Exhibits

Nurse reviews updated chart data.

For each intervention, click to indicate if it is indicated or contraindicated. Each row must have only one response option selected.

Rationale for Correct Choices:

• Alcoholic cirrhosis: The client has a history of chronic heavy alcohol use, jaundice, RUQ tenderness, a distended abdomen, and abnormal liver ultrasound findings, all consistent with alcoholic cirrhosis. The presence of regenerative nodules and a nodular liver surface on imaging further supports this diagnosis.
• Aspartate aminotransferase (AST): The AST is elevated at 120 U/L (normal range: 10–40 U/L), which commonly occurs in alcoholic liver disease. In alcoholic cirrhosis, AST levels often exceed ALT and indicate ongoing hepatocellular injury.
• Ammonia: The client’s ammonia level is elevated at 90 mcg/dL (normal: 15–45 mcg/dL), suggesting impaired hepatic clearance and early signs of hepatic encephalopathy, both seen in advanced liver disease such as cirrhosis.

Rationale for Incorrect Choices:

• Acute pancreatitis: The client does not report severe epigastric pain radiating to the back, which is typical for pancreatitis. There is also no elevation of serum lipase or amylase, and imaging does not show pancreatic inflammation or edema.
• Hepatitis A: Hepatitis A usually presents with acute onset of symptoms like fever, malaise, and dark urine. It is typically short-term and not associated with the chronic liver changes (nodular liver, regenerative nodules) found in this client.
• Chloride: While slightly elevated, the chloride level is not specific to liver disease and has minimal diagnostic value in cirrhosis. It is not typically used as a marker for hepatic dysfunction or alcoholic liver disease.
• White blood cell count: The WBC count is elevated (16,000/mm³), but this can be attributed to various causes such as inflammation or infection. It does not specifically support the diagnosis of cirrhosis like AST and ammonia levels do.

Rationale for Correct Choices:

• Hyponatremia: The client shows signs of neurological impairment (confusion and altered LOC), which are common symptoms of hyponatremia. The significant, concentrated urine output despite normal IV fluid intake suggests water retention and sodium dilution.
• Syndrome of inappropriate antidiuretic hormone (SIADH): A hypothalamic tumor can disrupt normal ADH regulation, leading to SIADH. In SIADH, excessive ADH causes water retention without sodium retention, resulting in dilutional hyponatremia. The high urine output relative to intake further supports inappropriate ADH secretion.

Rationale for Incorrect Choices:

• Hypernatremia: This condition is associated with dehydration, increased serum osmolality, and symptoms like thirst and dry mucous membranes, not confusion with preserved fluid intake and high urine output seen here.
• Hypokalemia: This typically presents with muscle weakness, cramping, or arrhythmias. It does not account for the client’s confusion or link directly to hypothalamic tumors and fluid imbalance.
• Diabetes insipidus: Although linked to hypothalamic or pituitary damage, diabetes insipidus causes hypernatremia due to water loss and low urine osmolality, not confusion from fluid retention and hyponatremia.
• Addison’s disease: Addison’s typically presents with hypotension, hyperkalemia, and fatigue. It is an adrenal insufficiency condition, not primarily linked to hypothalamic tumors or SIADH-like fluid handling.