A client with cirrhosis and portal hypertension has developed esophageal varices.
For which complication is this client most at risk?
Angina.
Hemorrhage.
Gastroesophageal reflux.
Hypoglycemia.
The Correct Answer is B
Choice A rationale
Angina is chest pain resulting from reduced blood flow to the heart muscle, typically caused by coronary artery disease and myocardial ischemia. While a patient with severe blood loss might experience secondary cardiac stress, angina is not a direct or primary complication of esophageal varices. The pathology of varices is rooted in venous congestion within the portal system, which is entirely distinct from the arterial atherosclerotic processes that characterize coronary heart disease.
Choice B rationale
Esophageal varices are dilated, fragile submucosal veins that develop due to portal hypertension, which redirects blood flow from the liver to systemic collateral vessels. These vessels have thin walls and are under high pressure, making them extremely susceptible to rupture. A rupture leads to massive upper gastrointestinal hemorrhage, which is a leading cause of mortality in patients with cirrhosis. Maintaining hemodynamic stability and preventing these bleeds is the primary goal of clinical management.
Choice C rationale
Gastroesophageal reflux involves the backflow of acid into the esophagus, primarily due to sphincter dysfunction. While patients with cirrhosis may have increased abdominal pressure from ascites that could worsen reflux, it is not the most critical risk associated with varices. The presence of varices themselves does not cause acid reflux; rather, the mechanical fragility of the veins poses a much more immediate and lethal threat of bleeding compared to the mucosal irritation of reflux.
Choice D rationale
Hypoglycemia can occur in patients with end-stage cirrhosis because the liver is responsible for gluconeogenesis and glycogen storage. If the liver fails, glucose regulation is impaired. However, esophageal varices are a vascular complication of portal hypertension, not a metabolic complication of liver cell failure. While both issues can exist in the same patient, the specific presence of varices does not cause low blood sugar; it specifically predisposes the patient to vascular rupture.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Stress is considered a modifiable risk factor because individuals can adopt various coping mechanisms and lifestyle changes to reduce its impact on the body. Chronic stress triggers the sympathetic nervous system, leading to sustained elevations in cortisol and adrenaline, which increase blood pressure. Through techniques such as mindfulness, cognitive behavioral therapy, or environmental adjustments, a patient can successfully lower their stress levels and subsequently reduce their risk for hypertension.
Choice B rationale
Obesity is a modifiable risk factor that is directly linked to metabolic and cardiovascular health. Excessive adipose tissue increases systemic vascular resistance and places a higher demand on the heart to pump blood. However, weight can be managed and reduced through a combination of caloric restriction and increased physical energy expenditure. Achieving a healthy Body Mass Index significantly lowers the mechanical and chemical strain on the circulatory system.
Choice C rationale
Gender is a non-modifiable risk factor because it is determined by biological sex chromosomes and the resulting hormonal profile established at birth. Statistical data shows that men often develop hypertension earlier in life compared to premenopausal women, largely due to the protective effects of estrogen. Since an individual cannot change their biological sex or the innate hormonal framework they were born with, it is classified as a permanent risk characteristic.
Choice D rationale
Sodium intake is a modifiable risk factor because it is entirely dependent on an individual's nutritional choices and eating habits. High sodium consumption leads to water retention and increased extracellular fluid volume, which directly raises blood pressure levels. By adhering to a low-sodium diet, such as the DASH diet, patients can effectively decrease the osmotic pressure within their vessels. This behavioral change is a cornerstone of non-pharmacological hypertension management.
Correct Answer is C
Explanation
Choice A rationale
Multiple sclerosis is a chronic autoimmune disease that specifically targets the central nervous system, which includes the brain and spinal cord. It does not primarily affect the peripheral nervous system, which consists of the nerves outside these structures. Peripheral nerve issues are more characteristic of conditions like Guillain-Barre syndrome or peripheral neuropathy. Understanding that MS is a central nervous system disorder is vital for recognizing the types of neurological deficits and imaging findings expected during diagnosis.
Choice B rationale
There is no single definitive blood test that can confirm a diagnosis of multiple sclerosis. Diagnosis is usually based on clinical findings, magnetic resonance imaging showing lesions disseminated in time and space, and sometimes cerebrospinal fluid analysis for oligoclonal bands. Blood tests are primarily used to rule out other conditions that mimic MS, such as systemic lupus erythematosus or vitamin B12 deficiency. Relying solely on a blood test suggests a misunderstanding of the diagnostic process.
Choice C rationale
Multiple sclerosis is characterized by an immune-mediated attack on the myelin sheath, which is the protective insulation surrounding nerve fibers in the central nervous system. This process of demyelination disrupts the normal transmission of electrical impulses, leading to various neurological symptoms. By correctly identifying that the disease involves the loss of myelin within the central nervous system, the client demonstrates an accurate understanding of the underlying pathophysiology and the reason for their varied physical and cognitive symptoms.
Choice D rationale
The clinical course of multiple sclerosis is typically characterized by unpredictable relapses and remissions or a steady progression of symptoms. It is very rare for symptoms to remain exactly the same every day; instead, patients often experience fluctuations in fatigue, motor strength, and sensory perception depending on disease activity and external factors like heat or stress. Believing that symptoms will be identical daily shows a lack of awareness regarding the episodic and variable nature of MS.
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