You are receiving shift report on a patient with intrahepatic biliary disease (cirrhosis). The nurse tells you the patient’s bilirubin levels are very high. Based on your knowledge, what could you expect to see regarding this patient? (Select all that apply)

Yellowing of the sclera

Dark brown urine

Frothy light-colored urine

Jaundice of the skin

Bluish mucous membranes

Answer and Explanation

Correct Answer : A,B,D

Choice A reason: Yellowing of the sclera (icterus) is expected with high bilirubin in cirrhosis, as impaired liver function causes bilirubin accumulation. Conjugated bilirubin deposits in the sclera, visible early due to its vascularity, making this a correct clinical finding.

Choice B reason: Dark brown urine results from excess conjugated bilirubin excreted by the kidneys in cirrhosis. High bilirubin levels overwhelm liver clearance, leading to bilirubinuria, which darkens urine, making this a correct and common finding in this condition.

Choice C reason: Frothy light-colored urine is not associated with high bilirubin. Light urine suggests dilute urine or low bilirubin excretion, opposite to the dark urine seen in cirrhosis, making this an incorrect finding for this patient’s condition.

Choice D reason: Jaundice of the skin occurs with elevated bilirubin in cirrhosis, as bilirubin deposits in tissues. This yellowish discoloration is a hallmark of liver dysfunction, reflecting impaired bilirubin metabolism, making this a correct clinical manifestation.

Choice E reason: Bluish mucous membranes suggest cyanosis from hypoxemia, not related to high bilirubin. Cirrhosis causes jaundice, not oxygenation issues, unless complicated by other conditions, making this an incorrect finding for this patient.

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Correct Answer is C

Explanation

Choice A reason: The egg would not stay the same size, as ocean water is hypertonic (higher salinity) compared to Lake Michigan’s fresh water. Osmotic differences drive water movement into the egg, causing swelling, making this an incorrect prediction.

Choice B reason: “None of the above” is incorrect, as the egg will swell due to osmosis. Fresh water in Lake Michigan has lower solute concentration than the egg’s cytoplasm, causing water influx, making this an invalid choice.

Choice C reason: The sea star egg will swell in Lake Michigan’s fresh water, which is hypotonic to the egg’s hypertonic cytoplasm. Water moves into the egg via osmosis, increasing its volume, making this the correct prediction for the egg’s response.

Choice D reason: The egg would shrink in a hypertonic environment, like concentrated saltwater, not fresh water. Lake Michigan’s hypotonic fresh water causes water influx, not loss, making shrinking an incorrect outcome for the egg.

A. Immune thrombocytopenic purpura (ITP) B. Thrombotic thrombocytopenic purpura (TTP) C. Hemophilia D. Disseminated intravascular coagulation (DIC)

Correct Answer is D

Explanation

Choice A reason: Immune thrombocytopenic purpura (ITP) causes isolated thrombocytopenia due to autoimmune platelet destruction, leading to bleeding like petechiae. However, it does not typically cause prolonged PT/aPTT, elevated D-dimer, or DVT, making it inconsistent with Lorretta’s multi-system coagulopathy.

Choice B reason: Thrombotic thrombocytopenic purpura (TTP) involves microangiopathic hemolytic anemia, thrombocytopenia, and organ damage but typically presents with neurological or renal symptoms, not prolonged PT/aPTT or DVT. Lorretta’s coagulopathy and DVT history better align with another condition, making TTP incorrect.

Choice C reason: Hemophilia, a genetic clotting factor deficiency, causes prolonged aPTT but not thrombocytopenia, elevated D-dimer, or DVT. It primarily affects males and causes joint or muscle bleeds, not diffuse bleeding like Lorretta’s, making this an incorrect diagnosis.

Choice D reason: Disseminated intravascular coagulation (DIC) involves widespread clotting and bleeding, causing thrombocytopenia, prolonged PT/aPTT, elevated D-dimer, and petechiae. Lorretta’s DVT history and anticoagulant use may trigger DIC, with leg swelling indicating thrombosis, making this the correct diagnosis.

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You are receiving shift report on a patient with intrahepatic biliary disease (cirrhosis). The nurse tells you the patient’s bilirubin levels are very high. Based on your knowledge, what could you expect to see regarding this patient? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

If a sea star egg is taken from the ocean and put into Lake Michigan, would you expect the egg to shrink, swell, or stay the same size?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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You are receiving shift report on a patient with intrahepatic biliary disease (cirrhosis). The nurse tells you the patient’s bilirubin levels are very high. Based on your knowledge, what could you expect to see regarding this patient? (Select all that apply)