A nurse is assessing a client diagnosed with cirrhosis.
Which of the following manifestations should the nurse expect?
Tarry stools.
Spider angiomas.
Moist skin.
Blood in the urine.
The Correct Answer is B
Choice A rationale
Tarry stools are not a typical manifestation of cirrhosis. They are more commonly associated with gastrointestinal bleeding.
Choice B rationale
Spider angiomas are a common manifestation of cirrhosis. They are small, dilated blood vessels with a bright red center point and radiating branches, and they are often found on the face, neck, and chest.
Choice C rationale
Moist skin is not a typical manifestation of cirrhosis. Cirrhosis can cause various skin changes, but they typically include jaundice, pruritus, and palmar erythema.
Choice D rationale
Blood in the urine is not a typical manifestation of cirrhosis. It is more commonly associated with urinary tract infections, kidney stones, or bladder disorders.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Spina bifida is indeed an example of a neural tube defect. It occurs when the neural tube doesn’t close completely somewhere along the spine during fetal development. This is the correct answer.
Choice B rationale
Cerebral palsy is not a neural tube defect. It is a group of disorders that affect a person’s ability to move and maintain balance and posture.
Choice C rationale
Muscular dystrophy is not a neural tube defect. It is a group of diseases that cause progressive weakness and loss of muscle mass.
Choice D rationale
Hydrocephalus is not a neural tube defect. It is a condition in which an accumulation of cerebrospinal fluid (CSF) occurs within the brain.
Correct Answer is B
Explanation
Choice A rationale
While it is important to notify the doctor, it is not the first action. The priority is to manage the patient’s symptoms and ensure their safety.
Choice B rationale
Administering diazepam is the correct first action. Delirium tremens is a severe form of alcohol withdrawal that can cause dangerous changes in breathing, blood pressure, and heart rate. Benzodiazepines like diazepam are the first line of treatment.
Choice C rationale
Obtaining a medical history is important, but it is not the first action. The priority is to treat the patient’s symptoms and stabilize their condition.
Choice D rationale
Raising the side rails of the bed is important for patient safety, but it is not the first action. The priority is to treat the patient’s symptoms. Diabetic ketoacidosisDiabetic ketoacidosis Explore
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