilli are walled off and
skin tests read positive. However, all but infants and immunosuppressed people will
remain asymptomatic. The general population has a 10% risk of developing active TB
over their lifetime, in many cases because of a break in the body's immune defenses.
The active stage shows the classic symptoms of TB: fever, hemoptysis, and night sweats.
27. A client was infected with TB 10 years ago but never developed the disease. He's now being
treated for cancer. The client begins to develop signs of TB. This is known as which of the
following types of infection?
 active infection
rationale: Some people carry dormant TB infections that may develop into active
disease. In addition, primary sites of infection containing TB bacilli may remain inactive
for years and then activate when the client's resistance is lowered, as when a client is
being treated for cancer. There's no such thing as tertiary infection, and superinfection
doesn't apply in this case.
28. A client has active TB. Which of the following symptoms will he exhibit?
 Chills, fever, night sweats, and hemoptysis
Rationale: Typical signs and symptoms are chills, fever, night sweats, and hemoptysis.
Chest pain may be present from coughing, but isn't usual. Clients with TB typically have
low-grade fevers, not higher than 102*F. Nausea, headache, and photophobia aren't
usual TB symptoms.
29. Which of the following diagnostic tests is definitive for TB?
 Sputum culture
Rationale: The sputum culture for Mycobacterium tuberculosis is the only method of
confirming the diagnosis. Lesions in the lung may not be big enough to be seen on x-ray.
Skin tests may be falsely positive or falsely negative.
30. A client with a positive Mantoux test result will be sent for a chest x-ray. For which of the
following reasons is this done?
 To determine the extent of the lesions
Rationale: If the lesions are large enough, the chest x-ray will show their presence in the
lungs. Sputum culture confirms the diagnosis. There can be false-positive and false-
negative skin test results. A chest x-ray can't determine if this is a primary or secondary
infection.
31. A chest x-ray should a client's lungs to be clear. His Mantoux test is positive, with a 10mm if
induration. His previous test was negative. These test results are possible because:
 He's a "tuberculin converter," which means he has been infected with TB since his last
skin test
32. A client with a positive skin test for TB isn't showing signs of active disease. To help prevent the
development of active TB, the client should be treated with isoniazid, 300 mg daily, for how
long?
 9 to 12 months
Rationale: Because of the increased incidence of resistant strains of TB, the disease must
be treated for up to 24 months in some cases, but treatment typically lasts for 9-12
months. Isoniazid is the most common medication used for the treatment of TB, but
other antibiotics are added to the regimen to obtain the best results.
33. A client with a productive cough, chills, and night sweats is suspected of having active TB. The
physician should take which of the following actions?
 Admit him to the hospital in respiratory isolation
Rationale: The client is showing s/s of active TB and, because of the productive cough, is
highly contagious. He should be admitted to the hospital, placed in respiratory isolation,
and three sputum cultures should be obtained to confirm the diagnosis. He would most
likely be given isoniazid and two or three other antitubercular antibiotics until the
diagnosis is confirmed, then isolation and treatment would continue if the cultures were
positive for TB. After 7 to 10 days, three more consecutive sputum cultures will be
obtained. If they're negative, he would be considered non-contagious and may be sent
home, although he'll continue to take the antitubercular drugs for 9 to 12 months.
34. A client is diagnosed with active TB and started on triple antibiotic therapy. What signs and
