While conducting a physical assessment, a client with cirrhosis of the liver reports to the nurse having had a 5 lb (2.3 kg) weight gain within the last week. Which assessment finding correlates with the client's comment?
Decreased bowel sounds.
Increased respiratory rate.
Increased abdominal girth.
Decreased level of consciousness.
The Correct Answer is C
Choice A reason: Decreased bowel sounds may be associated with cirrhosis due to altered digestion but do not directly correlate with weight gain.
Choice B reason: An increased respiratory rate can be a sign of many conditions, including fluid overload, but it is not a specific indicator of weight gain due to fluid accumulation.
Choice C reason: Increased abdominal girth is a common sign of ascites, which is fluid accumulation in the abdomen often seen in cirrhosis, correlating with the reported weight gain.
Choice D reason: Decreased level of consciousness may indicate hepatic encephalopathy in cirrhosis patients but does not directly correlate with the weight gain described.

Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","E"]
Explanation
The correct answer is: A. Teach the client to use an incentive spirometer every 2 hours while awake and E. Remove the urinary catheter as soon as possible and encourage voiding.
Choice A reason:
Teaching the client to use an incentive spirometer every 2 hours while awake helps prevent postoperative pulmonary complications such as pneumonia. This intervention promotes lung expansion and clears secretions, reducing the risk of infection.
Choice B reason:
Administering low molecular weight heparin as prescribed is important for preventing deep vein thrombosis (DVT) and pulmonary embolism, but it does not directly reduce the risk of infection.
Choice C reason:
Assessing the pain level and medicating as needed is crucial for patient comfort and mobility, but it does not directly address infection prevention. Effective pain management can indirectly support recovery by enabling better mobility and respiratory function.
Choice D reason:
Maintaining sequential compression devices while in bed is aimed at preventing DVT, not infections. These devices help improve blood circulation and reduce the risk of blood clots.
Choice E reason:
Removing the urinary catheter as soon as possible and encouraging voiding reduces the risk of catheter-associated urinary tract infections (CAUTIs). Prompt removal of the catheter minimizes the duration of exposure to potential pathogens, thereby reducing infection risk.
Correct Answer is ["A","B","D","F"]
Explanation
Choice A Reason: Weight reduction treatment is a modifiable risk factor for prediabetes. Losing a small amount of weight, around 5% to 7% of body weight, can significantly lower the risk of developing type 2 diabetes. For a 200-pound person, this means losing about 10 to 14 pounds.
Choice B Reason: Exercise planning is crucial as it helps improve insulin sensitivity and glucose metabolism. The recommendation is at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking or light cycling.
Choice C Reason: Long-acting insulin is not typically used in the management of prediabetes. Insulin therapy is more commonly a part of the treatment regimen for individuals with type 1 diabetes or those with type 2 diabetes who cannot control their blood glucose levels with oral medications.
Choice D Reason: Nutrition education is essential for managing prediabetes. A diet rich in fiber, whole grains, and non-starchy vegetables, and low in added sugars and saturated fats, can help manage blood glucose levels3.
Choice E Reason: Extra carbohydrates are not recommended for prediabetes management as they can lead to increased blood glucose levels. Instead, a balanced diet with controlled carbohydrate intake is advised.
Choice F Reason: Oral antidiabetic medications, such as metformin, may be prescribed to help lower blood glucose levels and improve insulin sensitivity in individuals with prediabetes.
Choice G Reason: Short-acting insulin is not indicated for prediabetes management for the same reasons as long-acting insulin; it is not typically part of the treatment regimen unless the individual has progressed to type 2 diabetes and requires insulin therapy.
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