A nurse is caring for a client who has a new diagnosis of liver disease. Which of the following manifestations should the nurse expect?

Night sweats

Acanthosis nigricans

Hemosiderin staining

Pruritus

Answer and Explanation

The Correct Answer is D

Choice A Reason: Night sweats

Night sweats are not typically associated with liver disease. They are more commonly linked to conditions such as infections, hormonal imbalances, or certain cancers1. While liver disease can cause a variety of symptoms, night sweats are not a primary manifestation.

Choice B Reason: Acanthosis nigricans

Acanthosis nigricans is characterized by dark, velvety patches of skin, usually in body folds and creases. It is often associated with insulin resistance, obesity, and certain endocrine disorders. It is not a common manifestation of liver disease.

Choice C Reason: Hemosiderin staining

Hemosiderin staining refers to the deposition of iron in the skin, which can cause a brownish discoloration. This condition is more commonly associated with chronic venous insufficiency or hemochromatosis, a genetic disorder that causes iron overload. It is not a typical symptom of liver disease.

Choice D Reason: Pruritus

Pruritus, or itching, is a common symptom of liver disease. It is often caused by the accumulation of bile salts in the skin due to impaired bile flow, a condition known as cholestasis. This symptom can be particularly distressing for patients and is a significant indicator of liver dysfunction.

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Correct Answer is B

Explanation

Choice A Reason: Alternate the use of ice and heat

Alternating the use of ice and heat is not typically recommended for the initial treatment of a soft-tissue injury. Ice is generally used during the first 24-48 hours to reduce swelling and inflammation. Heat can be applied later to help relax muscles and improve blood flow, but it should not be used immediately after an injury as it can increase swelling.

Choice B Reason: Apply ice pack intermittently

Applying the ice pack intermittently is important to prevent skin damage and frostbite. It is generally recommended to apply ice for 15-20 minutes at a time, followed by a break of at least 20 minutes before reapplying. This helps to reduce swelling and pain without causing harm to the skin and underlying tissues.

Choice C Reason: Do not place ice pack directly on the skin

Placing an ice pack directly on the skin can cause frostbite and damage to the skin and tissues. It is important to wrap the ice pack in a thin cloth or towel before applying it to the injured area. This provides a barrier that protects the skin while still allowing the cold to penetrate and reduce swelling.

Choice D Reason: Leave ice pack on for no more than 20 minutes at a time

Leaving the ice pack on for no more than 20 minutes at a time is crucial to prevent frostbite and skin damage. Prolonged exposure to cold can cause harm, so it is important to limit the duration of each application and take breaks in between.

A. The client should maintain systolic BP between 130 and 135 mm Hg. B. The client should maintain systolic BP between 141 and 145 mm Hg. C. The client should maintain systolic BP between 136 and 140 mm Hg. D. The client should maintain systolic BP between 120 and 129 mm Hg.

Correct Answer is D

Explanation

Choice A Reason: The client should maintain systolic BP between 130 and 135 mm Hg

Maintaining a systolic BP between 130 and 135 mm Hg is higher than the recommended range for someone who has experienced a transient ischemic attack (TIA). According to the American Heart Association, the goal for systolic BP in patients with a history of TIA or stroke should be lower to reduce the risk of recurrent events. While this range is not extremely high, it is still above the optimal target for secondary prevention.

Choice B Reason: The client should maintain systolic BP between 141 and 145 mm Hg

This range is significantly higher than the recommended target for systolic BP in patients with hypertension and a history of TIA. Elevated BP in this range increases the risk of recurrent stroke and other cardiovascular events. Effective BP management is crucial in reducing these risks, and maintaining a systolic BP in this range would not be advisable.

Choice C Reason: The client should maintain systolic BP between 136 and 140 mm Hg

Although this range is slightly lower than choice B, it is still above the optimal target for patients with a history of TIA. Research indicates that tighter BP control can significantly reduce the risk of recurrent strokes. Therefore, maintaining a systolic BP in this range would not be ideal for secondary prevention.

Choice D Reason: The client should maintain systolic BP between 120 and 129 mm Hg

This range aligns with the current guidelines for BP management in patients with a history of TIA or stroke. Maintaining a systolic BP between 120 and 129 mm Hg helps reduce the risk of recurrent cerebrovascular events4. This target is considered optimal for secondary prevention and is supported by evidence from various studies and clinical guidelines.

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A nurse is caring for a client who has a new diagnosis of liver disease. Which of the following manifestations should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client about the use of ice for treatment of a soft-tissue injury. Which of the following instructions should be included? (Select All that Apply.)

Correct Answer is B

Explanation

A nurse is providing discharge instructions to a client who has hypertension that has resulted in a transient ischemic attack (TIA). Which of the following information should the nurse discuss with the client regarding blood pressure (BP) management?

Correct Answer is D

Explanation

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