symptoms would the client show if therapy is inadequate?
 Positive acid-fast bacilli in a sputum sample after 2 months of treatment
Rationale:
Continuing to have acid-fast bacilli in the sputum after 2 months indicated continued
infection.
35. A client diagnosed with active TB would be hospitalized primarily for which of the following
reasons?
 To prevent spread of the disease
Rationale: The client with active TB is highly contagious until three consecutive sputum
cultures are negative, so he's put in respiratory isolation in the hospital.
36. A community health nurse is conducting an educational session with community members
regarding TB. The nurse tells the group that one of the first symptoms associated with TB is:
 A cough with the expectoration of mucoid sputum
Rationale: One of the first pulmonary symptoms includes a slight cough with the
expectoration of mucoid sputum.
37. Isoniazid (INH) and rifampin (Rifadin) have been prescribed for a client with TB. A nurse reviews
the medical record of the client. Which of the following, if noted in the client's history, would
require physician notification?
 Hepatitis B
Rationale: Isoniazid and rafampin are contraindicated in clients with acute liver disease
or a history of hepatic injury.
38. A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would
not be consistent with the usual clinical presentation of TB and may indicate the development of
a concurrent problem?
  High-grade fever
Rationale: The client with TB usually experiences cough (non-productive or productive),
fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and
sweats (which may occur at night), and a low-grade fever.
39. The nurse obtains a sputum specimen from a client with suspected TB for laboratory study.
Which of the following laboratory techniques is most commonly used to identify tubercle bacilli
in sputum?
 Acid-fast staining
Rationale: The most commonly used technique to identify tubercle bacilli is acid-fast
staining. The bacilli have a waxy surface, which makes them difficult to stain in the lab.
However, once they are stained, the stain is resistant to removal, even with acids.
Therefore, tubercle bacilli are often called acid-fast bacilli.
40. Which of the following family members exposed to TB would be at highest risk for contracting
the disease?
 76-year-old grandmother
Rationale: Elderly persons are believed to be at higher risk for contracting TB because of
decreased immunocompetence. Other high-risk populations in the US include the urban
poor, AIDS, and minority groups.
41. The public health nurse is providing follow-up care to a client with TB who does not regularly
take his medication. Which nursing action would be most appropriate for this client?
 Ask the client's spouse to supervise the daily administration of the medications.
Rationale: Directly observed therapy (DOT) can be implemented with clients who are
not compliant with drug therapy. In DOT, a responsible person, who may be a family
member or a health care provider, observes the client taking the medication. Visiting
the client, changing the prescription, or threatening the client will not ensure
compliance if the client will not or cannot follow the prescribed treatment.
42. The nurse should include which of the following instructions when developing a teaching plan
for clients receiving INH and rifampin for treatment for TB?
 Limit alcohol intake
Rationale: INH and rifampin are hepatotoxic drugs. Clients should be warned to limit
intake of alcohol during drug therapy. Both drugs should be taken on an empty stomach.
If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours
after these drugs are administered. Clients should not double the dosage of these drugs
because of their potential toxicity. Clients taking INH should avoid foods that are rich in
tyramine, such as cheese and dairy products, or they may develop hypertension.

