A nurse is caring for a client who has liver cirrhosis with ascites, bleeding esophageal varices, and portal hypertension. The nurse recognizes which of the following laboratory findings as indicating the client's gastrointestinal (GI) tract is digesting and absorbing blood?
Decreased bilirubin
Decreased chloride
Elevated blood urea nitrogen (BUN)
Elevated HbA1c
The Correct Answer is C
Rationale:
A. Decreased bilirubin is unrelated to digestion of blood in the GI tract.
B. Chloride levels do not indicate blood digestion.
C. When a client with esophageal varices bleeds into the GI tract, the digestion and absorption of blood proteins lead to increased nitrogen load, reflected as elevated BUN.
D. HbA1c reflects long-term blood glucose control, not acute digestion of blood.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Elevated AST indicates hepatocellular injury, but it does not directly reflect fluid volume status.
B. In liver cirrhosis, the liver produces less albumin, leading to reduced plasma oncotic pressure. Low albumin allows fluid to leak into interstitial spaces, causing ascites, edema, and overall fluid volume excess.
C. Prolonged PT reflects impaired clotting factor synthesis in cirrhosis, not fluid status.
D. High bilirubin indicates impaired bile excretion and liver dysfunction, but it is not a direct marker of fluid overload.
Correct Answer is B
Explanation
Rationale:
A. Lifting restrictions are typically advised for 2–4 weeks after laparoscopic cholecystectomy, not immediately postoperatively.
B. Encouraging ambulation once the client is fully awake helps prevent complications such as atelectasis, deep vein thrombosis, and promotes bowel function.
C. Placing the client flat in a supine position can increase the risk of respiratory complications; semi-Fowler’s is preferred.
D. Offering ice cream is not appropriate immediately after surgery; clear liquids are usually initiated first to assess tolerance.
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