Adult Nursing 2 Test 9

The nurse is reviewing the medication administration record of the client. Which medication would lead the nurse to suspect that the client is suffering from an acute attack of gout?

Colchicine

After undergoing a liver biopsy, a client should be placed in which position?

Right lateral decubitus position After a liver biopsy, the client is placed on the right side to exert pressure on the liver and prevent bleeding.

Clients with chronic liver dysfunction have problems with insufficient vitamin intake. Which may occur as a result of vitamin C deficiency?

Scurvy

The nurse is asking the client with acute pancreatitis to describe the pain. What pain symptoms does the client describe related to acute pancreatitis?

Severe mid-abdominal to upper abdominal pain radiating to both sides and to the back

A nurse is responsible for monitoring the diet of a client with hepatic encephalopathy. Which daily protein intake should this 185 lb male consume?

100-126 grams

As part of the assessment process for a client suspected of having gout, the nurse evaluated the client's serum uric acid levels. Select the value that is considered above the saturation point for crystal formation.

6.8 mg/dL Hyperuricemia, a serum uric acid concentration above 6.8 can cause urate crystal deposition which can lead to gout.

Which client is most likely to develop systemic lupus erythematosus (SLE)?

A 27 year old black female SLE strikes nearly 10 times as many women as men and is most common in women between ages 15-40. SLE affects more black women than white women. Its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women.

Which of the following procedures involves a surgical fusion of the joint?

Arthrodesis

A client with rheumatoid arthritis tells the nurse about experiencing mild tinnitus, gastric intolerance, and rectal bleeding. What medication does the nurse suspect is causing these side effects?

Aspirin Salicylates like aspirin may have these side effects.

What is the priority intervention for a client who has been admitted repeatedly with attacks of gout?

Assess diet and activity at home Foods high in purine need to be avoided, and alcohol intake has to be limited. Stressful activities should also be avoided.

The nurse is caring for a patient with cirrhosis of the liver and observes that the patient is having hand flapping tremors. What does the nurse document this finding as?

Asterixis May be seen in stage II encephalopathy

Which of the following would the nurse expect to assess in a client with hepatic encephalopathy?

Asterixis Hepatic encephalopathy is manifested by: disorientation, confusion, personality changes, memory loss, flapping tremor called asterixis, a positive Babinski reflex, sulfurous breath odor (fetor hepaticus), and lethargy to deep coma

A client with a history of IV drug use is being treated for hepatitis, and presents with jaundice and arthralgias. The client most likely has hepatitis

B

When caring for a client with cirrhosis, which symptoms should the nurse report immediately?

Change in mental status

When caring for a client with cirrhosis which symptoms should the nurse report immediately?

Change in mental status and Signs of GI bleeding

The nurse intervenes to assist the client with fibromyalgia to cope with which symptoms?

Chronic fatigue, generalized muscle aching, and stiffness

What is usually the first choice of treatment of rheumatoid arthritis RA?

Disease modifying antirheumatic drugs (DMARDS)

What type of deficiency results in macrolytic anemia?

Folic acid

A nursing student is reviewing for an upcoming anatomy and physiology exam. Which of the following would the student correctly identify as a function of the liver? SATA

Glucose metabolism, Ammonia conversion, Protein metabolism

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of bumps does the nurse understand these are?

Heberden's nodes DJD affects the hands; the fingers frequently develop painless bony nodules on the dorsolateral surface of the interphalangeal joints.

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. What instruction should the nurse give to the client to minimize injury?

Install safety devices in the home. Most accidents occur in the home, and safety devices such as hand rails are the most important element in minimizing injury.

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds?

Lung sounds are diminished in the apical area

The nurse is caring for a patient who has ascites as a result of hepatic dysfunction. What intervention can the nurse provide to determine if the ascites is incresing? SATA

Measure abdominal girth daily Perform daily weights

Which joint is most commonly affected in gout?

Metatarsophalangeal Seen in 90% of clients, this is referred to as podagra.

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease modifying antirheumatic drug (DMARD) will the nurse educate the client about?

Methotrexate (Rheumatrex) This med reduces the amount of joint damage and slows the damage to other tissues as well.

A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?

Monitor your body temperature Fever can signal an exacerbation and should be reported to the physician.

Which condition is the leading cause of disability and pain in the elderly?

Osteoarthritis

The nurse is performing a health history with a new client in the clinic. What is the most common reason for a client to seek medical attention for arthritis?

Pain Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue

The nurse is teaching a client who was admitted to the hospital with acute hepatic encephalopathy and ascites about an appropriate diet. The nurse determines that the teaching was effective when the client chooses

Pancakes with butter and honey and orange juice Teach clients to select a diet high in carbs with protein intake consistent with liver function

The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?

Raynaud's phenomenon

A patient is prescribed Sandostatin for the treatment of esophageal varices. The nurse knows that the purpose of this cyclic octapeptide is to reduce portal pressure by

Selective vasodilation of the portal system

A patient comes to the clinic with an inflamed wrist. How should the nurse splint the joint to immobilize it?

Slight dorsiflexion

The nurse is assessing a client who has had rheumatoid arthritis for several years. What clinical manifestation will the nurse expect to find in a client?

Small joint involvement Clinical manifestations of rheumatoid arthritis are usually bilateral and symmetrical and include small joint involvement and joint stiffness in the morning. Obesity, Bouchard's nodes and asymmetric joint involvement can be seen in the early stage of the disease.

Gynecomastia is a common side effect of which of the following diuretics?

Sprionolactone (Aldactone)

A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's ECG is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic enchephalopathy?

Stage 2 Also may include disorientation, mood swings, and increased drowsiness

A nurse is assessing a postoperative client for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider?

