A nurse is assessing a client with cirrhosis who has become increasingly confused and irritable.

The nurse notes tremors in the client's hands when arms are extended.

The provider suspects hepatic encephalopathy.

Highlight the portions of the passage that reflect signs, causes, and treatments of hepatic encephalopathy.

Some sentences or phrases may be unrelated or incorrect.

The client with cirrhosis appears disoriented and has difficulty answering simple asks.

The nurse observes asterixis when the client extends their arms.

Laboratory results show elevated mental status.

The provider prescribes lactulose to lower ammonia levels.

The client is placed on a high protein diet to support liver regeneration.

The nurse encourages the client to ambulate in the hallway to reduce the risk of acquiring pneumonia.

A CT scan of the brain is ordered to rule out a stroke.

The nurse monitors the client closely for worsening neurologic functions.

Choice A rationale

Scabies typically presents as intensely pruritic papules, vesicles, and burrows, rather than non-pruritic blisters. The characteristic itch is often worse at night and is caused by the mite’s burrowing and excretions under the skin, leading to a hypersensitivity reaction, and does not typically resolve with crusting within 7 days.

Choice B rationale

Prophylactic treatment for household members and close contacts is highly recommended to prevent re-infestation and control the spread of scabies. Even asymptomatic contacts can harbor mites and transmit the infection, making simultaneous treatment crucial for effective eradication and breaking the transmission cycle.

Choice C rationale

Scabies eggs typically hatch within 3 to 4 days after being laid by the female mite in the stratum corneum. The entire life cycle, from egg to adult, takes approximately 10 to 17 days. A 30-day incubation period for eggs is inaccurate and significantly longer than the actual biological process.

Choice D rationale

Scabies is caused by the microscopic mite *Sarcoptes scabiei* var. *hominis*, which burrows into the superficial layers of the epidermis. The female mite deposits eggs and feces within these burrows, leading to an intensely itchy hypersensitivity reaction in the host. This direct infestation causes the characteristic symptoms.

Choice A rationale

Hypertension is not a characteristic manifestation of Addison's disease; rather, hypotension, particularly orthostatic hypotension, is commonly observed. This is due to the deficiency of mineralocorticoids, primarily aldosterone, which leads to impaired sodium and water reabsorption in the renal tubules, resulting in decreased intravascular volume and blood pressure.

Choice B rationale

Weight gain is atypical in Addison's disease; instead, clients often experience weight loss. This is primarily due to the combined effects of anorexia, nausea, vomiting, and diarrhea, which are common gastrointestinal symptoms stemming from glucocorticoid deficiency and metabolic disturbances.

Choice C rationale

Excessive thirst, or polydipsia, is not a primary characteristic of Addison's disease. While severe dehydration from vomiting or diarrhea could induce thirst, the fundamental pathophysiology of Addison's disease, involving hypocortisolism and hypoaldosteronism, does not directly lead to excessive thirst as a predominant symptom.

Choice D rationale

Hyperpigmentation of the skin, particularly in areas exposed to sun and pressure points, is a classic manifestation of Addison's disease. This occurs due to increased production of pro-opiomelanocortin (POMC) in response to low cortisol, leading to elevated levels of melanocyte-stimulating hormone (MSH) fragments that stimulate melanin synthesis in melanocytes.