A client with cirrhosis has an episode of bleeding esophageal varices that is controlled with administration of vasopressin and endoscopic sclerotherapy. To detect possible complications of the bleeding episode, it is most important for the nurse to monitor serum
ammonia levels
potassium levels.
bilirubin levels.
creatinine levels
The Correct Answer is A
A. ammonia levels: After a bleeding episode in cirrhosis, red blood cell breakdown in the gastrointestinal tract increases nitrogen load, raising the risk of hepatic encephalopathy. Monitoring serum ammonia helps detect early neurotoxicity. Timely identification allows interventions such as lactulose to prevent worsening mental status.
B. potassium levels: Potassium monitoring is important with vasopressin use due to potential electrolyte disturbances, but it does not directly indicate complications from the bleeding episode. Changes in potassium alone are less critical for detecting post-bleeding complications.
C. bilirubin levels: Bilirubin reflects liver function and cholestasis, but short-term elevations after a variceal bleed are not the most immediate complication to monitor. It is more relevant for chronic liver disease monitoring rather than acute bleeding events.
D. creatinine levels: Creatinine is useful for detecting renal impairment, which can occur in advanced cirrhosis, but it does not directly indicate complications from acute variceal bleeding. Renal monitoring is secondary to assessing for hepatic encephalopathy risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Calculation:
- Calculate the Total 24-Hour Fluid Volume
The Parkland formula is: Total Volume = 4 mL × Weight (kg) × % TBSA burned
Weight: 72 kg
% TBSA Burned: 60%
Total Volume = 4 × 72 × 60
= 17,280 mL
- Calculate the Volume to be Infused in the First 8 Hours
Half of the total 24-hour volume is given in the first 8 hours.
Volume for 8 hours = Total Volume ÷ 2
= 17,280 ÷ 2
= 8,640 mL
- Calculate the Infusion Rate for the First 8 Hours
Flow Rate = Volume for 8 hours ÷ 8 hours
= 8,640 ÷ 8
= 1,080 mL/hr
Correct Answer is B
Explanation
A. acute glomerulonephritis: Acute glomerulonephritis typically presents with hematuria, proteinuria, and edema, but it is not directly related to crush injuries. It is an immune-mediated condition rather than a consequence of muscle trauma.
B. myoglobinuria: Crush injuries release myoglobin from damaged muscle into the bloodstream, which can accumulate in the kidneys and cause acute tubular necrosis. Dark, cola-colored urine is characteristic of myoglobinuria. This is a common cause of acute kidney injury following severe trauma.
C. embolus in a renal artery: A renal artery embolus can cause sudden flank pain and oliguria, but it is less likely in the context of a crush injury. It does not typically produce dark-colored urine.
D. bilirubinemia: Bilirubinemia causes jaundice and dark urine from liver dysfunction, not directly from muscle trauma. The client’s history and urine color are more consistent with myoglobinuria than liver-related causes.
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