Tachycardia and tachypnea With shock, the sympathetic nervous system is activated due to changes in blood volume and blood pressure. The SNS stimulates the cardiovascular system, causing tachycardia and the respiratory system causing tachypnea.

A client with hepatitis who has not responded to medical treatment is scheduled for a liver transplant. Which of the following most likely would be ordered?

Tacrolimus A client would receive immunosuppressants to reduce the risk for organ rejection. Tacrolimus and cyclosporine are two immunosuppressants that may be used

A client is taking ibuprofen for the treatment of osteoarthritis. What education will the nurse give the client about the medication?

Take the medication with food to avoid stomach upset

A client with an inflamed knee scheduled to have an arthrocentesis asks the nurse what the synovial fluid will look like. What is the best response by the nurse?

The fluid will be milky, cloudy and dark yellow. An arthrocentesis shows abnormal synovial fluid as cloudy, milky, or dark yellow and contains numerous inflammatory components such as leukocytes and complement.

A patient is scheduled for a diagnostic paracentesis, but when coagulation studies were reviewed, the nurse observed they were abnormal. How does the nurse anticipate the physician will proceed with the paracentesis?

The physician will use and ultrasound guided paracentesis

A nurse practitioner treating a patient who is diagnosed with hepatitis A should provide health care information. Which of the following statements are correct for this disorder? SATA

There is a 70% chance jaundice will occur Transmission of the virus is possible with oral-anal contact during sex Typically there is a spontaneous recovery

A patient with suspected esophageal varices is scheduled for an upper endoscopy with moderate sedation. After the procedure is performed, how long should the nurse withhold food and fluids?

Until the gag reflex returns

The nurse is caring for a patient with ascites due to cirrhosis of the liver. What position does the nurse understand will activate the renin-angiotensin aldosterone and sympathetic nervous system and decrease responsiveness to diuretic therapy?

Upright

Which position should be used for a client undergoing a paracentesis?

Upright at the edge of the bed The client should be placed in an upright position on the edge of the bed or in a chair with the feet supported on a stool. The Fowler position should be used for the client confined to bed.

A client has received a diagnosis of portal hypertension. What does portal hypertension treatment aim to reduce?

Venous pressure and Fluid accumulation

Which newer pharmacological therapy, used to treat osteoarthritis, is thought to prevent the loss of cartilage and repair chondral defects, as well as have some anti-inflammatory effects?

Viscosupplementation

A client with severe and chronic liver disease is showing manifestations related to inadequate vitamin intake and metabolism. He reports difficulty driving at night because he cannot see well. Which of the following vitamins is most likely deficient for this client?

Vitamin A Vitamin A deficiency results in night blindness and eye and skin changes. Vitamin K deficiency can cause hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses.

During assessment, a patient with chronic liver dysfunction tells the nurse that he is experiencing spontaneous episodes of bleeding and has noticed increased areas of bruising on his chest and arms. The nurse suspects a deficiency in

Vitamin K

A client with viral hepatitis A is being treated in an acute care facility. Because the client requires enteric precautions, the nurse should:

Wash her hands after touching the client

A middle aged obese female presents to the ED with severe radiating right side flank pain, nausea, vomiting, and fever. A likely cause of these symptoms is

acute cholecystitis

A middle aged obese female presents to the ER with severe radiating right sided flank pain, nausea, vomiting and fever. A likely cause of these symptoms is

acute cholecystitis

The nurse is managing the care of a client with osteoarthritis. What is the appropriate treatment strategy the nurse will teach about

administration of NSAIDs

The nurse is providing medication teaching to a client with rheumatoid disease. What common actions are seen with diclonfenac and aspirin? SATA

anti-inflammatory analgesic antipyretic antiplatelet

TPN should be used cautiously in clients with pancreatitis because such clients

cannot tolerate high glucose concentration

A nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

clay colored stools

The presence of crystals in synovial fluid obtained from arthrocentesis is indicative of

gout

What is NOT a symptom on osteoarthritis?

morning stiffness that lasts at least 1 hour This is a symptom of RA

The nurse teaches the client that osteoarthritis is

the most common and frequently disabling of joint disorders

Which term is used to describe a chronic liver disease in which scar tissue surrounds the portal areas?

Alcoholic cirrhosis

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching for this condition?

Applications of ice Encouraging the client to eat a healthy diet, avoiding caffeine and alcohol, regular exercise, and stress reduction are part of the teaching plan.

A client with a history of IV drug use is being treated for hepatitis, and presents today with jaundice and arthralgia. This client most likely has hepatitis:

B The client's presentation is most similar to hepatitis B. Mode of transmission is from infected blood or plasma, needles, syringes, surgical or dental equipment contaminated with infected blood; also sexually transmitted through vaginal secretions and semen of carriers or those actively infected. Mode of transmission for hep C is similar to HBV, although less severe and without jaundice. Mode of transmission for hep A is the oral route from feces and saliva of infected persons.

Which finding is consistent with the diagnosis of rheumatoid arthritis?

Cloudy synovial fluid In a client with RA, arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow.

Which of the following is a plasma protein associated with immunologic reaction?

Complement

A client has an elevated serum ammonia concentration and is exhibiting changes in mental status. The nurse should suspect which condition?

Hepatic encephalopathy This is a central nervous system dysfunction resulting from liver disease. It is frequently associated with elevated ammonia concentration that produces changes in mental status, altered LOC, and coma.

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hepatitis C increases a person's risk for liver cancer Hepatitis A is transmitted primarily by fecal-oral route, and hepatitis B is frequently spread by sexual contact and infected blood. Hepatitis E is similar to hepatitis A whereas hepatitis G is similar to hepatitis C.

A client has developed drug induced hepatitis from a drug reaction to antidepressants. What treatment does the nurse anticipate the client will receive to treat the reaction?

