A nurse is caring for an older adult client who has just been admitted to the intensive care unit with a diagnosis of confusion/delirium. The client has an end- stage liver failure diagnosis with increasing ascites. Their spouse questions the nurse about the client's mental status because they state that the client is usually lucid. Which of the following indications is likely the contributing factor for the admitting diagnosis?

"This is likely related to a new-onset schizophrenia."

"This is likely related to new-onset hepatic encephalopathy."

"This is likely related to new-onset dementia."

“This is likely related to a new-onset UTI."

Answer and Explanation

The Correct Answer is B

A. "This is likely related to a new-onset schizophrenia.": Schizophrenia typically develops in younger adults and would not be expected in an older adult with end-stage liver failure. It also does not explain the rapid onset of confusion.

B. "This is likely related to new-onset hepatic encephalopathy.": Hepatic encephalopathy is common in clients with liver failure and can cause confusion, delirium, and changes in mental status due to the accumulation of toxins like ammonia, which can cross the blood-brain barrier, causing neurological dysfunction.

C. "This is likely related to new-onset dementia.": Dementia generally develops gradually over time, not acutely. The sudden onset of confusion in a client with liver failure is more likely related to hepatic encephalopathy rather than dementia.

D. “This is likely related to a new-onset UTI.": While urinary tract infections can cause confusion, particularly in older adults, this client’s end-stage liver failure and ascites are more likely to be contributing to the mental status changes through hepatic encephalopathy.

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Correct Answer is D

Explanation

A. Client report of anorexia: Anorexia is not a common symptom of hypoparathyroidism. The primary concerns are related to calcium levels and neuromuscular symptoms, not appetite changes.

B. Flaccid muscles: Hypoparathyroidism typically causes muscle spasms or stiffness due to low calcium levels, not flaccid muscles. Muscle rigidity or tetany is more characteristic.

C. Negative Chvostek's sign: A negative Chvostek's sign indicates normal calcium levels, but in hypoparathyroidism, Chvostek's sign is typically positive (facial muscle twitching) due to low calcium levels.

D. Client report of numbness in his hands: Numbness or tingling, especially in the hands and around the mouth, is a common symptom of hypoparathyroidism due to low calcium levels, which affect nerve function.

A. Administer intravenous propranolol and schedule elective band ligation B. Transfuse packed red blood cells to a hemoglobin >13 g/dL C. Initiate IV octreotide and antibiotics, and arrange for endoscopic variceal ligation D. Start diuretics to reduce ascitic fluid immediately

Correct Answer is C

Explanation

A. Administer intravenous propranolol and schedule elective band ligation: Propranolol is used for preventing future bleeding from varices, not for acute management. Band ligation is performed after stabilization, not in an emergency setting.

B. Transfuse packed red blood cells to a hemoglobin >13 g/dL: Transfusions may be necessary for shock, but the goal is stabilization, not to achieve a specific hemoglobin level immediately. Blood transfusion should be done cautiously to correct hypovolemia.

C. Initiate IV octreotide and antibiotics, and arrange for endoscopic variceal ligation: Octreotide helps control bleeding by reducing portal pressure, and antibiotics prevent infections. Endoscopic ligation is the definitive treatment for bleeding varices, after initial stabilization.

D. Start diuretics to reduce ascitic fluid immediately: Diuretics are for chronic management of ascites, not acute bleeding. The priority is to control the hemorrhage and stabilize the patient first.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has hypoparathyroidism. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

Correct Answer is C

Explanation

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should nurse include in the teaching?

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

A nurse is caring for a client who reports consuming heavy amounts of alcohol. Which of the following manifestations should the nurse expect?

A nurse is providing education to a client who needs a cholecystectomy due to a build-up of calculi or gallstones. Which of the following is the best response from the nurse to explain what caused this problem?

A nurse is reviewing the laboratory results for four clients. The nurse should recognize which of the following clients has a manifestation of hypoparathyroidism?

A nurse is caring for a client who is newly diagnosed with hyperthyroidism and reports dry eyes and sensitivity to light. The nurse notes that the client's eyes have a bulging appearance. Which of the following should the nurse include in the client's plan of care?

A nurse is planning care for a client who has hyperthyroidism and is receiving radioactive iodine (radioiodine). Which of the following statements by the nurse regarding special precautions is appropriate?