A client with chronic cirrhosis has esophageal varices. It is most important for the nurse to monitor the client for the onset of which problem?
Hematemesis
Brown, foarmy urine.
Clay-colored stool.
Anorexia.
The Correct Answer is A
A Hematemesis refers to vomiting blood, which can occur when esophageal varices rupture and bleed into the gastrointestinal tract. It is a hallmark sign of upper gastrointestinal bleeding and requires immediate medical attention. Monitoring for hematemesis allows for early detection of variceal bleeding and prompt intervention to prevent further complications.
B Brown, foamy urine may indicate the presence of blood or protein in the urine, which can occur in various kidney and urinary tract disorders.
C Clay-colored stool may indicate a lack of bile in the stool, which can occur in conditions affecting the liver or bile ducts, such as obstructive jaundice.
D Anorexia, or loss of appetite, is a common symptom in clients with chronic liver disease, including cirrhosis. However, while anorexia may impact nutritional status and overall health, it is not directly related to the complications of esophageal varices.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. The correct instruction to include in a discharge teaching plan for an adult client with hypernatremia is to review food labels for sodium content. Hypernatremia is a condition characterized by high levels of sodium in the blood, and it is often due to fluid loss rather than excessive sodium intake.
A. Hypernatremia is characterized by elevated levels of sodium in the blood, and reducing sodium intake is typically part of the treatment plan. Instructing the client to use salt tablets would exacerbate the hypernatremia and could lead to further complications.
B. This instruction is not directly related to managing hypernatremia. While monitoring urine output is important for assessing hydration status and kidney function, it may not specifically address the underlying cause of hypernatremia.
C. Hypernatremia is often caused by dehydration or inadequate water intake, leading to elevated sodium levels in the blood. Therefore, hydrating is an important instruction but not the most important.
Correct Answer is C
Explanation
C. Hemoglobin is a protein in red blood cells that carries oxygen throughout the body. Anemia, characterized by low hemoglobin levels, can lead to symptoms such as fatigue, weakness, and pale appearance. Diclofenac, like other nonsteroidal anti-inflammatory drugs (NSAIDs), can cause gastrointestinal bleeding, which may result in iron deficiency anemia.
A. While abnormality in sodium levels can occur and may contribute to symptoms such as fatigue, pale appearance, and weakness, sodium levels are not typically affected directly by diclofenac use or rheumatoid arthritis.
B. Low total protein levels can contribute to symptoms such as fatigue and weakness. However, total protein levels may not be directly affected by diclofenac use or rheumatoid arthritis.
D. Assessing glucose levels is not be the most relevant laboratory value to review in this situation.
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