High dose corticosteroids

A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?

Ineffective breathing pattern

When performing a physical exam on a client with cirrhosis, a nurse notices that the client's abdomen is enlarged. Which of the following interventions should the nurse consider?

Measure abdominal girth according to a set routine.

A young client with anorexia, fatigue, and jaundice is diagnosed with hepatitis B and has just been admitted to the hospital. The client asks the nurse how long the stay in the hospital will be. In planning care for the client, the nurse identifies impaired psychosocial issues and assigns the highest priority to which client outcome?

Minimizing social isolation

A client is actively bleeding from esophageal varices. Which medication would the nurse most expect to be administered to this client?

Octreotide (Sandostatin) This causes splanchnic vasoconstriction by inhibiting glucagon release and is used mainly in the management of active hemorrhage.

The nurse is preparing a client for a thyroid test. Which medications that the client is taking should be documented on the lab slip as possibly affecting the thyroid test?

Phenytoin, Metoclopramide, Furosemide, Amphetamine

In actively bleeding patients with esophageal varices, the initial drug of therapy is usually:

Pitressin

A client with acute exacerbation of arthritis is temporarily confined to bed. What position will the nurse recommend to prevent flexion deformities?

Prone

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management?

Strategies for remaining active

The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease managment?

Strategies for remaining active

Which intervention should the nurse implement to manage pain for the client with rheumatoid arthritis? SATA

Support joints with splints and pillows Provide diversional activities Provide opportunities for the client to verbalize feelings

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

Swan neck deformity

Which disorder is characterized by an increased autoantibody production?

Systemic lupus erythematosus (SLE)

A nurse is educating a client who has been treated for hepatic encephalopathy about dietary restrictions to prevent ammonia accumulation. What should the nurse include in the dietary teaching?

The amount of protein is not restricted in the diet. Protein intake should not be restricted in hepatic encephalopathy, as it was recommended in the past. Protein intake should be maintained at 1.2 - 1.5 g/kg per day.

A nurse is caring for a client with cirrhosis. The nurse assesses the client at noon and discovers that the client is difficult to arouse and has an elevated serum ammonia level. The nurse should suspect which situation?

The client's hepatic function is decreasing. If the client didn't take his morning dose of lactulose, he wouldn't have elevated ammonia levels and decreased LOC this soon.

Which term indicates an accumulation of crystalline depositions in articular surfaces, bones, soft tissue, and cartilage?

Tophi When problematic, tophi are surgically excised.

Which of the following diagnostic studies definitely confirms the presence of ascites?

Ultrasound of liver and abdomen

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

You must have the second one in one month and the third in six months

What is an age related change of the hepatobiliary system?

decreased blood flow Age related changes of the hepatobiliary system include decreased blood flow, decreased drug clearance capability, increased presence of gall stones, and a steady decrease in the size and weight of the liver.

The nurse is discussing life management with the client with rheumatoid arthritis. What assessment finding indicates the client is having difficulty implementing self care?

increased fatigue Fatigue is common with RA. Finding a balance between activity and rest is an essential part of the therapeutic regimen.

What does the nurse recognize as clinical manifestations consistent with ascites? SATA

rapid weight gain, visible distended veins, increased abdominal girth, stretch marks

The nurse is working with a client with systemic lupus erythematosus (SLE). What are the immune abnormalities characterized by SLE? SATA

susceptibility abnormal innate and adaptive immune responses autoantibodies immune complexes inflammation damage

A nurse is taking health history data from a client. Use of which of the following medications would especially alert the nurse to an increased risk of hepatic dysfunction and disease in the client? SATA

Acetaminophen Ketoconazole Valproic acid

The nurse is preparing a care plan for a client with hepatic cirrhosis. Which nursing diagnoses are appropriate? SATA

Activity intolerance related to fatigue, general debility, muscle wasting, and discomfort Risk for injury related to altered clotting mechanisms Disturbed body image related to changes in appearance, sexual dysfunction, and role function

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

Administering ordered analgesics and monitoring their effects.

A nurse is assessing a client with possible osteoarthritis. What is the most significant risk factor for primary osteoarthritis?

Age Development of primary OA is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary OA usually has identifiable precipitating events such as trauma.

A client reporting shortness of breath is admitted with a diagnosis of cirrhosis. A nursing assessment reveals an enlarged abdomen with striae, an umbilical hernia, and 4+ pitting edema of the feet and legs. What is the most important data for the nurse to monitor?

Albumin With the movement of albumin from the serum to the peritoneal cavity, the osmotic pressure of the serum decreases. This, combined with increased portal pressure, results in movement of fluid into the peritoneal cavity. The low oncotic pressure caused by hypoalbuminemia is a major pathophysiologic factor in the development of ascites and edema.

The side effect of bone marrow depression may occur with which medication used to treat gout?

Allopurinol

Which drug is not used in the treatment of rheumatoid arthritis?

Allopurinol Allopurinol is used in the treatment of gout. Etanercept, adalimumab, and methotrexate are all used in the treatment of RA.

A nurse is managing the care of a client who has gout. Which medication would be prescribed as the drug of choice to prevent tophi formation and promote tophi regression?

Allopurinol This xanthine oxidase inhibitor is considered the drug of choice for preventing the precipitation of an attack, preventing tophi formation, and promoting the regression of existing tophi. Uricosuric agents, such as probenecid (Benemid), correct hyperuricemia and dissolve deposited urate.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is:

Alpha-interferon

The nurse is caring for a client who has been diagnosed with a "rheumatic disease". What nursing diagnoses will most likely apply to this client's care? SATA

Alteration of self-concept, Pain, Fatigue

The nurse is assessing a client with hepatic cirrhosis for mental deterioration. For what clinical manifestations will the nurse monitor? SATA

Alterations in mood, Agitation, Insomnia

A health care provider orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result helps to confirm an SLE diagnosis?