Viral Hepatitis
Hepat: prefix for LIVER

Itis: suffix for inflammation

Hepatitis = liver inflammation

Liver inflammation can occur for many reasons:

  drugs
 excessive alcohol usage
 medications
 viruses (most common and referred to as viral hepatitis): this is where a virus attacks the
cells of the liver causing them to malfunction.
There are 5 types of viral Hepatitis we’re going to compare in this review: A, B, C, D, E.

During the comparison below, be sure you pay special attention to how each type is transmitted, if it
causes acute and/or chronic infections, testing results and what they mean, treatment,
and prevention (especially if a vaccine or post-exposure immune globulin is available).

Role of the Liver

The liver is an amazing organ, and it’s really not given a lot of credit considering what it does for the body
because when your liver fails everything else in the body will as well.

This is because the liver is sort of like the gatekeeper of the body. It filters, protects, breaks down and
stores substances, and releases them to keep the body in balance, etc.

Where’s it located? It’s found in the upper right quadrant just under the diaphragm.

How it’s structured? It has two lobes and 8 segments. Each of the segments are made up of these
functional units called lobules. This is where the liver’s hepatocytes live and work. These cells do majority
of the work performed by the liver.

The liver receives blood from two sources:

 Hepatic artery: this vessel pumps fresh oxygenated blood to the liver from the aorta to
keep the cells of the liver supplied with oxygen so they can function and won’t die.
 Hepatic portal vein: this vessel pumps blood rich in nutrients (very poor in
oxygen) from the GI system that just broke down the food the person just consumed. The
blood will flow to the hepatocytes, which will decide what is stored, removed, and goes to
the body…so it filters the blood (toxic chemicals, potential bacteria, drugs).
What are the specific awesome functions of the liver?

 It produces bile that will help digest fats. The bile is squirted into the small intestine to help
digest fats. Bile is stored in the gallbladder.
 It plays a role with the coagulation process (remember how Warfarin worked?).
 Provides immune system protection by producing immune factor proteins and eliminates
dangerous bacteria from the blood.
 It helps regulate the blood glucose levels by storing and creating glucose based on the
body’s needs.
 It turns ammonia into urea. Ammonia is created with the breakdown of proteins. It is highly
toxic to the brain if it accumulates in the blood, which is why the liver turns it into urea and
lets the kidneys dispose of it through the urine.
  It breaks down red blood cells. When this occurs it will create bilirubin. Bilirubin is
a brownish yellow substance, which is placed in the bile and excreted in the stool. This is
why stool is normally brown.

Hepatitis A:

How do you get it (transmission)?

 Most common is fecal-oral: a person is most likely to get the virus from consuming
contaminated food or water.
 Acute type of infection only: no long term complications likely because the virus is in the
body for a short time and killed by the body
Signs & Symptoms (note: all types of hepatitis have similar symptoms as the ones below)

 asymptomatic (some patient may be without symptoms)

 Jaundice

 GI symptoms: nausea, vomiting, stomach pain, loss of appetite

 Fever
 Very tired
 Dark urine (bilirubin)
 Clay-colored stool (no bilirubin in stool)
 Arthralgia (joint pain)
With Hepatitis A, the patient can be contagious 2 weeks BEFORE the signs and symptoms appear and 1-
3 weeks from when the symptoms appeared.

Diagnosed: anti-HAV (antibodies of the hepatitis A virus) presence with IgM and IgG in the blood

 anti-HAV igM = active infection (in icteric phase)

 anti-HAV IgG = past infection and recovered and has immunity…if received the vaccine it
worked

 How to remember? IgM (think mean virus is present in the body) and
IgG (think the virus is gone)
Treatment: none at time (clears on its own)….rest and supportive treatment

Prevention: handwashing, vaccine: (2 doses given 6 months apart as part of the pediatric vaccine
schedule), want to receive the vaccine if travelling outside US, Hepatitis A immune globin (IG): if came
into contact will the virus, needs to receive IG within 2 weeks of exposure….it will provide temporary
passive immunity.

Hepatitis B:

How you get it (transmitted)?

  blood and other body fluids like semen, salvia, ammonitic or vaginal fluid etc.
 Most common transmission route is sexual intercourse and intravenous drug use. It can
also be spread via the birthing process if mother is Hepatitis B positive. Therefore, it can
be spread via the percutaneous (via a puncture in the skin…example: needle) or mucosal
routes.
 Acute and chronic infections can occur. Infants and young children at most risk for
chronic infections.

 Chronic infections can lead to major complications like: cirrhosis, liver

failure, and liver cancer
Signs and symptoms: same as above if present

Diagnosed:

 HBsAg (Hepatitis B surface antigen): show infectious (educate: avoid sexual intercourse
and intimacy like kissing until it is negative)
 Anti-HBs (Hepatitis b surface antibody): means patient is recovered (had a previous
infection) and immune (example: effective Hepatitis B vaccine)
Treatment:

 acute: none just supportive treatment

 chronic: antiviral medications or interferon

 Peginterferon alfa-2a (Pegasys): given subcutaneous

Prevention: handwashing, vaccine for all infants (3-4 doses over 6-18 months) and people at risk for
Hepatitis B..example: healthcare workers (3 doses over 6 months), following sharp precautions, all
pregnant women tested due to transmission at birth, post-exposure Hepatitis B immune globulin within
24 hours of exposure (12 hours after birth) to provide temporary passive immunity.

