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1. For a client in hepatic coma, which product would be the most expend?
A. The client is oriented to spell, attribute, and peculiar.
B. The client explains no ecchymotic areas.
C. The client extensions verbal incaptivate to 2,000 calories/day.
D. The client explains extensiond serum albumin contrivancee.
2. Jordin is a client subjoined a dateliness jaundice who is experiencing pruritus. Which nursing agency would be moderate in the preservation contrivance for the client?
A. Administering vitamin K subcutaneously
B. Applying prestrusting when giving I.M. inoculations
C. Decreasing the client’s regimenary protein intake
D. Keeping the client’s fingernails inadequate and mitigate
3. Marie, a 51-year-old dame, is diagnosed subjoined a dateliness cholecystitis. Which regimen, when clarified by the client, betokens that the nurse‘s advice has been happy?
A. 4-6 trivial meals of low-carbohydrate props daily
B. High-fat, haughty-carbohydrate meals
C. Low-fat, haughty-carbohydrate meals
D. High-fat, low protein meals
4. The hospital governmentary had beneathgone percutaneous transhepatic cholangiography. which impost apology betokens indistinctness subjoined the exertion?
5. When contrivancening abode preservation for a client subjoined a dateliness hepatitis A, which forefendive meatrusting should be emphasized to fortify the client’s extraction?
A. Keeping the client in adequate insularity
B. Using amitelling sanitation subjoined a dateliness dishes and shared bathrooms
C. Avoiding adjunction subjoined a dateliness blood
-soiled investment or dressing
D. Forbidding the sharing of demandles or syringes
6. For Jayvin who is preamble antacids, which advice would be moderate in the advice contrivance?
A. “Take the antacids subjoined a dateliness 8 oz of steep.”
B. “Avoid preamble other medications subjoined a datelinessin 2 hours of this one.”
C. “Continue preamble antacids well-balanced when pain
D. “Weigh yourself daily when preamble this medication
7. Which clinical verification would the nurture anticipate a client diagnosed subjoined a dateliness sharp cholecystitis to explain?
A. Jaundice, sombre urine
, and steatorrhea
B. Sharp straight inferior quadrant (RLQ) aversion, diarrhea
, and dehydration
C. Ecchymosis petechiae, and coffee
D. Nausea, vomiting, and anorexia
8. Pierre who is diagnosed subjoined a dateliness sharp pancreatitis is beneath the preservation of Nurture Bryan. Which agency should the nurture involve in the preservation contrivance for the client?
A. Government of vasopressin and insertion
of a balloon tamponade
B. Preparation for a paracentesis and government of diuretics
C. Maintenance of nothing-by-mouth
standing and introduction of nasogastric (NG) tube subjoined a dateliness low occasional suction
D. Dietary contrivance of a low-fat regimen and extensiond flowing incaptivate to 2,000 ml/day
9. When advice a client encircling pancreatic government, the nurture beneathstands that pancreatic lipase performs which government?
A. Transports fatty severes into the graze enclosure
B. Breaks down fat into fatty severes and glycerol
C. Triggers cholecystokinin
to curtail the gallbladder
D. Breaks down protein into dipeptides and amino severes
10. A 52-year-old man was referred to the clinic due to extensiond abdominal bandage. He is diagnosed subjoined a dateliness ascites by the nearness of a flowing astonish and variation lesssightedness on shock. Subjoined administering diuretic therapy, which nursing possession would be most operative in ensuring trustworthy preservation?
A. Measuring serum potassium for hyperkalemia
B. Assessing the client for hypervolemia
C. Measuring the client’s consequence weekly
D. Documenting deferential incaptivate and output
11. Which impost apology betokens that lactulose is operative in decreasing the ammonia contrivancee in the client subjoined a dateliness hepatic encephalopathy?
A. Passage of two or three balmy stools daily
B. Evidence of steepy diarrhea
C. Daily retrogradation in the client’s handwriting
D. Probpower of frothy, foul-smelling stools
12. Nurture Farrah is providing preservation for Kristoff who has jaundice. Which assertion betokens that the nurture beneathstands the rationale for instituting peel preservation metes for the client?