An above normal anti DNA test The anti-DNA test is rarely positive with other diseases, therefore this test is important in diagnosing SLE.

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

Anorexia, Nausea and Vomiting Also possibly fatigue and weakness

The nurse is completing a plan of care for a client with cirrhosis who has ascites and 4+ pitting edema of the feet and legs identifies a nursing diagnosis of risk for impaired skin integrity. Which nursing intervention is appropriate for this problem?

Arrange for a low air loss bed

When inspecting the abdomen of a client with cirrhosis, the nurse observes that the veins over the abdomen are dilated. The nurse documents this finding as which of the following?

Caput Medusae

A client with a history of peptic ulcer disease is diagnosed with rheumatoid arthritis. What medication will the nurse anticipate will be prescribed to produce an anti-inflammatory effect and protect the stomach lining?

Celecoxib This is a cyclooxygenase-2 inhibitor. It has been shown to inhibit inflammatory processes, but does not inhibit the protective prostaglandin synthesis in the GI tract.

A client with gallstones tells the nurse, "The doctor has to do something. Isn't there something he can give me to dissolve them?" What medication does the nurse know may help dissolve the gallstones?

Chenodiol

A client comes to the clinic and informs the nurse that he is there to see the physician for RUQ abdominal discomfort, nausea, and frequent belching especially after eating a meal high in fat. What disorder do these symptoms correlate with?

Cholelithiasis Initial symptoms include belching, nausea, RUQ discomfort with pain or cramps after high fat meal

The nurse is teaching a client about the characteristics of osteoarthritis (OA). How will the nurse determine the client teaching was successful?

Clients may develop Heberden nodes

Which nursing assessment is most important in a client diagnosed with ascites?

Daily measurement of weight and abdominal girth

A client is being placed on a purine restricted diet. What foods will the nurse include in the client's diet plan?

Dairy products Primary hyperuricemia may be caused by severe dieting or starvation, excessive intake of foods that are high in purines (shellfish, organ meats, and alcohol) or hereditary.

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? SATA.

Diarrhea, Intestinal cramping, Nausea and vomiting

The nurse is assessing a patient with a diagnosis of scleroderma. What clinical manifestations of scleroderma does the nurse assess?

Dysphagia due to hardening of the esophagus Decreased ventilation due to lung scarring Dyspnea due to fibrotic cardiac tissue

A client is receiving vasopressin for the urgent management of active bleeding due to esophageal varices. What most serious complication should the nurse assess the client for after the administration?

ECG changes This medication causes coronary artery constriction that may dispose clients with CAD to cardiac ischemia, therefore the nurse monitors the client for chest pain, ECG changes, and vital sign changes.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestation will the nurse expect to find?

Early morning stiffness OA is characterized by early morning stiffness that decreases with activity. Large joints are usually involved with OA. Joint pain is a constant with OA.

The nurse is gathering a health history for a client with osteoarthritis. What clinical manifestations will the nurse expect to find?

Early morning stiffness OA is characterized by early morning stiffness that decreases with activity; large joints are usually involved with OA; joint pain is a constant with OA

A client is seeing the physician for a suspected tumor of the liver. What lab study results would indicate that the client may have a primary malignant liver tumor?

Elevated alpha-fetoprotein

A client with rheumatoid arthritis is prescribed a tumor necrosis factor (TNF)-alpha inhibitor. What medication might be prescribed?

Etanercept

A group of students is reviewing information about the liver and associated disorders. The group demonstrates understanding of the information when they identify which of the following as a primary function of the liver?

Excrete bile

A client who has been diagnosed with osteoarthritis (OA) asks if he or she will eventually begin to notice deformities in the hands and fingers as the condition progresses. Which concept should the nurse include in the response?

Hand and finger deformities are associated with the development of RA.

The client with osteoarthritis is seen in the clinic. Which assessment finding indicates that the client is having difficulty implementing self care?

Has a weight gain of 5 pounds. Obesity is a risk factor for OA. Excess weight is a stressor on the weight bearing joints. Weight reduction is often a part of the therapeutic regimen.

A client is prescribed a disease modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?

Hydroxychloroquine The DMARD hydroxychloroquine is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair. The nurse should emphasize the need for ophthalmic exams every 6-12 months.

A mother brings her teenage son to the clinic, where tests show that he has hepatitis A virus. They ask the nurse how this could have happened. Which of the following explanations would the nurse correctly identify as possible causes? SATA

Infection at school, Suboptimal sanitary habits, Consumption of sewage contaminated water or shellfish, Sexual activity Typically, a child or young adult acquires the infection at school through poor hygiene, hand to mouth contact, or close contact during play. The virus is carried home, where haphazard sanitary habits spread it through the family. An infected food handler can spread the disease, and people can contract it by consuming water or shellfish from sewage contaminated waters. Outbreaks have occurred in daycare centers and institutions as a result of poor hygiene among people with developmental disabilities.

A client has a serum study that is positive for the rheumatoid factor. What will the nurse tell the client about the significance of this test result?

It is suggestive of rheumatoid arthritis. Rheumatoid factor is present in about 70-80% of patients with RA, but its presence alone is not diagnostic of RA, and its absence dose not rule out the diagnosis.

A physician orders lactulose (Cephulac) 30 mL three times daily, when a client develops an increased serum ammonia level. To evaluate the effectiveness of lactulose, the nurse should monitor:

Level of consciousness In cirrhosis, the liver fails to convert ammonia to urea. Ammonia then build up in the blood and is carried to the brain, causing cerebral dysfunction. When this occurs, lactulose is administered to promote ammonia excretion in the stool and this improve cerebral function. Because LOC is an accurate indicator of cerebral function, the nurse can evaluate the effectiveness of lactulose by monitoring the client's LOC.