Hepatitis C :

How you get it (transmitted)?

 Blood and body fluids…. spread via percutaneous (via the skin through a puncture) or in
body fluids with mucosal route
 Most common transmission route intravenous drugs.

 Other ways but not as common: sexual contact, if received blood or blood
products before 1992, sharp injuries (needle or instruments), long-term
dialysis increases risk of exposure too
Signs and symptoms: same as above if present

Acute and chronic infections can occur. A high percentage of Hepatitis C becomes chronic, which
increases the risk for liver disease.

 Chronic infections can lead to major complications like: cirrhosis, liver failure, and
liver cancer
Diagnosed: presence of anti-HCV (antibodies to HCV) for chronic infection…not for acute infections

Treatment:

 antiviral medication like direct acting antivirals (DAAs)

Prevention: handwashing, NO vaccine currently or immune globulin for post-exposure, following sharp
precautions, strict blood and organ donation screening

Hepatitis D:

How you get it (transmitted)? Only infects a person when they have Hepatitis B.

 Blood and body fluids…. spread via percutaneous (via the skin through a puncture) or in
body fluids with mucosal route…same as Hepatitis B.
 Not as common in the US compared to Southern and Easter Europe and Mediterranean
and Middle East.
 Acute and chronic infections can present.
Signs and symptoms: same as above if present

Diagnosed: presence of HDAg (hepatitis D antigen) and anti-HDV

Treatment: antiviral medications or interferon (Peginterferon alfa-2a (Pegasys)

Prevention: handwashing, getting the Hepatitis B vaccine, NO vaccine for Hepatitis D or post-exposure
immune globulin

Hepatitis E:

How you get it (transmission)?

 Fecal-oral: from consuming contaminated water or food (can also be transmitted in

undercooked meat like pork or wild game)
 Acute infection only: can cause major complications in pregnant women in the
3rd trimester
 Tends to be more prevalent in developing countries and in people who globally travel
Signs and symptoms: same as above if present

Diagnosed: antibodies to detect HEV

Treatment: none rest and supportive treatment

Prevention: handwashing, no vaccine being used here in the US at this time, if travelling outside US use
bottled water, cook meat thoroughly

Quick highlighted review of the above comparison:

 Hepatitis A and E are very similar:

  Both transmitted fecal-oral

 Both ONLY cause acute infections

 Both treatment: supportive and rest

 Hepatitis A has a vaccine and immune globulin….Hepatitis E

does NOT have a vaccine im the US or post-exposure immune globulin

 Hepatitis B, C, D are similar:

 All transmitted via blood/body fluids

 All cause either acute and chronic infections

 All treatment can include antivirals and interferon

 Only Hepatitis B has a vaccine and post-exposure immune globulin.

Handwashing (strict)

Eat low fat and high carb meals (needs proper nutrition to help with liver regeneration and low fat intake
because bile production is altered…remember bile helps digest fats)

Personal hygiene products NOT to be shared (inform about the types of products: toothbrushes, razors,
drinking cups, utensils, towels etc.)

Toxic substances AVOIDED…especially over-the-counter products that are liver toxic: alcohol, sedative,
aspirin, acetaminophen etc.

Individual bathrooms…don’t share bathroom with family members

Test results:

 Hepatitis A: anti-HAV IgM (active) and anti-HAV IgG (recovered/immune)

 Hepatitis B: HBsAG (infectious) and anti-HBV (recovered/immune)
Interferon (Peginterferon alfa-2a given subq) and Immune globulin for Hepatitis A (within 2 weeks of
exposure) and Hepatitis B Immune globulin (within 24 hours of exposure)

Small but frequent meals…this may help with the nausea and patient should NOT cook for others until not
infectious.

