The nurse notes these laboratory results for a client with cirrhosis: PT 20 seconds (11-12.5 sec) and serum ammonia 35 mcg/dL (15-45 mcg/dL). What action by the nurse would be a priority?

Auscultate lungs

Monitor I&O

Check stools for blood

Initiate fall precautions

Answer and Explanation

The Correct Answer is C

A)   While important, it is not directly related to the coagulopathy indicated by the prolonged PT.
B)   Important for overall fluid management but not directly related to the risk of bleeding.
C)   With a significantly prolonged PT, assessing for signs of gastrointestinal bleeding is a priority.

D)   Important for safety, but the immediate risk of bleeding due to coagulopathy takes precedence.

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Correct Answer is D

Explanation

A) While reviewing the diet history is important to understand nutritional intake and habits, it is not the priority action in this case.
B) Consulting a dietitian is important but should follow an assessment that identifies the specific issue causing the symptoms.
C) This action may be necessary if the patient is dehydrated but doesn’t address the primary concern of foul-smelling stools and weight loss.
D) This test is crucial as it helps confirm the diagnosis of malabsorption, which is likely given the patient’s history of chronic pancreatitis and symptoms described. This would be the priority to confirm the cause of the symptoms.

A. Gallstones B. Duodenitis C. Type 2 diabetes mellitus D. Hepatitis C

Correct Answer is A

Explanation

A) Gallstones are a leading cause of acute pancreatitis as they can block the pancreatic duct.
B) While inflammation of the duodenum can cause abdominal symptoms, it does not directly lead to acute pancreatitis.
C) Diabetes results from the dysfunction of the pancreas after damage but does not cause acute pancreatitis.
D) Hepatitis C affects the liver and does not directly cause pancreatitis.

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The nurse notes these laboratory results for a client with cirrhosis: PT 20 seconds (11-12.5 sec) and serum ammonia 35 mcg/dL (15-45 mcg/dL). What action by the nurse would be a priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is D

Explanation

The nurse is collecting a health history of a client admitted for possible acute pancreatitis. Which health history item would increase the client's risk for this diagnosis?

Correct Answer is A

Explanation

The nurse is preparing a client presentation regarding pancrelipase (Viokase) therapy. Which information would the nurse include in the teaching session?

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

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.

Which question would the nurse ask to identify a risk factor for liver disease?

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?

When planning care for a client with acute pancreatitis, which order would the nurse anticipate that will contribute to pain control?

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

The nurse should evaluate results of which laboratory tests while caring for a client who has cirrhosis of the liver? Select all that apply.