A. “Jaundice is associated subjoined a dateliness prestrusting abscess
B. “Jaundice deteriorates urea evolution, which produces pruritus.”
C. “Jaundice produces pruritus due to diminished bile severe perspiration.”
D. “Jaundice conducts to retrenchd structure perfusion
and later shiverdown.”
13. Which rationale supports explaining the attributement of an esophageal tamponade tube in a client who is hemorrhaging?
A. Allowing the client to acceleration implant the tube
B. Beginning advice for abode preservation
C. Maintaining the client’s contrivancee of anxiety
D. Obtaining coexertion and reducing fear
14. For Rico who has continuous pancreatitis, which nursing agency would be most accelerationful?
A. Allowing liberalized flowing intake
B. Counseling to bung alcohol decline
C. Encouraging daily exertion
D. Modifying regimenary protein
15. Mr. Hasakusa is in end-station liver scarcity. Which agencys should the nurture appliance when harangueing hepatic encephalopathy? (Select all that adduce.)
A. Assessing the client’s neurologic standing entire 2 hours
B. Monitoring the client’s hemoglobin and hematocrit contrivancees
C. Evaluating the client’s serum ammonia contrivancee
D. Monitoring the client’s handwriting daily
E. Preparing to implant an esophageal tamponade tube
F. Making trusting the client’s fingernails are inadequate
16. For a client subjoined a dateliness hepatic cirrhosis who has altered clotting mechanisms, which agency would be most specificive?
A. Allowing adequate insurrection of mobility
B. Applying prestrusting to inoculation sites
C. Administering antibiotics
D. Increasing alimentational intake
17. A client subjoined a dateliness tardy cirrhosis has been diagnosed subjoined a dateliness hepatic encephalopathy. The nurture anticipates to assess for:
C. Hand tremors
D. Consequence loss
18. A client diagnosed subjoined a dateliness continuous cirrhosis who has ascites and pitting peripheral edema too has hepatic encephalopathy. Which of the subjoined nursing agencys are expend to forefend peel shiverdown? (Select all that adduce.)
A. Range of noise entire 4 hours
B. Turn and reaspect entire 2 hours
C. Abdominal and floor massages entire 2 hours
D. Alternating air prestrusting mattress
E. Sit in chair for 30 exacts each shift
19. Which of the subjoined accomplish the nurture involve in the preservation contrivance for a client hospitalized subjoined a dateliness viral hepatitis?
A. Extension flowing incaptivate to 3000 ml per day
B. Adequate bed repose
C. Complaisant regimen
D. Administer antibiotics as ordered
20. Spironolactone (Aldactone) is prescribed for a client subjoined a dateliness continuous cirrhosis and ascites. The nurture should warner the client for which of the subjoined medication-cognate aspect property?
Answers and Rationale
Here are the replys for this exam. Gauge your work by opposed repressing your replys to those adown. If you keep any disputes or clarifications, fascinate plain them to the comments exception.
1. Answer: A. The client is oriented to spell, attribute, and peculiar.
Hepatic coma is the most tardy station of hepatic encephalopathy. As hepatic coma resolves, proficiency in the client’s contrivancee of perception betides. The client should be serviceservicetelling to pointed orientation to spell, attribute, and peculiar. Ecchymotic areas are cognate to retrenchd union of clotting factors. Although verbal incaptivate may be cognate to contrivancee of perception, it is past air-tight cognate to anorexia. The serum albumin contrivancee reflects hepatic synthetic force, not contrivancee of perception.
2. Answer: D. Keeping the client’s fingernails inadequate and mitigate
The client subjoined a dateliness pruritus proofs longing, which may conduct to peel shiverdown and perchance infection
from scratching. Keeping his fingernails inadequate and mitigate accelerations forefend peel shiverdown and poison from scratching. Applying prestrusting when giving I.M. inoculations and administering vitamin K subcutaneously are specificive if the client develops bleeding
problems. Decreasing the client’s regimenary incaptivate is expend if the client’s ammonia contrivancees are extensiond.
3. Answer: C. Low-fat, haughty-carbohydrate meals
For the client subjoined a dateliness cholecystitis, fat incaptivate should be base. The calories from fat should be substituted subjoined a dateliness carbohydrates. Reducing carbohydrate incaptivate would be contraindicated. Any regimen haughty in fat may conduct to another aggression of cholecystitis.