What might be the first and only physical sign of symptomatic osteoarthritis (OA)?

Limited passive movement

A client was admitted to critical care unit with esophageal varices and a precarious physical condition. What predisposes the client to have bleeding varices? SATA

Little protective tissue to protect fragile veins Chemical irritation Straining at stool Rough food

A client asks the nurse how to identify rheumatoid nodules with RA. What characteristic will the nurse include?

Located over bony prominence Rheumatoid nodules are usually non-tender, movable, and evident over body prominences, such as the elbow or base of the spine. The nodules are not reddened.

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture

What is not a symptom of osteoarthritis?

Morning stiffness that lasts at least one hour That is a symptom of RA. Symptoms of OA include deep, aching pain with motion early in the disease, limited joint motion, and instability of weight bearing joints.

A patient is suspected of having myositis. The nurse prepares the patient for what procedure that will confirm the diagnosis?

Muscle biopsy

A client is scheduled to have a laparoscopic cholecystectomy as an outpatient. The client asks the nurse when he will be able to resume normal activities. What information should the nurse provide?

Normal activities may be resumed in 1 week

A patient who had a recent myocardial infarction was brought to the ER with bleeding esophageal varices and is presently receiving fluid resuscitation. What first line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?

Octreotide (Sandostatin)

After being in remission from Hodgkin's disease for 18 months, a client develops a fever of unknown origin. The physician orders a blind liver biopsy to rule out advancing Hodgkin's disease and infection. Twenty-four hours after the biopsy, the client has a fever, complains of severe abdominal pain and rigidity, and seems increasingly confused. The nurse suspects that these findings result from:

Peritonitis from bleeding in the liver caused by the liver biopsy

A client is seen in the office for reports of joint pain, swelling, and a lot grade fever. What blood studies does the nurse know are consistent with a positive diagnosis of rheumatoid arthritis (RA)?

Positive C-reactive protein Positive ANA RBC count of <4.0 million

A nurse in the surgical ICU just received a client from recovery following a Whipple procedure. Which nursing diagnoses should the nurse consider when caring for this acutely ill client? SATA

Potential for infection Alterations in respiratory function Acute pain and discomfort

A client is admitted with an acute attack of gout. What interventions are essential for this client? SATA

Probenecid, Corticosteroid therapy, Pain medication, Serum uric acid concentration

The nurse is constructing a teaching plan for the client newly diagnosed with scleroderma. What should the nurse include in the teaching plan?

Protect the hands and feet from cold

What liver function study is used to show the size of the liver and hepatic blood flow and obstruction?

Radioisotope liver scan

The nurse is caring for a client with hepatitis. Which of the following would lead the nurse to suspect that the client is in the prodromal phase?

Rash The following s/s would be noted in this phase- urticaria, nausea, vomiting, anorexia, fever, malaise, arthralgia, headache, RUQ discomfort, enlargement of the spleen, liver, and lymph nodes, weight loss, and rash

The result of which diagnostic study is decreased in the client diagnosed with rheumatoid arthritis?

Red blood cell count

A client is diagnosed with systemic lupus erhythematosus (SLE). What is the most appropriate action for the nurse to take in order to evaluate the client's stage of disease?

Review the client's medical record Review of the record and diagnostic findings would be used.

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

Safe exercise, medication dosages and side effects, assistive devices This client needs information on how to exercise safely to maintain joint mobility; medication doses and side effects are always essential parts of teaching; assistive devices such as splints, walkers, and canes may assist the client to perform safe self care.

Octreotide (________) is a synthetic analog of the hormone somatostatin, and it is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstrictive effects of vasopressin. It is considered the preferred treatment regimen for immediate control of variceal bleeding. It is used mainly in the management of active hemorrhage. Vasopressin (______) may be the initial mode of therapy in urgent situations because it produces constriction of the splanchnic aterial bed and decreases portal pressure. Vasopressin constricts distal esophageal and proximal gastric veins, thus reducing the inflow into the portal system and therefore the portal pressure.

Sandostatin Pitressin

Which connective tissue disorder is characterized by insoluble collagen being formed and accumulating excessively in the tissues?

Scleroderma Scleroderma occurs initially in the skin but also occurs in the blood vessels, major organs, and body systems, potentially resulting in death.

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What dose the nurse understand that this clinical manifestation is?

Sicca syndrome This is a condition of dry eyes and dry mouth that can result from infiltration of the lacrimal and salivary glands with lymphocytes.

A nurse is assessing a postoperative patient for hemorrhage. What responses associated with the compensatory stage of shock should be reported to the healthcare provider?

Tachycardia and tachypnea

What intervention will best help a client with ankylosing spondylitis (AS)?

Teach the client to use a walker or cane

A client with gout has been advised to lose weight. The client informs the nurse of plans to go on a "guaranteed rapid weight loss" plan that involves fasting and heavy exercise. Which response would be most appropriate?

There might be some difficulties with your plan and fasting Clients should avoid fasting, low carb diets, and rapid weight loss because these measures increase the likelihood of ketone formation, which inhibits uric acid excretion. Gradual weight loss helps reduce serum uri acid levels in clients with gout.

A patient with bleeding esophageal varices has had pharmacologic therapy with Octreotide (Sandostatin) and endoscopic therapy with esophageal varices banding, but the patient has continued to have bleeding. What procedure that will lower portal pressure does the nurse prepare the patient for?

Transjugular intrahepatic portosystemic shunting (TIPS) A TIPS procedure is indicated for the treatment of an acute episode of uncontrolled variceal bleeding refractory to pharmacologic or endoscopic therapy. This procedure will rapidly lower portal pressure.

