A nurse in a clinic is caring for a client who has alcohol use disorder. The client reports frequent bruising and nosebleeds. Which of the following conditions should the nurse suspect?

Diabetes mellitus

Hepatitis A

Cirrhosis

Cholecystitis

Answer and Explanation

The Correct Answer is C

A. Diabetes mellitus
Diabetes mellitus can cause easy bruising and slow wound healing, but it is not typically associated with frequent nosebleeds.

B. Hepatitis A
Hepatitis A primarily affects the liver and does not cause frequent bruising and nosebleeds.

C. Cirrhosis
Cirrhosis, which is scarring of the liver tissue due to long-term liver damage, can lead to impaired liver function. One consequence of cirrhosis is decreased production of clotting factors, which can result in easy bruising. Additionally, the enlarged spleen in cirrhosis can lead to thrombocytopenia (low platelet count), contributing to bleeding tendencies, including nosebleeds. Cirrhosis is the most likely condition given the symptoms described.

D. Cholecystitis
Cholecystitis is inflammation of the gallbladder and is not directly associated with frequent bruising and nosebleeds.

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Correct Answer is ["A","D","E"]

Explanation

A. Perform leg exercises every 2 hr: This is a good practice for any postoperative patient to prevent blood clots and maintain circulation. It's especially important for patients who might be relatively immobile due to surgery.

B. Irrigate the nasogastric tube every 4 to 8 hr: This is generally not a standard procedure. Nasogastric tubes are typically used for drainage or feeding. If there's a blockage or other issue, healthcare providers might intervene, but routine irrigation is not commonly done.

C. Maintain bed rest for 48 hr following surgery: While some rest might be necessary immediately after surgery, the trend in modern healthcare is to encourage mobility as soon as it's safe. Early mobilization can prevent complications such as blood clots and aid in recovery.

D. Encourage hourly use of an incentive spirometer while awake: Incentive spirometry is often encouraged postoperatively to prevent lung complications like atelectasis. Regular use helps keep the lungs expanded and functioning optimally.

E. Document the color, consistency, and amount of nasogastric drainage: This is crucial. Monitoring the drainage can provide important information about the patient's condition, such as bleeding or the effectiveness of the treatment. Any changes should be reported to the healthcare provider.

A. Obtain the client's vital signs. B. Weigh the client. C. Change the client's dressing. D. Administer pain medication.

Correct Answer is D

Explanation

A. Obtain the client's vital signs:
Vital signs are essential for assessing the client's overall condition and can provide crucial information about the client's stability. However, in this scenario, there's a higher priority nursing action that needs immediate attention.

B. Weigh the client:
Daily weight measurement is important, especially in postoperative patients, to monitor for fluid retention or loss. However, this is not the most urgent action in this situation.

C. Change the client's dressing:
Changing the dressing involves maintaining the surgical site's cleanliness and preventing infections. While this is important, it's not the highest priority in this situation.

D. Administer pain medication:
Correct Choice. Addressing the client's pain is a priority to ensure their comfort and well-being, especially postoperatively. Managing pain effectively is crucial for the client's recovery and can facilitate other necessary activities, such as changing the dressing or weighing the client.

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A nurse in a clinic is caring for a client who has alcohol use disorder. The client reports frequent bruising and nosebleeds. Which of the following conditions should the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting in the plan of care for a client who had surgery for a bowel obstruction. The client has a nasogastric tube in place. Which of the following actions should the nurse include in the client's plan of care? (Select all that apply.)

Correct Answer is ["A","D","E"]

Explanation

Correct Answer is D

Explanation

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