4. Answer: A. Fervor and chills
Septicemia is a low indistinctness subjoined a percutaneous transhepatic cholangiography. Evidence of fervor and chills, perchance forcible of septicemia, is specificive. Hypotension
, not hypertension
, is associated subjoined a dateliness septicemia. Tachycardia, not bradycardia, is most slight to betide. Loaart and diarrhea may betide but are not severe wonders of sepsis
5. Answer: B. Using amitelling sanitation subjoined a dateliness dishes and shared bathrooms
Hepatitis A is catching through the fecal verbal ignoringage or from defiled steep or prop. Measures to fortify the extrpossession involve amitelling handwashing
, peculiaral hygiene and sanitation, and use of gauge precautions. Adequate insularity is not required. Avoiding adjunction subjoined a dateliness class-soiled investment or dressings or quiting the sharing of demandles or syringes are precautions demanded to forefend transmission of hepatitis B
6. Answer: B. “Avoid preamble other medications subjoined a datelinessin 2 hours of this one.”
Antacids opposedvail gastric severe and retrench the parching of other medications. The client should be instructed to quit preamble other medications subjoined a datelinessin 2 hours of the antacid
. Water, which dilutes the antacid, should not be captured subjoined a dateliness antacid. A histamine receptor rival should be captured well-balanced when aaccount subsides. Daily consequences are implicated if the client is preamble a diuretic, not an antacid.
7. Answer: D. Nausea, vomiting, and anorexia
Acute cholecystitis is an sharp inflammation of the gallbladder commsingly manifested by the subjoined: anorexia, loathing, and vomiting; biliary colic
; delicacy and inflexibility the straight better quadrant (RUQ) elicited on palpation (e.g., Murphy’s wonder); fervor; fat intolerance; and wonders and indications of jaundice. Ecchymosis, petechiae, and coffee-ground emesis are clinical verifications of esophageal bleeding. The coffee-ground probpower betokens old bleeding. Jaundice, sombre urine, and steatorrhea are clinical verifications of the icteric deportment of hepatitis.
8. Answer: C. Maintenance of nothing-by-mouth standing and introduction of nasogastric (NG) tube subjoined a dateliness low occasional suction
With sharp pancreatitis, the client is kept on nothing-by-mouth standing to hinder pancreatic stimulation and secretion of pancreatic enzymes. NG intubation subjoined a dateliness low occasional suction is used to acceleration loaart and vomiting, retrench aversionful abdominal distention, and dedistribute hydrochloric severe. Vasopressin would be expend for a client diagnosed subjoined a dateliness bleeding esophageal varices. Paracentesis and diuretics would be expend for a client diagnosed subjoined a dateliness gate hypertension and ascites. A low-fat regimen and extensiond flowing incaptivate would excite enhance-embitter the pancreatitis.
9. Answer: B. Breaks down fat into fatty severes and glycerol
Lipase hydrolyses or shivers down fat into fatty severes and glycerol. Lipase is not implicated subjoined a dateliness the enravishment of fatty severes into the graze enclosure. Fat itself triggers cholecystokinin quit. Protein shiverdown into dipeptides and amino severes is the government of trypsin, not lipase.
10. Answer: D. Documenting deferential incaptivate and output
For the client subjoined a dateliness ascites receiving diuretic therapy, preservationful incaptivate and output metement is imported for trustworthy diuretic therapy. Diuretics conduct to flowing losses, which if not warnered air-tight and documented, could attribute the client at facilitate for solemn flowing and electrolyte imbalances
. Hypokalemia, not hyperkalemia, commsingly betides subjoined a dateliness diuretic therapy. Consequently urine output extensions, a client should be assessed for hypovolemia, not hypervolemia. Weights are too an deferential indicator of flowing poise. However, for this client, consequences should be succeeded daily, not weekly.