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns?

Tricyclic antidepressants

Alcohol, which is toxic to the liver, is a common cause of hepatic disorders. As part of health teaching, the nurse advises a group of women that the amount of daily alcohol use should be limited to the equivalent of:

Two 6 oz glasses of wine

Which of the following liver function studies is used to show the size of the abdominal organs and the presence of masses?

Ultrasonography

Which of the following liver function studies is used to show the size of abdominal organs and the presence of masses?

Ultrasound

The nurse is administering Cephulac (Lactulose) to decrease ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?

Watery diarrhea

A client is recovering from an attack of gout. What will the nurse include in the client teaching?

Weight loss will reduce uric acid levels and reduce stress on joints.

A client who has just been diagnosed with hepatitis A asks how they got this disease. What is the nurses best response?

You may have eaten contaminated restaurant food Hepatitis A is typically transmitted by the oral fecal route most often through contaminated water or shellfish. It can be transmitted via sexual activity, but is more likely through oral-anal contact or anal intercourse with multiple sex partners. A

When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

irritability and drowsiness

A client with a lengthy history of alcohol addiction is being seen for jaundice. The appearance of jaundice would most likely indicate

liver disorder Jaundice is a sign of disease, but it is not itself a unique disease. Jaundice accompanies many diseases that directly or indirectly affect the liver and is probably the most common sign of a liver disorder

The nurse is assessing a client with a history of ankylosing spondylitis. What will the nurse most commonly assess?

low back pain The most common symptoms to watch for are low back pain and stiffness.

A physician has ordered a liver biopsy for a client with cirrhosis whose condition is deteriorating. The nurse reviews the client's recent lab findings and recognizes that the client is at risk for complications due to

low platelet count

What initial measure can the nurse implement to reduce risk of injury for a client with liver disease?

pad the side rails on the bed Padding the side rails can reduce injury if the client becomes agitated or restless.

A client with advanced cirrhosis has a prothrombin time of 15 seconds, compared to a control time of 11 seconds. The nurse expects to administer

phytonadione (Mephyton)

A client who was recently diagnosed with carcinoma of the pancreas and is having a procedure in which the head of the pancreas is removed. In addition, the surgeon will remove the duodenum and stomach, redirecting the flow of secretions from the stomach, gallbladder, and pancreas to the middle section of the small intestine. What procedure is this client having performed?

radical pancreatoduodenectomy

A client with acute liver failure exhibits confusion, a declining LOC, and slowed respirations. The nurse finds him very difficult to arouse. The diagnostic information which best explains the client's behavior is

subnormal serum glucose and elevated serum ammonia levels In acute liver failure, serum ammonia levels increase because the liver can't adequately detoxify the ammonia produced in the GI tract. In addition, serum glucose levels decline because the liver isn't capable of releasing stored glucose. Elevated serum ammonia and subnormal serum glucose levels depress the client's LOC.

A red butterfly shaped rash on the face and patchy loss of hair are associated with

systemic lupus erythematosus (SLE)

What disorder is characterized by an increased autoantibody production?

systemic lupus erythematosus (SLE) SLE is an immunoregulatory disturbance that results in increased autoantibody production.

An important message for any nurse to communicate is that drug induced hepatitis is a major cause of acute liver failure. The medication that is the leading cause is

Acetaminophen Other medications commonly associated with liver injury include anesthetic agents, medications used to treat rheumatic and musculoskeletal disease, antidepressants, psychotropic medications, anticonvulsants, and antituberculosis agents.

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform ROM exercises?

After the client has had a warm paraffin hand bath. Whether resting or moving, clients in this stage of the disease have considerable chronic pain, which is typically worse in the morning after a night's rest. Warmth helps decrease the symptoms of pain and will be the best time to perform ROM exercises.

The single modality of pharmacologic therapy for chronic type B viral hepatitis is

Alpha-interferon This is a biologic response modifier that is highly effective for treatment of hep B

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?

An exercise routine that includes ROM exercises.

Which of the following refers to fixation of a joint?

Ankylosis This eliminates friction, but at the drastic cost of immobility.

The nurse is educating a client about the risks of stroke related to the new prescription of a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about?

Celecoxib This COX-2 inhibitor is associated with an increased risk of cardiovascular events, including myocardial infarction and stroke.

When caring for a client with advanced cirrhosis and hepatic encephalopathy, which assessment finding should the nurse report immediately?

Change in the client's handwriting and or cognitive performance The earliest symptoms of hepatic encephalopathy include mental status changes and motor disturbances. The client will appear confused and unkempt and have altered mood and sleep patterns. Neurologic status should be assessed frequently. Mental status is monitored by the nurse keeping the client's daily record of handwriting and arithmetic performance. The nurse should report any change in mental state immediately.

A client is admitted for suspected GI disease. Assessment data reveal muscle wasting, a decrease in chest and axillary hair, and increased bleeding tendency. The nurse suspects the client has:

Cirrhosis The client may also have mild fever, edema, abdominal pain, and an enlarged liver

When assessing a client with cirrhosis of the liver, which of the following stool characteristics is the client likely to report?

Clay colored or whitish This is a result of no bile in the GI tract.

A nurse is assigned to a client with polymyositis. Which expected outcome in the care plan relates to a potential problem associated with polymyositis?

Client will exhibit no signs or symptoms of aspiration An expected outcome of no signs or symptoms of aspiration relates to symmetrical muscle weakness- a potential problem that may lead to speaking and swallowing problems.

A nurse is caring for a client with a warm and painful toe from gout. What medication will the nurse administer?

Colchicine Gout is caused by urate crystal deposits in the joints. The health care provider orders colchicine to reduce these deposits and thus ease joint inflammation.

