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A client with hepatic encephalopathy is being treated with lactulose. What is an expected outcome of this treatment?
- A. Reduction in blood ammonia levels
- B. Improvement in liver enzyme levels
- C. Decrease in bilirubin levels
- D. Increase in urine output
Correct Answer: A
Rationale: Step-by-step rationale:
1. Lactulose works by reducing blood ammonia levels through promoting its excretion in the stool.
2. Hepatic encephalopathy is caused by elevated blood ammonia levels affecting brain function.
3. Therefore, the expected outcome of lactulose treatment is a reduction in blood ammonia levels, improving the client's condition.
Summary:
- Reduction in blood ammonia levels is the correct outcome as lactulose targets this mechanism.
- Improvement in liver enzyme levels and decrease in bilirubin levels are not direct effects of lactulose.
- Increase in urine output is not a typical outcome of lactulose treatment for hepatic encephalopathy.
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A 40-year-old man presents with abdominal pain, diarrhea, and weight loss. He has a history of Crohn's disease. Laboratory tests reveal low hemoglobin and elevated ESR. What is the most likely diagnosis?
- A. Ulcerative colitis
- B. Irritable bowel syndrome
- C. Celiac disease
- D. Crohn's disease flare
Correct Answer: D
Rationale: The correct answer is D: Crohn's disease flare. Given the patient's history of Crohn's disease, symptoms of abdominal pain, diarrhea, weight loss, and abnormal lab findings (low hemoglobin, elevated ESR) are indicative of a flare-up of Crohn's disease. This is supported by the clinical presentation and the lab results. Ulcerative colitis (A) presents differently with rectal bleeding and mucous diarrhea. Irritable bowel syndrome (B) does not typically cause weight loss or abnormal lab findings. Celiac disease (C) would present with malabsorption symptoms and specific antibodies, not consistent with this patient's presentation. Crohn's disease flare (D) is the most likely diagnosis based on the information provided.
A client who is acutely ill has vigilant oral care included in their plan of care. What factor increases this client's risk for dental caries?
- A. Hormonal changes induced by the stress response leading to an acidic oral environment
- B. Systemic infections commonly affecting the teeth
- C. Intravenous hydration lacking fluoride
- D. Inadequate nutrition and reduced saliva production contributing to cavities
Correct Answer: D
Rationale: The correct answer is D because inadequate nutrition and reduced saliva production contribute to cavities. In acute illness, the client may not be able to consume a balanced diet, leading to nutrient deficiencies that weaken teeth. Reduced saliva flow decreases the mouth's ability to naturally clean and protect teeth. Choices A, B, and C are incorrect because hormonal changes from stress do not directly lead to acidic oral environment, systemic infections do not commonly affect teeth, and lack of fluoride from intravenous hydration is not a primary factor for dental caries.
A client with liver cirrhosis and ascites is being treated with spironolactone. What is a key nursing consideration for this medication?
- A. Monitoring for signs of hyperkalemia
- B. Checking for signs of hypoglycemia
- C. Assessing for signs of dehydration
- D. Observing for symptoms of hyponatremia
Correct Answer: A
Rationale: The correct answer is A: Monitoring for signs of hyperkalemia. Spironolactone is a potassium-sparing diuretic commonly used in clients with liver cirrhosis and ascites. The key nursing consideration is monitoring potassium levels due to the risk of hyperkalemia, as spironolactone reduces potassium excretion. Hyperkalemia can lead to serious cardiac arrhythmias. Checking for hypoglycemia (B) is not directly related to spironolactone use. Assessing for dehydration (C) is important but not the key consideration for this medication. Observing for hyponatremia (D) is not a common side effect of spironolactone.
A 65-year-old female client arrives in the emergency department with shortness of breath and chest pain. The nurse accidentally administers 10 mg of morphine sulfate instead of the prescribed 4 mg. Later, the client's respiratory rate is 10 breaths/minute, oxygen saturation is 98%, and she states her pain has subsided. What is the legal status of the nurse?
- A. The nurse is guilty of negligence and will be sued.
- B. The client would not be able to prove malpractice in court.
- C. The nurse is protected by the Good Samaritan Act.
- D. The healthcare provider should have given the morphine sulfate dose.
Correct Answer: B
Rationale: The correct answer is B: The client would not be able to prove malpractice in court. In this scenario, although the nurse made an error in administering a higher dose of morphine, the client's condition improved, as evidenced by stable vital signs and pain relief. Therefore, there was no harm caused to the client due to the mistake. In malpractice cases, the client needs to prove that harm or injury resulted from the healthcare provider's actions. Since the client's condition improved, it would be difficult to establish malpractice in this situation.
Choice A is incorrect because negligence requires harm or injury to occur, which is not the case here. Choice C is incorrect as the Good Samaritan Act typically applies to individuals providing emergency care in good faith at the scene of an emergency, not within a healthcare setting. Choice D is incorrect as the focus is on the nurse's error in administering the incorrect dose, not on the healthcare provider's responsibility in this context.
A client with rheumatoid arthritis is prescribed methotrexate. Which instruction should the nurse include in the client's teaching?
- A. Avoid alcohol while taking this medication.
- B. Take the medication with a full meal.
- C. Increase your intake of high-fiber foods.
- D. Avoid exposure to sunlight.
Correct Answer: A
Rationale: The correct answer is A: Avoid alcohol while taking this medication. Methotrexate can cause liver toxicity, and alcohol consumption can exacerbate this risk. It is important for the client to avoid alcohol to prevent potential harm to the liver.
B: Taking the medication with a full meal is not a necessary instruction for methotrexate. It is typically recommended to take methotrexate on an empty stomach.
C: Increasing intake of high-fiber foods is not directly related to methotrexate therapy. It is important for overall health but not specifically for this medication.
D: Avoiding exposure to sunlight is not a common instruction for methotrexate. While some medications can increase sensitivity to sunlight, this is not a typical concern with methotrexate.