11. Answer: A. Passage of two or three balmy stools daily
Lactulose curtails serum ammonia contrivancees by inducing catharsis, behind decreasing colonic pH
and hindering fecal flora from supple ammonia from urea. Ammonia is departd subjoined a dateliness the stool
. Two or three balmy stools daily betoken operativeness of the offal. Unsound diarrhea betokens overdose. Daily retrogradation in the client’s handwriting betokens an extension in the ammonia contrivancee and worsening of hepatic encephalopathy. Frothy, foul-smelling stools betoken steatorrhea, caused by diminished fat digestion.
12. Answer: C. “Jaundice produces pruritus due to diminished bile severe perspiration.”
Jaundice is a indication characterized by extensiond bilirubin force in the class. Bile severe perspiration is diminished, increasing the bile severes in the peel and causing pruritus. Jaundice is not associated subjoined a dateliness prestrusting ulcer
construction. However, edema and hypoalbuminemia are. Jaundice itself does not deteriorate urea evolution or conduct to retrenchd structure perfusion.
13. Answer: D. Obtaining coexertion and reducing horror
An esophageal tamponade tube would be implanted in fastidious situations. Typically, the client is horrible and haughtyly disturbed. The nurture for-this-reason explains encircling the attributement to acceleration succeed the client’s coexertion and curtail his horror. This loveness of tube is used singly inadequate premonitional and is not implicated for abode use. The tube is bulky and unhappy. The client would not be accelerationing to implant the tube. A client’s trouble should be retrenchd, not maintained, and depending on the quantity of hemorrhage, the client may not be ready.
14. Answer: B. Counseling to bung alcohol decline
Chronic pancreatitis typically results from general episodes of sharp pancreatitis. Past than half of continuous pancreatitis cases are associated subjoined a dateliness alcoholism. Counseling to bung alcohol decline would be the most accelerationful for the client. Dietary protein revision is not expedient for continuous pancreatitis. Daily exertion and liberalizing flowing incaptivate would be accelerationful but not the most wholesome agency.
15. Answer: A, C, D
Hepatic encephalopathy results from an extensiond ammonia contrivancee due to the liver’s inforce to clandestine ammonia to urea, which conducts to neurologic dysgovernment and practictelling brain
loss. The nurture should warner the client’s neurologic standing, serum ammonia contrivancee, and handwriting. Monitoring the client’s hemoglobin and hematocrit contrivancees and introduction of an esophageal tamponade tube harangue esophageal bleeding. Keeping fingernails inadequate harangue jaundice.
16. Answer: B. Applying prestrusting to inoculation sites
The client subjoined a dateliness cirrhosis who has altered clotting is at haughty facilitate for hemorrhage. Prolonged impression of prestrusting to inoculation or bleeding sites is specificive. Adequate insurrection may extension the client’s implicit for wear, consequently an unsupervised client may mar himself and bleed excessively. Antibiotics and amitelling alimentation are specificive to advance liver rising. However, they are not most specificive for a client at haughty facilitate for hemorrhage.
17. Answer: C. Hand tremors
Hepatic encephalopathy results from the hoard of neurotoxins in the class, for-this-reason the nurture wants to assess for wonders of neurological involvement. Flapping of the hands (asterixis), changes in mentation, disturbance, and confusion
are low. These clients typically keep ascites and edema so proof consequence construct. Malaise and stomatitis are not cognate to neurological involvement.
18. Answer: B, D
Edematous structure must accept meticulous preservation to forefend structure shiverdown. Range of noise exertions rescue flexure government but do not forefend peel shiverdown. Abdominal or floor massage accomplish not forefend peel shiverdown but must be spotless preservationfully to forefend shivers in peel uprightness
. The feet should be kept at the contrivancee of center or haughtyer so Fowler’s aspect should be industrious. An air prestrusting mattress, preservationful repositioning can forefend peel shiverdown.
19. Answer: B. Adequate bed repose
Treatment of hepatitis consists of bed repose during the sharp deportment to curtail metabolic demands on the liver, thus increasing class yield and cell rising. Forcing flowings, antibiotics, and complaisant regimens are not distribute of the tenor contrivance for viral hepatitis.
20. Answer: B. Hyperkalemia
This is a potassium-sparing diuretic so clients should be warnered air-tight for hyperkalemia. Diarrhea, dizziness, and headaches are other past low aspect property. Tachycardia, jaundice, and constipation are not anticipateed aspect property of spironolactone (Aldactone)