Elevated serum ammonia level causes which complication of cirrhosis?

Choice A reason: Asking the nursing assistant to determine if Marvin can safely sit in a bedside chair is not appropriate. Safety assessments, especially for patients with recent neurological events, should be done by a registered nurse or a physical therapist. This ensures that any nuanced clinical signs indicating instability or risk are recognized and addressed promptly.
Choice B reason: Passive range of motion (ROM) exercises are essential for patients with hemiplegia to prevent complications such as muscle atrophy, joint contractures, and decreased circulation. Regularly performing these exercises can maintain the health of the muscles and joints, promote better blood flow, and help in maintaining some degree of flexibility in the affected limbs.
Choice C reason: Assessing neurologic status is crucial in patients who have had a recent stroke and received tPA treatment. Frequent neurologic assessments help in monitoring for any changes or signs of deterioration. This includes checking consciousness, pupil response, motor function, and sensory perception. Changes in these parameters can indicate complications or the need for immediate medical interventions.
Choice D reason: Coordinating with speech therapy for a swallowing evaluation is essential because Marvin has dysphagia. Swallowing assessments by a speech therapist can determine the patient's ability to swallow safely and the appropriate dietary modifications needed to prevent aspiration, a common risk in patients with dysphagia. This is vital to prevent pneumonia or other respiratory complications.
Choice E reason: Using pillows and positioning devices to maintain proper body alignment is important in preventing complications such as pressure ulcers, muscle contractures, and discomfort. Proper positioning can also assist in maintaining better respiratory function and overall comfort. It also prevents the development of deformities and promotes functional posture, which is especially important for patients with hemiplegia.
Choice F reason: Pulling on his arm to position him on his side is inappropriate and can cause injury, especially in a patient with hemiplegia. This technique can lead to shoulder dislocations or increased pain. Instead, proper repositioning techniques using assistive devices and help from additional staff members should be employed to ensure safe and effective movement of the patient.

Choice A reason: Weight loss is indicative of hypermetabolism caused by excessive thyroid hormone production. The increased metabolic rate leads to higher energy consumption, resulting in unintentional weight loss even if the patient maintains or increases their food intake.
Choice B reason: Begins to cry when he tells you he recently lost his wife. Emotional responses, such as crying, can be associated with personal loss and grief but are not directly linked to hypermetabolism or excess thyroid hormone. This statement reflects the patient's emotional state rather than a physiological manifestation of hyperthyroidism.
Choice C reason: Hyperactive bowel sounds are a common manifestation of hypermetabolism due to hyperthyroidism. The increased metabolic rate accelerates gastrointestinal motility, resulting in hyperactive bowel sounds and sometimes diarrhea.
Choice D reason: 1+ pitting edema noted in bilateral lower extremities is related to fluid retention and heart failure rather than hypermetabolism. Edema is not a typical manifestation of hyperthyroidism and is more indicative of cardiovascular or renal issues.
Choice E reason: A heart rate of 124 (tachycardia) is a common finding in patients with hyperthyroidism. Excess thyroid hormones increase the heart rate and cardiac output, leading to symptoms such as palpitations and tachycardia.
Choice F reason: Bounding radial pulses are indicative of increased cardiac output and stroke volume, which are common in hyperthyroidism due to the hypermetabolic state induced by excess thyroid hormones. This leads to strong and forceful pulses.
Choice G reason: Anxious and restless behavior is a manifestation of the increased adrenergic activity associated with hyperthyroidism. Excess thyroid hormones stimulate the nervous system, leading to symptoms such as anxiety, restlessness, and irritability.