Phases of Viral Hepatitis

Preicteric (prodromal) Phase: body symptoms…joint pain, fatigue, nausea vomiting, abdominal pain
change in taste, liver enzymes and bilirubin increasing

Icteric Phase: DECREASE in body symptoms but will have jaundice and dark urine (from build-up of
bilirubin), clay-colored stool (bilirubin not going to stool to give it’s normal brown color) enlarged liver and
pain in this area
Posticteric (convalescent) Phase: jaundice and dark urine start to subside and stool returns to normal
brown color, liver enzymes and bilirubin decrease to normal

Labs to Know Regarding Hepatitis

Liver Enzymes (can be obtained from a comprehensive metabolic panel)

 ALT(alanine transaminase): 7 to 56 U/L (will be elevated)

 AST(aspartate transaminase) 10-40 U/L (will be elevated)
Bilirubin: <1 mg/dL (will be elevated with hepatitis…causes jaundice/dark urine)

Ammonia level (from separate test): 15-45 mcg/dL (elevated with hepatitis and will see as mental status
changes)

 Lactulose administered for high ammonia level…causes diarrhea but lowers ammonia
level

1. The liver receives blood from two sources. The _____________ is responsible for
pumping blood rich in nutrients to the liver.
 hepatic portal vein
rationale: The liver receives blood from two sources. The hepatic portal vein is
responsible for pumping blood rich in nutrients to the liver.
2. Which statements are INCORRECT regarding the anatomy and physiology of the liver?
Select all that apply:
 The liver turns urea, a by-product of protein breakdown, into ammonia.
 The liver has 3 lobes and 8 segments.
Rationale: The liver has 2 lobes (not 3), and the liver turns ammonia (NOT urea),
which is a by-product of protein breakdown, into ammonia. All the other
statements are true about liver’s anatomy and physiology.
3. You’re providing an in-service on viral hepatitis to a group of healthcare workers. You are
teaching them about the types of viral hepatitis that can turn into chronic infections.
Which types are known to cause ACUTE infections ONLY? Select all that apply:
 Hepatitis A and heap E
Rationale: Only Hepatitis A and E cause ACUTE infections…not chronic.
Hepatitis B, C, and D can cause both acute and chronic infections.
4. Which patients below are at risk for developing complications related to a chronic
hepatitis infection, such as cirrhosis, liver cancer, and liver failure? Select all that apply:’
 An infant who contracted Hepatitis B at birth.
 A 32-year-old female with Hepatitis C who reports using IV drugs.
 A 50-year-old male with alcoholism and Hepatitis D.
Rationale: Infants or young children who contract Hepatitis B are at a very high
risk of developing chronic Hepatitis B (which is why option B is correct). Option C
is correct because most cases of Hepatitis C turn into chronic cases and IV drug
use increases this risk even more. Option D is correct because Hepatitis D
occurs when Hepatitis B is present and constant usage of alcohol damages the
liver. Therefore, the patient is at high risk of developing chronic hepatitis.
Hepatitis A and E tend to only cause acute infections….not chronic.
5. A patient is diagnosed with Hepatitis A. The patient asks how a person can become
infected with this condition. You know the most common route of transmission is?
 Fecal-oral
Rationale: Hepatitis A is most commonly transmitted via the fecal-oral route.
6. Which of the following is NOT a common source of transmission for Hepatitis A? Select
all that apply:
 Semen
 Blood
Rationale: The most common source for transmission of Hepatitis A is water and
food.
7. A 36-year-old patient’s lab work show anti-HAV and IgG present in the blood. As the
nurse you would interpret this blood work as?
 The patient has recovered from a previous Hepatitis A infection and is now
immune to it.
Rationale: When a patient has anti-HAV (antibodies of the Hepatitis A virus) and
IgG, this means the patient HAD a past infection of Hepatitis A but it is now gone,
and the patient is immune to Hepatitis A now. If the patient had anti-HAV and
IgM, this means the patient has an active infection of Hepatitis A.
8. TRUE or FALSE: A patient with Hepatitis A is contagious about 2 weeks before signs and
