UWorld- 310 Exam 3

The nurse provides discharge instructions to a client with cirrhosis who has portal hypertension, ascites, and esophageal varies. Which statement by the client indicates that the teaching was effective?

"I should avoid straining while having a bowel movement."

The nurse is reinforcing teaching to a client with a hiatal hernia. Which statement by the client indicates that further teaching is needed?

"Losing weight may not reduce my reflux, so I plan to take weight lifting classes."

The nurse assesses for cancer risk factors during a screening event at a gastroenterology clinic. Which of the following client statements include risk factors for esophageal cancer. Select all that apply.

- "A few years ago, I switched from smoking cigarettes to smoking cigars 1-2 times per week" - "I am so proud that I was able to lose 10 lbs, but I'm still considered obese for my height." - "I drink 3-4 beers nightly to relax, but I did switch to light beer recently." - I have struggled with daily episodes of acid reflux for years, especially at nighttime."

The nurse is reinforcing teaching about ulcer prevention with a client newly diagnosed with peptic ulcer disease. Which of the following client statements indicates appropriate understanding of teaching? Select all that apply.

- "I need to avoid taking medicines like ibuprofen without a prescription." - "I should avoid drinking excess coffee or soda." - "I should enroll in a smoking cessation program." - "I should reduce or eliminate my intake of alcoholic beverages."

The nurse is caring for a client with cirrhosis of the liver. Which blood test values would the nurse typically anticipate to be elevated when reviewing the client's morning laboratory results? Select all that apply.

- Ammonia - Bilirubin - Prothrombin time

A client admitted 3 days ago with upper GI bleeding underwent an endoscopic procedure to stop the bleeding. The client is started on a clear liquid diet today. Which foods are appropriate for the nurse to offer the client? Select all that apply.

- Apple juice - Chicken broth - Unsweetened tea

A client diagnosed with cirrhosis is experiencing pruritus . Which strategies are appropriate for the nurse to teach the client to promote comfort and skin integrity. Select all that apply.

- Apply cool, moist washcloths to the affected areas - Keep the fingernails trimmed short to minimize scratching - Use skin protectant or moisturizing cream over unbroken skin - Wear cotton gloves or long sleeves clothing to avoid scratching

The nurse prepares to admit a client with worsening cirrhosis who is on the waiting list for a liver transplant. Based on the clients electronic health record, the nurse anticipates which assessment finding? Select all that apply.

- Ascites - Bruising - Itching - Lethargy

The nurse is caring for a client with liver cirrhosis who was admitted for cellulitis of the leg. Which assessments would the nurse perform to determine if the client's condition has progressed to hepatic encephalopathy? Select all that apply.

- Ask if the client knows what day it is - Ask the client to extend the arms

During morning rounds, the nurse notices that a client admitted 3 days ago with hepatic encephalopathy is sleepy and confused. The client is scheduled for discharge later today. Which interventions are appropriate for the nurse to implement ? Select all that apply.

- Assess the client's hand movements with the arms extended - Compare current mental status findings with those from previous shifts - Contact the health care provider to request a blood draw for ammonia level

The nurse understands that which of these body substances are modes of transmission for hepatitis B? Select all that apply.

- Blood -Semen - Vaginal secretions

The nurse is reviewing lifestyle and nutritional strategies to help reduce symptoms in a client with newly diagnosed gastroesophageal reflux disease. Which strategies should the nurse include? Select all that apply.

- Choose foods that are low in fat - Limit or eliminate the use of alcohol and tobacco - Try to avoid caffeine, chocolate, and peppermint

The nurse is caring for a client with right upper quadrant pain and jaundice. The client's alanine aminotransferase/asparte aminotransferase (ALT/AST) levels are 7 times the normal values. What questions would be most helpful regarding the etiology for these findings? Select all that apply.

- Do you use IV elicit drugs? - How much alcohol do you typically drink? - What over the counter drugs do you take?

The nurse will implement which nursing action when caring for a client recently diagnosed with a hiatal hernia? Select all that apply.

- Elevate the head of the bed - Instruct the client to avoid tobacco and caffeine - Offer small, frequent, low fat meals - Teach the client to avoid lifting or straining

A client with ascites due to cirrhosis has increasing shortness of breath and abdominal pain. The health care provider requests the nurse prepare the client for a paracentesis. Which nursing actions would the nurse implement prior to the procedure:? Select all that apply.

- Obtain baseline vital signs, abdominal circumference, and weight - Place client in a high fowlers position or as upright as possible - Request that the client empty the bladder

The nurse is caring for a client with cirrhosis. Assessment findings include ascites, peripheral edema, shortness of breath, fatigue, and generalized discomfort. Which interventions would be appropriate for the nurse to implement to promote the clients comfort? Select all that apply.

- Place the client in semi-fowlers position - Provide alternating air pressure mattress - Use music to provide distraction

A client with end stage liver disease is admitted for a transplant workup. The clients spouse states that the client has no stopped drinking alcohol and may be unable to quit for 6 months before the transplant. Which is the most appropriate action for the nurse to implement?

Assess the clients motivation to make the necessary self care changes before and after the transplant.

The unlicensed assistive personnel (UAP) assists a client with cirrhosis who underwent paracentesis 4 hours ago. The UAP reports to the nurse that the client was lightheaded and unsteady while ambulating to the chair. What action should the nurse implement first?

Assess the symptoms reported by the UAP

The nurse assessing a client with an upper gastrointestinal bleed would expect the clients stool to have which appearance?

Black tarry stool

The nurse is caring for a client with a balloon tamponade tube in place due to bleeding esophageal varies. The client suddenly develops respiratory distress, and the nurse finds that the tube has been partially pulled out. Which intervention should be the nurses first priority?

Cut the tube with scissors.

The nurse administers lactulose to a client diagnosed with cirrhosis and hepatic encephalopathy. Which nursing action is inappropriate with administering this medication?

Hold if 3 soft stools occur in a day

The nurse admits a client with cirrhosis who has an upper GI bleed from suspected GI varies. Which new prescription should the nurse question?

Insert and maintain nasogastric tube

The nurse prepares to administer IV albumin to a client with severe liver disease who has a low serum albumin of 1.5g/dL. Which characteristics finding associated with hypoalbuminemia should the nurse anticipate assessing?

Pitting edema

The nurse is caring for a client with end stage liver failure from hepatitis C who is being seen in the clinic for worsening ascites. The client is treated in the infusion center with intravenous (IV) albumin, IV furosemide, and oral spironolactone. The following day the nurse checks the clients labs. Which of the following lab findings is most important for the nurse to communicate to the health care provider?

Potassium 3.0 mEq/L

The nurse prepares to assess the newly admitted client diagnosed with chronic alcohol abuse whose laboratory report shows a magnesium level of 1.0 mEq/L. Which assessment finding does the nurse anticipate?

Tremors and brisk deep tendon reflexes.

The nurse is evaluating a client with liver cirrhosis who received IV albumin after a paracentesis to drain ascites. Which assessment finding indicates that the albumin has been effective?

Vital signs remain within the clients normal parameters.