The client being treated for esophageal varices has a Sengstaken-Blakemore tube inserted to control the bleeding. The most important assessment is for the nurse to: A. Check that the hemostat is on the bedside. B. Monitor IV fluids for the shift. C. Regularly assess respiratory status. D. Check that the balloon… Read More »
Which phase of hepatitis would the nurse incur strict precautionary measures at? A. Icteric B. Non-icteric C. Post-icteric D. Pre-icteric Correct Answer: D. Pre-icteric Pre-icteric is the infective phase and precautionary measures should be strictly enforced. However, most patients are not always diagnosed during this phase. Nonspecific… Read More »
Sitty, a 66 y.o. patient underwent a colostomy for a ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor? A. Blanched stoma B. Edematous stoma C. Reddish-pink stoma… Read More »
A client presents to the emergency room, reporting that he has been vomiting every 30 to 40 minutes for the past 8 hours. Frequent vomiting puts him at risk for which of the following? A. Metabolic acidosis with hyperkalemia B. Metabolic acidosis with hypokalemia C. Metabolic alkalosis with hyperkalemia D. Metabolic… Read More »
Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following mechanisms of action? A. Decreased GI motility. B. Decreased gastric secretions. C. Increased fluid absorption. D. Binding to diarrhea-causing bacteria for excretion. Correct Answer: D. Binding to diarrhea-causing bacteria for excretion. Absorbent antidiarrheal medications bind to… Read More »
A client diagnosed with chronic cirrhosis who has ascites and pitting peripheral edema also has hepatic encephalopathy. Which of the following nursing interventions are appropriate to prevent skin breakdown? Select all that apply. A. Range of motion every 4 hours B. Turn and reposition every 2 hours C. Abdominal and foot massages… Read More »
A female client complains of gnawing epigastric pain for a few hours after meals. At times, when the pain is severe, vomiting occurs. Specific tests are indicated to rule out: A. Cancer of the stomach B. Peptic ulcer disease C. Chronic gastritis D. Pylorospasm Correct Answer: B.… Read More »
Which of the following will the nurse include in the care plan for a client hospitalized with viral hepatitis? A. Increase fluid intake to 3000 ml per day B. Adequate bed rest C. Bland diet D. Administer antibiotics as ordered Correct Answer: B. Adequate bed rest. Treatment… Read More »
You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate? A. The patient demonstrates an increase in the level of consciousness. B. The patient exhibits improved skin integrity. C. The patient experiences no evident signs of bleeding. D. The patient verbalizes… Read More »
Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity? A. Restrict fluids. B. Encourage ambulation. C. Increase sodium in the diet. D. Give antacids as prescribed. Correct Answer: A. Restrict fluids… Read More »