For each client assessment finding below, click to specify if the finding is consistent with cirrhosis or viral hepatitis: Each finding may support more than one disease process

Exhibits

Report of pain

Eye sclera finding

Alcohol intake history

Report of energy level

Answer and Explanation

The Correct Answer is {"A":{"answers":"A,B"},"B":{"answers":"A,B"},"C":{"answers":"A"},"D":{"answers":"A,B"}}

Rationale:

Report of pain: Abdominal pain is common in both cirrhosis and viral hepatitis due to liver inflammation, capsule stretching, or complications like ascites. In hepatitis, pain is often acute and located in the right upper quadrant, while in cirrhosis, it may be more generalized or related to portal hypertension.
Eye sclera finding: Jaundice, noted as yellowing of the sclera, occurs in both conditions due to impaired bilirubin metabolism. In cirrhosis, it's due to chronic hepatocellular failure, while in viral hepatitis, it's from acute inflammation impairing bilirubin excretion.
Alcohol intake history: A 25-year history of heavy alcohol use is a strong risk factor for alcoholic cirrhosis. While alcohol use can worsen viral hepatitis, it is not a primary cause of viral hepatitis, which is due to infection with hepatitis viruses (A, B, C, etc.).
Report of energy level: Fatigue is a common symptom in both conditions due to impaired liver function, toxin accumulation, anemia, or systemic inflammation. In viral hepatitis, fatigue is often sudden and profound, while in cirrhosis, it is usually chronic and progressive.

Nursing Test Bank

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Correct Answer is C

Explanation

Rationale:
A. Close the pinch clamp on the CVC: Clamping the catheter is important to stop further air entry, but placing the client in the proper position takes priority to trap the air and prevent it from reaching the pulmonary circulation.

B. Obtain a prescription for stat ABGs: ABGs may help assess respiratory compromise, but they are not the immediate action. This diagnostic step should follow emergency interventions that prevent further complications from an air embolism.

C. Place the client in left Trendelenburg position: This is the priority action because it helps trap any air in the right atrium and prevents it from entering the pulmonary arteries, reducing the risk of a fatal air embolism. Positioning the client correctly is a critical first step in managing suspected air embolism.

D. Check the tubing for placement of a locking adaptor: Verifying equipment setup is important for preventing future incidents, but it does not address the client’s current critical condition. Immediate positioning takes precedence.

A. "Lie down after meals." B. "Elevate the head of the bed while sleeping." C. "Eat a snack 1 hour before going to bed." D. "Eat three large meals each day."

Correct Answer is B

Explanation

Rationale:
A. "Lie down after meals.": Lying down after eating increases the risk of gastric contents refluxing into the esophagus due to gravity. Clients with GERD should remain upright for at least 2 to 3 hours after meals to minimize symptoms.
B. "Elevate the head of the bed while sleeping.": Elevating the head of the bed by 6 to 8 inches helps prevent nighttime reflux by using gravity to reduce backward flow of stomach acid into the esophagus, which is a key strategy in GERD management.
C. "Eat a snack 1 hour before going to bed.": Eating close to bedtime can exacerbate GERD symptoms by increasing gastric volume and acid production, especially when the client lies down soon after eating. A longer gap between the last meal and sleep is advised.
D. "Eat three large meals each day.": Large meals increase gastric pressure and acid production, worsening reflux symptoms. Clients with GERD should eat smaller, more frequent meals to reduce gastric distension and minimize acid reflux episodes.

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For each client assessment finding below, click to specify if the finding is consistent with cirrhosis or viral hepatitis: Each finding may support more than one disease process Exhibits

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is teaching a client who has a new diagnosis of gastroesophageal reflux disease. Which of the following instructions should the nurse include?

Correct Answer is B

Explanation

A nurse is assessing a client's understanding of a surgical procedure prior to witnessing their signature on the informed consent form. The nurse determines that the client does not understand what the procedure will involve. Which of the following actions should the nurse take?

A nurse is assessing a client who has a history of type 2 diabetes mellitus. The nurse should identify which of the following findings as an indication of a microvascular complication?

A nurse is caring for a client who is receiving peritoneal dialysis. Which of the following actions should the nurse take?

A nurse notes that a client's eyes are protruding slightly from their orbits. Which of the following laboratory findings should the nurse expect?

A nurse in a community clinic is caring for a client who has systemic lupus erythematosus (SLE). Which of the following statements by the client should the nurse determine is the priority?

A nurse is planning preventative strategies for a client who is at risk for pressure injuries. Which of the following actions should the nurse include in the plan?

A nurse is completing an admission assessment for a client who has bacterial meningitis. Which of the following personal protective equipment should the nurse use while caring for the client?

A nurse is caring for a client who recently assumed the role of caregiver for their aging parents who have chronic illnesses. The nurse should identify that which of the following statements by the client indicates acceptance of the role change?

For each client assessment finding below, click to specify if the finding is consistent with cirrhosis or viral hepatitis: Each finding may support more than one disease process

Exhibits