A nurse is caring for a client who has cirrhosis of the liver. Which of the following actions should the nurse take?
Monitor for abdominal ascites.
Implement a low-carbohydrate diet.
Review serum amylase levels.
Place warm compresses on areas of pruritus
The Correct Answer is A
A.
A. Monitor for abdominal ascites - Ascites is a common complication of cirrhosis due to portal hypertension and decreased albumin production. Monitoring for abdominal distention and fluid
accumulation is essential for assessing the progression of cirrhosis and implementing appropriate interventions.
B. Implement a low-carbohydrate diet - While dietary modifications may be necessary for clients with cirrhosis, such as reducing sodium intake, implementing a low-carbohydrate diet is not typically a primary intervention for cirrhosis.
C. Review serum amylase levels - Serum amylase levels are typically assessed to diagnose pancreatitis, which is not directly related to cirrhosis unless complications such as alcoholic pancreatitis are present.
D. Place warm compresses on areas of pruritus - Pruritus (itching) is a common symptom of liver disease, including cirrhosis, due to bile salt accumulation. While warm compresses may provide
temporary relief, they do not address the underlying cause of pruritus in cirrhosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A.
A. Hepatitis C is a contraindication to atorvastatin due to the potential for hepatotoxicity and worsening liver function in individuals with preexisting liver disease.
B. Crohn's disease, peptic ulcer disease, and bronchitis are not contraindications to atorvastatin.
However, caution may be needed in individuals with gastrointestinal conditions due to potential gastrointestinal side effects of the medication.
C. Peptic ulcer disease is not a contraindication to atorvastatin. However, caution may be warranted in individuals with a history of gastrointestinal bleeding or ulcers due to potential gastrointestinal side effects of the medication.
D. Bronchitis is not a contraindication to atorvastatin. Atorvastatin primarily affects cholesterol levels and does not directly interact with bronchitis, a respiratory condition.
Correct Answer is D
Explanation
A. "Wearing an underwire bra between feedings" can compress the breast tissue, potentially leading to milk stasis and increasing the risk of mastitis.
B. "Covering your breasts immediately after feedings" can trap moisture and warmth, creating an environment conducive to bacterial growth and increasing the risk of mastitis.
C. "Applying cold compresses to your breasts before feedings" may provide temporary relief for discomfort, but it is not a primary preventive measure for mastitis.
D. "Trying to have your baby empty your breasts with each feeding" helps ensure thorough milk removal, which can prevent milk stasis and decrease the risk of mastitis. This is the correct choice.
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