A preoperative client scheduled to have an open cholecystectomy says to the nurse, "The doctor said that after surgery, I will have a tube in my nose that goes into my stomach. Why do I need that?" What most common reason for a client having an NG tube in place after abdominal surgery should the nurse include in a response?

Decompression Negative pressure exerted through a tube inserted in the stomach removes secretions and gaseous substances from the stomach, preventing abdominal distention, nausea, and vomiting.

A client comes to the ER complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

Degenerative joint disease

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?

Eating organ meats and sardines During an acute attack, high purine foods are avoided, including organ meats, gravies, meat extracts, anchovies, herring, mackerel, sardines, and scallops.

While conducting a physical examination of a client, which of the following skin findings would alert the nurse to the possibility of liver problems? Select all that apply.

Ecchymoses, Petechiae, Jaundice The skin, mucosa, and sclerae are inspected for jaundice. The nurse observes the skin for petechiae or ecchymotic areas, spider angiomas, and palmar erythema.

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?

Elevated erythrocyte sedimentation rate. ESR may be elevated, particularly as the disease progresses. ESR shows inflammation associated with RA. RBC count and C4 complement component are decreased.

What is an appropriate nursing intervention in the care of the client with osteoarthritis (OA)?

Encourage weight loss and an increase in aerobic activity. Clients should be assisted to plan their daily exercise at a time when pain is least severe, or plan to use an analgesic before exercise.

What is an appropriate nursing intervention in the care of the client with osteoarthritis?

Encourage weight loss and increase in aerobic activity

What test should the nurse prepare the client for that will locate stones that have collected in the common bile duct?

Endoscopic retrograde cholangiopancreatography (ERCP)

A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?

Facial erythema, pericarditis, pleuritis, fever and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly have of these patients have the classic butterfly rash. May also cause profuse proteinuria (more than 0.5g/day), pleuritis, paricarditis, photosensitivity, and painless mucous membrane ulcers.

The nurse teaches the client that the presence of crystals in the synovial fluid obtained from arthrocentesis confirms which disease process?

Gout Crystals indicate gout; Bacteria indicate infective arthritis.

The nurse identifies which type of jaundice in an adult experiencing a transfusion reaction?

Hemolytic Hemolytic jaundice occurs because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. This type of jaundice is encountered in clients with hemolytic transfusion reactions and other hemolytic disorders.

Which type of jaundice is seen in adults is the result of increased destruction of RBCs?

Hemolytic This results because, although the liver is functioning normally, it cannot excrete the bilirubin as quickly as it is formed. Obstructive and hepatocellular jaundice are results of liver disease. Nonobstructive jaundice occurs with hepatitis.

A client with cirrhosis has portal hypertension, which is causing esophageal varices. What is the goal of the interventions that the nurse will provide?

Reduce fluid accumulation and venous pressure

A patient is hospitalized with a severe case of gout. The patient has gross swelling of the large toe and rates pain 10/10. With a diagnosis of gout, what should the lab results reveal?

Hyperuricemia Gout is caused by hyperuricemia (increased serum uric acid)

Clients diagnosed with esophageal varices are at risk for hemorrhagic shock. Which is a sign of potential hypovolemia?

Hypotension Also include cool, clammy skin; tachycardia; decreased BP; and decreased urine output

What point should be included in the medication teaching for a client taking adalimumab?

It is important to monitor for injection site reactions. The medication is injected subcutaneously and must be refrigerated. The med should be withheld if fever occurs.

A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process?

It will get better and worse again It is an unpredictable disease characterized by periods of exacerbation and remission. There is no cure, but symptoms can be managed.

A client has a history of osteoarthritis OA. Which signs and symptoms should the nurse expect to find on physical assessment?

Joint pain, crepitus, Heberden's nodes Clinical findings for OA include joint pain, crepitus, Heberden's nodes (bony growths at the distal interphalangeal joints), Bouchard's nodes (growths involving the proximal interphalangeal joints), and enlarged joints. The joint pain occurs with movement and is relieved by rest. As the disease progresses, pain may also occur at rest.

The nurse is completing a health history with a client in a clinic. What assessment finding best correlated with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity A characteristic feature or OA (degenerative joint disease) is joint stiffness that decreases with activity or movement. Erythema and edema over the affected joint, anorexia, weight loss, and fever and malaise are associated with rheumatoid arthritis, a more severe and destructive form of arthritis.

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?

Lactulose This is administered to detoxify ammonium and act as an osmotic agent, drawing water into the bowel, which causes diarrhea in some clients.

A client is suspected of having cirrhosis of the liver. What diagnostic procedure will the nurse prepare the client for in order to obtain a confirmed diagnosis?

Liver biopsy A liver biopsy, which reveals hepatic fibrosis, is the most conclusive diagnostic procedure. It can be performed in the radiology department with ultrasound or CT to identify appropriate placement of the trocar or biopsy needle.

A physician orders spironolactone (Aldcatone), 50mg by mouth four times daily, for a client with fluid retention caused by cirrhosis. Which finding indicates that the drug is producing a therapeutic effect?

Loss of 2.2 lbs (1kg) in 24 hours Because spironolactone is a diuretic, weight loss is the best indicator of its effectiveness.

A client with rheumatoid arthritis arrives at the clinic for a checkup. Which statement by the client refers to the most overt clinical manifestation of rheumatoid arthritis?

My finger joints are oddly shaped Joint abnormalities are the most obvious manifestations of RA.

A client with rheumatoid arthritis reports joint pain. What intervention is a priority to assist the client?

NSAIDs NSAIDs are the mainstay of treatment for RA pain. They help to decrease inflammation in the joints. Heat, rather than ice packs is used to relieve pain. Paraffin baths may also help. Surgery is reserved for joint replacement when the joint is no longer functional.

