A client with cirrhosis has the following laboratory results: albumin 4.9 g/dl. (3.5-5 g/dL), PT 13 seconds (11-12.5 sec), and serum ammonia 68 mcg/dL (15-45 mcg/dL). Based on this information, what is the nurse's next action?

Assess level of consciousness

Assess for bleeding

Measure abdominal girth

Auscultate bowel sounds

Answer and Explanation

The Correct Answer is A

A)   Elevated serum ammonia levels can lead to hepatic encephalopathy, which affects mental status and consciousness, making this the priority assessment.
B)   The PT is slightly prolonged but not alarmingly high; bleeding is less of a concern compared to the elevated ammonia.
C)   This action is important in assessing fluid accumulation but is not as critical as assessing mental status in this scenario.
D)   While part of a comprehensive abdominal assessment, this is not the most critical action given the elevated ammonia level.

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Correct Answer is A

Explanation

A) Helps maintain muscle tone and promotes overall well-being without overstressing the body during recovery from hepatitis B.
B) Antibiotics are not effective against viruses like hepatitis B.

C) There is generally no need to restrict fluids in hepatitis B; adequate hydration supports overall health and liver function.

D) A high-fat diet is not recommended for liver disease; typically, a balanced, low-fat diet is more appropriate.

A. Check blood glucose every 4 hours B. 2 gram sodium diet C. Bedrest D. Insert indwelling urinary catheter

Correct Answer is B

Explanation

A) Monitoring blood glucose is more relevant for diabetic care.

B) A sodium diet is appropriate for managing fluid retention associated with liver disease.
C) Bedrest may be prescribed but not as specific to the management of fluid retention.
D) Insertion of an indwelling urinary catheter is not a standard intervention without additional justification.

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A client with cirrhosis has the following laboratory results: albumin 4.9 g/dl. (3.5-5 g/dL), PT 13 seconds (11-12.5 sec), and serum ammonia 68 mcg/dL (15-45 mcg/dL). Based on this information, what is the nurse's next action?

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Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who has hepatitis B. Which of the following interventions should the nurse include in the plan?

Correct Answer is A

Explanation

The nurse is admitting a client with liver disease who presents with dyspnea, weight gain and abdominal distention. Which order would the nurse anticipate?

Correct Answer is B

Explanation

The nurse is admitting a client with the diagnosis of hepatic encephalopathy. Which assessment finding should the nurse anticipate?

The client with cirrhosis is at risk for developing complications. Which condition is the most serious and potentially life-threatening?

The nurse is providing care to a client admitted with chronic pancreatitis. Which items are appropriate to include in the discharge teaching for this client? Select all that apply.

A female client is visiting the Medical Clinic with suspected hepatitis C. Which assessment question should the nurse ask this client?

A client with a history of chronic pancreatitis reports weight loss of 10 pounds over the last month and foul smelling stools. What would be a priority action for the nurse to take?

The nurse is preparing discharge teaching for a client who has had a paracentesis. What information should be included in the education session?

While assessing the client with acute pancreatitis the nurse notes the following: skin warm and dry with inelastic turgor, hypoactive bowel sounds, nausea and vomiting for 24 hours, and amber-colored urine. Which action would the nurse take next?

A client with cirrhosis has the following current assessment data: jaundice, decreased appetite, hemoglobin 15 g/dL (14-18 g/dL) and PT of 20.6 seconds (11-12.5 sec). What does the nurse identify as the priority problem for this client?