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

Answer and Explanation

The Correct Answer is 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.

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Correct Answer is A

Explanation

A. Troponin is a protein released into the bloodstream when there is damage to the heart muscle (myocardium), such as during a heart attack. Elevated troponin levels indicate myocardial injury or damage, making this the correct choice for indicating myocardial damage.

B. Erythrocyte sedimentation rate (ESR) measures the rate at which red blood cells settle in a tube of blood. It is a non-specific marker of inflammation and is not specific to myocardial damage.

C. Human B-type natriuretic peptide (BNP) is released by the heart in response to increased pressure and volume. Elevated levels are indicative of heart failure, not necessarily myocardial damage.

D. Activated partial thromboplastin time (aPTT) measures the time it takes for blood to clot. It is used to monitor the effectiveness of anticoagulant therapy and is not specific to myocardial

damage.

A. Herpes simplex virus 2 B. Candida albicans C. Staphylococcus aureus D. Lyme disease

Correct Answer is D

Explanation

A. Herpes simplex virus 2: Herpes simplex virus infections are not typically reportable to the

Centers for Disease Control and Prevention (CDC). These infections are commonly managed at the local level.

B. Candida albicans: Candida albicans infections are not typically reportable to the CDC. Candida species are common pathogens and are usually managed at the local level.

C. Staphylococcus aureus: Staphylococcus aureus infections, including methicillin-resistant

Staphylococcus aureus (MRSA), are not typically reportable to the CDC unless part of a larger outbreak or public health concern.

D. Lyme disease: Lyme disease is a reportable infection that requires notification to public health authorities, including the Centers for Disease Control and Prevention (CDC). Lyme disease is a vector-borne illness transmitted through the bite of infected ticks.

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A nurse is caring for a client who has cirrhosis of the liver. Which of the following actions should the nurse take?

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