The nurse is reviewing the record of a client with a diagnoses of Cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?

Dorsiflex the client's foot

Ask the client to extend the arms

Measure the abdominal girth

Instruct the client to lean forward

Answer and Explanation

The Correct Answer is B

A. Dorsiflex the client’s foot: Foot dorsiflexion does not assess asterixis; it is used in neurologic tests (e.g., clonus assessment).

B. Ask the client to extend the arms: Asterixis ("liver flap") is a flapping tremor seen in hepatic encephalopathy due to high ammonia levels. The nurse assesses for asterixis by asking the client to extend their arms and dorsiflex their wrists—a positive sign is a flapping movement of the hands.

C. Measure the abdominal girth: Abdominal girth measurement is used to assess ascites, not asterixis.

D. Instruct the client to lean forward: Leaning forward does not help in assessing asterixis; it is more relevant in pericarditis (relieves chest pain).

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Correct Answer is A

Explanation

A. Increased serum amylase: Amylase, like lipase, is an enzyme produced by the pancreas. In acute pancreatitis, amylase levels rise significantly due to pancreatic inflammation.

B. Decreased serum lipase: Lipase is actually increased, not decreased, in pancreatitis. Elevated lipase is more specific than amylase for diagnosing pancreatitis.

C. Increased serum calcium: Hypocalcemia (low calcium) is more commonly seen in acute pancreatitis due to fat necrosis binding calcium in the pancreas.

D. Decreased WBC: WBC count is usually elevated in acute pancreatitis due to the body’s inflammatory response.

Correct Answer is ["25"]

Explanation

Total volume to be infused = 50 mL
Infusion rate = 2 mL/min

Time required = Total volume / Infusion rate
= 50 mL ÷ 2 mL/min
= 25 minutes

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The nurse is reviewing the record of a client with a diagnoses of Cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse admits a client to the emergency department who reports nausea and vomiting that worsens when he lies down. Antacids do not help. The provider suspects acute pancreatitis. Which of the following laboratory test results should the nurse expect to see?

Correct Answer is A

Explanation

The nurse is reviewing an order of infuse 12.5 grams of V Albumin to the client. The albumin is dispensed as 12.5 grams in 50 mL bottles and can be infused at 2 mL/minute. How long will it take to administer this dose of Albumin.

Correct Answer is ["25"]

Explanation

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The nurse is reviewing the record of a client with a diagnoses of Cirrhosis and notes that there is documentation of the presence of asterixis. How should the nurse assess for its presence?

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