The patient is a known intravenous drug abuser and presents to the emergency department complaining of abdominal pain and nausea. The patient denies having hepatitis or human immunodeficiency virus infection. Hepatitis is considered a differential diagnosis based on the patient's history. The nurse realizes that:
Hepatitis patients usually have normal-sized livers.
Hepatitis patients often do not know that they have the disease.
Hepatitis patients first present with scleral jaundice.
Nausea and vomiting are classic signs of full-blown hepatitis.
The Correct Answer is B
Choice B rationale
Many individuals with chronic hepatitis, particularly Hepatitis C, remain asymptomatic for years or even decades. Because the liver has a large functional reserve, significant damage can occur before the patient feels ill. Intravenous drug users are at high risk due to needle sharing, yet they often do not seek testing until end-stage symptoms appear. This lack of awareness contributes to the silent spread of the virus and delays the initiation of necessary antiviral therapies.
Choice A rationale
In the early or acute stages of hepatitis, the liver typically becomes enlarged and tender, a condition known as hepatomegaly. This occurs due to the inflammatory response triggered by the viral infection, leading to cellular swelling and infiltration by immune cells. A normal-sized liver is not a typical finding in active hepatitis. As the disease progresses to advanced cirrhosis, the liver may eventually shrink and become fibrotic, but during the initial presentation, enlargement is the standard.
Choice C rationale
Scleral icterus, or the yellowing of the white part of the eyes, is a common sign of liver dysfunction, but it is usually not the first symptom to appear. The pre-icteric phase of hepatitis often involves non-specific systemic symptoms such as extreme fatigue, low-grade fever, myalgia, and anorexia. Jaundice only develops once bilirubin levels in the blood exceed the normal range of 0.3 to 1.2 mg/dL, which typically happens days or weeks after the initial prodromal symptoms begin.
Choice D rationale
While nausea and vomiting are frequently associated with hepatitis, they are most common during the prodromal or pre-icteric phase rather than the full-blown icteric phase. During the peak of the illness, the primary features are jaundice, dark tea-colored urine, and clay-colored stools due to impaired bilirubin metabolism. Nausea is a general symptom of systemic inflammation and is not considered a specific classic sign of the later stages of the disease compared to jaundice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Dopamine is a potent vasopressor and inotropic agent used in septic shock to improve hemodynamic stability. At moderate to high doses, it stimulates beta-1 adrenergic receptors to increase myocardial contractility and alpha-adrenergic receptors to induce peripheral vasoconstriction. These combined actions result in an increased stroke volume and systemic vascular resistance, effectively raising the cardiac output and the mean arterial pressure. This is essential for maintaining adequate tissue perfusion when intravenous fluids alone fail.
Choice B rationale
Dopamine does not primarily act to decrease preload; in fact, its vasoconstrictive properties may increase venous return to the heart, potentially maintaining or slightly increasing preload. Preload reduction is typically achieved through diuretics or venous vasodilators like nitroglycerin. In the context of septic shock, the therapeutic goal is to support blood pressure and flow rather than reducing the volume or pressure within the ventricles before contraction, which could further compromise the patient's precarious hemodynamic state.
Choice C rationale
Dopamine actually increases myocardial oxygen consumption rather than decreasing it. By increasing the heart rate through its chronotropic effects and enhancing the force of contraction through its inotropic effects, the heart must work harder and requires more oxygen. This can be a significant side effect, especially in patients with underlying coronary artery disease. The drug is used in shock because the benefit of improving systemic perfusion outweighs the risk of increased cardiac oxygen demand.
Choice D rationale
Dopamine typically increases afterload because it causes systemic vasoconstriction via alpha-receptors, especially at higher infusion rates. Afterload is the resistance the heart must pump against to eject blood. In septic shock, systemic vascular resistance is pathologically low due to massive vasodilation. Therefore, increasing afterload is a desired therapeutic effect to restore vascular tone and ensure that the mean arterial pressure remains high enough to perfuse vital organs like the brain and kidneys.
Correct Answer is ["1"]
Explanation
4 Step 1 is (0.1 mg × 1000) to convert to mcg.
Step 2 is 100 mcg.
Step 3 is (100 mcg ÷ 100 mcg) × 1 tablet.
Step 4 is 1 tablet.
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