The nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute?

Temperature of 100.1° F (37.8° C)

Upper abdominal pain after eating

Clay-colored stools

Positive Murphy sign

Answer and Explanation

The Correct Answer is C

Chronic cholecystitis results from repeated episodes of acute inflammation or long-term irritation by gallstones, leading to a fibrotic and thickened gallbladder wall. While acute episodes are marked by fever and sharp pain, the chronic form involves a persistent inability to effectively process bile. This leads to long-standing biliary obstruction, which prevents the pigments necessary for stool coloration from reaching the intestinal tract.

Rationale:

A. A temperature of 100.1° F is a sign of acute inflammation or infection. Fever is a hallmark of acute cholecystitis, where the body is reacting to sudden gallbladder distention or bacterial growth. In chronic cholecystitis, the inflammatory response is low-grade and less likely to produce a significant or acute febrile state unless a new obstruction occurs.

B. Upper abdominal pain after eating (biliary colic) occurs in both acute and chronic cholecystitis. It is a general symptom of gallbladder disease triggered by the ingestion of fat. Because it is common to both stages of the disease, it is not a specific enough finding to distinguish between a chronic fibrotic state and an acute inflammatory episode.

C. Clay-colored stools (acholic stools) indicate a chronic or total biliary obstruction. Bile contains bilirubin, which is converted to stercobilin to give stool its brown color. When bile flow is chronically obstructed, the absence of these pigments results in light or clay-colored stools, signifying a long-standing failure of the biliary excretion system.

D. A positive Murphy sign is a specific indicator of acute cholecystitis. It occurs when the patient stops breathing in (inspiratory arrest) while the nurse palpates the right upper quadrant because the inflamed gallbladder comes into contact with the examiner's hand. This exquisite tenderness is a sign of acute inflammation, not the duller, more persistent symptoms of chronic disease.

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Correct Answer is A

Explanation

Hepatic encephalopathyis a reversible neuropsychiatric syndrome resulting from liver failure and portosystemic shunting. The damaged liver cannot detoxify nitrogenous wasteproducts, primarily ammonia, which is produced by the bacterial degradation of protein in the gut. Elevated serum ammoniacrosses the blood-brain barrier, causing astrocyte swelling and cerebral edema, which manifests as altered consciousness and a characteristic "flapping" tremor known as asterixis.

Rationale:

A.The nurse should explain that these interventions are designed to reduce the ammonialevel in the blood. Restricting protein limits the substrate for ammonia production, while lactulosecreates an acidic environment in the colon to convert ammonia into non-absorbable ammonium. This dual approach facilitates the excretion of neurotoxins through the stool, thereby improving the patient's cognitive status and neurological function.

B.While nausea and vomiting are common in liver disease, protein restriction and lactulose are not primary treatments for these gastrointestinal symptoms. In fact, lactulose frequently causes abdominal cramping and bloating as side effects. The scientific rationale for these specific therapies is focused entirely on metabolic detoxification rather than the management of nausea or vomiting.

C.Jaundice is caused by the accumulation of bilirubin due to impaired hepatic excretion or hemolysis, not elevated ammonia levels. Although jaundice is a hallmark of cirrhosis, neither lactulose nor moderate protein restriction directly influences the metabolic pathway of bilirubin. These treatments target the neuropsychiatric complications of liver failure rather than the pigmentary changes of the skin and sclera.

D.Heart failure is not the primary concern addressed by protein restriction and lactulose therapy in the context of hepatic encephalopathy. While cirrhosis can lead to high-output heart failure or cirrhotic cardiomyopathy, these conditions require diuretics and salt restriction. The nurse must clarify that these specific interventions are intended to protect brain function from toxic metabolic byproducts.

A. Steak B. Chocolate C. Carrots D. Popcorn

Correct Answer is B

Explanation

Gastroesophageal reflux disease(GERD), commonly experienced as heartburn, occurs when the lower esophageal sphincter(LES) fails to remain closed, allowing acidic gastric contents to reflux into the esophagus. Certain dietary components contain methylxanthines or specific fats that exert a pharmacological effect on the smooth muscle of the LES, causing it to relax. Reducing these triggers is a primary strategy to prevent mucosal injury and esophagitis.

Rationale:

A.Steak is a high-protein food that generally does not cause the immediate relaxation of the lower esophageal sphincter. While very fatty cuts of meat can delay gastric emptying and contribute to reflux, steak itself is not a classic, direct chemical trigger for heartburn. The patient should focus on eliminating known chemical relaxants of the esophageal muscle first.

B.Chocolateshould be eliminated because it contains methylxanthines(like theobromine) which relax the lower esophageal sphincter(LES). This relaxation allows stomach acid to backflow into the esophagus, causing the burning sensation known as pyrosis. Chocolate is also often high in fat, which further slows gastric emptying and increases the likelihood of reflux episodes.

C.Carrots are a non-acidic, low-fat vegetable that is generally well-tolerated by patients with GERD. They do not contain chemicals that affect sphincter tone or increase gastric acid production. Carrots are actually a recommended part of a "reflux-friendly" diet because they provide fiber and nutrients without triggering the symptoms of heartburn or esophageal irritation.

D.Popcorn is a whole-grain snack that is generally safe for GERD patients, provided it is not prepared with excessive butter or spicy seasonings. Plain or lightly salted popcorn does not possess the chemical properties needed to relax the esophageal sphincter. It is considered a low-risk food compared to the strong chemical triggers found in cocoa or caffeinated products.

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The nurse assesses a client who has cholecystitis. Which sign or symptom indicates that this condition is chronic rather than acute?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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