symptoms appear and 1-3 weeks after the symptoms appear.
 True
9. A 25-year-old patient was exposed to the Hepatitis A virus at a local restaurant one week
ago. What education is important to provide to this patient?
 Inform the patient to promptly go to the local health department to receive
immune globulin.
Rationale: Since the patient was exposed to Hepatitis A, the patient would need
to take preventive measures to prevent infection because infection is possible.
The patient should not wait until signs and symptoms appear because the patient
can be contagious 2 weeks BEFORE signs and symptoms appear. The vaccine
would not prevent Hepatitis A from this exposure, but from possible future
exposures because it takes the vaccine 30 days to start working. The best
answer is option D. The patient would need to receive immune globulin to
provide temporary immunity within 2 weeks of exposure.
10. Select all the ways a person can become infected with Hepatitis B:
 During the birth process
 IV drug use
 Hemodialysis
 Sexual intercourse
Rationale: Hepatitis B is spread via blood and body fluids. It could be transmitted
via the birthing process, IV drug use, hemodialysis, or sexual intercourse etc.
11. A patient has completed the Hepatitis B vaccine series. What blood result below would
demonstrate the vaccine series was successful at providing immunity to Hepatitis B?
 Positive anti-HBs
Rationale: A positive anti-HBs (Hepatitis B surface antibody) indicates either a
past infection of Hepatitis B that is now cleared and the patient is immune, OR
that the vaccine has been successful at providing immunity. A positive HBsAg
(Hepatitis B surface antigen) indicates an active infection.
12. A patient has lab work drawn and it shows a positive HBsAg. What education will you
provide to the patient?
 Avoid sexual intercourse or intimacy such as kissing until blood work is negative.
Rationale: A positive HBsAg (hepatitis B surface antigen) indicates an active
Hepatitis B infection. Therefore, the patient should avoid sexual intercourse and
other forms of intimacy until their HBsAg is negative.
13. A patient with Hepatitis A asks you about the treatment options for this condition. Your
response is?
 Supportive care
Rationale: There is no current treatment for Hepatitis A but supportive care and
rest. Treatments for the other types of Hepatitis such as B, C, and D include
antiviral or interferon (mainly the chronic cases) along with rest.
14. A patient was exposed to Hepatitis B recently. Postexposure precautions include
vaccination and administration of HBIg (Hepatitis B Immune globulin). HBIg needs to be
given as soon as possible, preferably ___________ after exposure to be effective.
 24 hours
Rationale: HBIg should be given 24 hours after exposure to maximum
effectiveness of temporary immunity against Hepatitis B. It would be given within
12 hours after birth to an infant born to a mother who has Hepatitis B.
15. You’re providing education to a patient with an active Hepatitis B infection. What will you
include in their discharge instructions? Select all that apply:
 “Follow a diet low in fat and high in carbs.”
 “Do not share toothbrushes, razors, utensils, drinking cups, or any other type of
personal hygiene product.”
Rationale:: The patient should NOT take acetaminophen (Tylenol) due to its
effective on the liver. The patient should eat small (NOT large), but frequent
meals…this may help with the nausea. The patient should rest (not perform
aerobic exercises daily) because this will help with liver regeneration.
16. What is the MOST common transmission route of Hepatitis C?
 IV drug use
Rationale: IV drug use is the MOST common transmission route of Hepatitis C.
17. A patient is diagnosed with Hepatitis D. What statement is true about this type of viral
Hepatitis? Select all that apply:
 The patient will also have the Hepatitis B virus.
 Hepatitis D is most common in Southern and Eastern Europe, Mediterranean,
and Middle East.
Rationale: These are true statements about Hepatitis D. Prevention for Hepatitis
D includes handwashing and the Hepatitis B vaccine (since it occurs only with