A client asks the nurse what the difference is between osteoarthritis and rheumatoid arthritis. What is the correct response?

OA is a noninflammatory joint disease. RA is characterized by inflammed, swollen joints. OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women, OA affects both sexes equally.

A patient who had a recent MI was brought to the ER with bleeding esophageal varices and is presently receiving fluid resuscitation. What first line pharmacologic therapy does the nurse anticipate administering to control the bleeding from the varices?

Octreotide (Sandostatin) This synthetic analogue of the hormone somatostatin, is effective in decreasing bleeding from esophageal varices, and lacks the vasoconstritive effects of vasopressin. Because of this safety and efficacy profile, ocrteotide is considered the preferred treatment regimen for immediate control of variceal bleeding.

A client has undergone a liver biopsy. Which postprocedure position is appropriate?

On the right side. In this position, the liver capsule at the site of penetration is compressed against the chest wall, and the escape of blood or bile through the perforation made for the biopsy is impeded.

What intervention is a priority for a client diagnosed with osteoarthritis?

Physical therapy and exercise These clients need to maintain joint mobility.

What is the most common cause of esophageal varices?

Portal hypertension Esophageal varices are almost always caused by portal hypertension, which results from obstruction of the portal circulation within the damaged liver.

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Positive Anti-dsDNA antibody test This test is very specific for SLE because is is not positive for other autoimmune disorders. Anti-smith antibodies are specific for SLE, but are found in only 20-30% of clients with SLE. ANA titre shows the presence of an autoimmune disease but it is not specific to SLE.

A client is admitted with an acute attack of gout. What interventions are essential for this client?

Probenecid, Corticosteroid therapy, Pain medication, Serum uric acid concentration Probenecid will assist in the excretion of uric acid, the causative agent. Steroids can decrease inflammation and pain. Serum uric acid concentrations will guide therapy and treatment.

The nurse is caring for a client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by hepatic disease?

Purpura and petechiae A hepatic disorder may disrupt the liver's normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding.

In what location would the nurse palpate for the liver?

RUQ A palpable liver presents as a firm, sharp ridge with a smooth surface

Which liver function study is used to show the size of the liver and hepatic blood flow and obstruction?

Radioisotope liver scan

The nurse is teaching a newly diagnosed client about systemic lupus erythematosus (SLE). What statement by the client indicates the teaching was successful?

The belief is that it is an autoimmune disorder with an unknown trigger. The disorder is more common in women than in men, most with the disorder in the 3rd or 4th decade of life. The disease is considered the great imitator because the clinical signs resemble many other conditions. SLE is a diffuse connective tissue disease that affects multiple body systems.

The nurse is completing a morning assessment of a client with cirrhosis. Which information obtained by the nurse will be of most concern?

The client's hands flap back and forth when the arms are extended Asterixis, an involuntary flapping of the hands, may be seen in stage II encephalopathy. It indicates that the client has hepatic encephalopathy and if untreated a hepatic coma may occur

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine positivity for the disorder. Which statement by the nurse is most accurate?

The diagnosis won't be based on the findings of a single test, but by combining all data found. There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the findings from the physical assessment and the lab test results.

Ammonia, the major etiologic factor in the development of encephalopathy, inhibits neurotransmission. Increased levels of ammonia are damaging to the body. The largest source of ammonia is from:

The digestion of dietary and blood proteins Circumstances that increase serum ammonia levels tend to aggravate or precipitate hepatic encephalopathy. The largest source of ammonia is the enzymatic and bacterial digestion of dietary and blood proteins in the GI tract. Ammonia from these sources increases as a result of GI bleeding (esophageal varices, chronic GI bleeidng) a high protein diet, bacterial infection, or uremia

A female client with chronic hepatitis B has been prescribed recombinant interferon alfa-2b in combination with ribavirin. Which of the following instructions should a nurse provide this client?

Use strict birth control methods. This is because ribavirin may cause birth defects. The client also needs to maintain physical rest during therapy.

What is the most effective strategy to prevent hepatitis B infection?

Vaccine Recommendations to prevent transmission of hepatitis B include vaccination of sexual contacts of individuals with chronic hepatitis, use of barrier protection during sexual intercourse, avoidance of sharing toothbrushes, razors with others, and covering open sores or skin lesions.

Which medication is used to decrease portal pressure, halting bleeding of esophageal varices?

Vasopressin This may be the initial therapy for esophageal varices because it constricts the splachnic arterial bed and decreases portal hypertension.

A client with carcinoma of the head of the pancreas is scheduled for surgery. Which of the following should a nurse administer to the client before surgery?

Vitamin K Clients with carcinoma of the head of the pancreas typically require vitamin K before surgery to correct a prothrombin deficiency.

A patient with severe chronic liver dysfunction comes to the clinic with bleeding of the gums and blood in the stool. What vitamin deficiency does the nurse suspect the patient may be experiencing?

Vitamin K deficiency Vitamin A deficiency- night blindness, eye, skin changes Thiamine deficiency- beriberi, polyneuritis, and Wernickle-Korsakoff psychosis Riboflavin deficiency- characteristic skin and mucous membrane lesions Pyridoxine deficiency- skin and mucous membrane lesions and neurologic changes Vitamin C deficiency- hemorrhagic lesions of scurvy Vitamin K deficiency- results in hypoprothrombinemia, characterized by spontaneous bleeding and ecchymoses Folic acid deficiency- macrocytic anemia

The nurse is administering Cephulac (lactulose) to decrease the ammonia level in a patient who has hepatic encephalopathy. What should the nurse carefully monitor for that may indicate a medication overdose?

Watery diarrhea