the Hepatitis B virus). It is transmitted via blood.
18. Select all the signs and symptoms associated with Hepatitis?
 Arthralgia
 Dark urine
 Yellowing of the sclera
 Fever
 Loss of appetite
Rationale: The bilirubin and ammonia levels are normal in these options, but they
would be abnormal in Hepatitis. A normal bilirubin is 1 or less, and a normal
ammonia is 15-45 mcg/dL.
19. A patient with Hepatitis has a bilirubin of 6 mg/dL. What findings would correlate with this
lab result? Select all that apply:
 Yellowing of the skin and sclera
 Clay-colored stools
 Dark urine
Rationale: This is associated with a high bilirubin level. A normal bilirubin level is
1 or less.
20. A patient with Hepatitis is extremely confused. The patient is diagnosed with Hepatic
Encephalopathy. What lab result would correlate with this mental status change?
 Ammonia 100 mcg/dL
Rationale: When ammonia levels become high (normal 15-45 mcg/dL) it affects
brain function. Therefore, the nurse would see mental status changes in a patient
with this ammonia level.
21. The physician writes an order for the administration of Lactulose. What lab result
indicates this medication was successful?
 Ammonia 16 mcg/dL
Rationale: Lactulose is ordered to decrease a high ammonia level. It will cause
excretion of ammonia via the stool. A normal ammonia level would indicate the
medication was successful (normal ammonia level 15-45 mcg/dL).
 22. How is Hepatitis E transmitted?
 Fecal-oral
23. Which patient below is at MOST risk for developing a complication related to a Hepatitis
E infection?
 A 26-year-old female in the 3rd trimester of pregnancy.
Rationale: The answer is B. Patients who are in the 3rd trimester of pregnancy
are at a HIGH risk of developing a complication related to a Hepatitis E infection.
24. What is the BEST preventive measure to take to help prevent ALL types of viral
Hepatitis?
 Hand hygiene
Rationale: Hand hygiene can help prevent all types of viral hepatitis. However,
not all types of viral Hepatitis have a vaccine available or are spread through
needle sticks or blood/organs donations. Remember Hepatitis A and E are
spread only via fecal-oral routes.
25. Select all the types of viral Hepatitis that have preventive vaccines available in the United
States?
 Hepatitis A and Hepa b
Rationale: Currently there is only a vaccine for Hepatitis A and B in the U.S.
26. A patient is prescribed Peginterferon alfa-2a. The nurse will prepare to administer this
medication what route?
 Subcutaneous
27. A patient with viral Hepatitis states their flu-like symptoms have subsided. However, they
now have yellowing of the skin and sclera along with dark urine. Based on this finding,
this is what phase of Hepatitis?
 Icteric
Rationale: The Preicteric (prodromal) Phase: flulike symptoms...joint pain,
fatigue, nausea vomiting, abdominal pain change in taste, liver enzymes and
bilirubin increasing….Icteric Phase: decrease in the flu-like symptoms but will
have jaundice and dark urine (buildup of bilirubin) yellowing of skin and white part
of the eyeball, clay-colored stool (bilirubin not going to stool to give it's normal
brown color) enlarged liver and pain in this area….Posticteric (convalescent)
Phase: jaundice and dark urine start to subside and stool returns to normal
brown color, liver enzymes and bilirubin decrease to normal
28. During the posticteric phase of Hepatitis the nurse would expect to find? Select all that
apply:
 Decreased liver enzymes and bilirubin level
 Resolved jaundice and dark urine
Rationale: Posticteric (convalescent) Phase: jaundice and dark urine start to
subside and stool returns to normal brown color, liver enzymes and bilirubin
decrease to normal

Hepatitis A
contact with infected feces, food and water

Hepatitis B
contact with infected blood
infected secretions or body fluids
parenteral exposure (needle sticks)

Hepatitis C
contact with infected blood
infected secretions or body fluids
parenteral exposure (needle sticks)
Hepatitis D
contact with infected blood
infected secretions or body fluids
parenteral exposure (needle sticks)

Hepatitis E
contact with infected feces, food and water