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A patient's serum liver enzyme tests reveal an elevated aspartate aminotransferase (AST). The nurse recognizes what about the elevated AST?
- A. It eliminates infection as a cause of liver damage.
- B. It is diagnostic for liver inflammation and damage.
- C. Tissue damage in organs other than the liver may be identified.
- D. Nervous system symptoms related to hepatic encephalopathy may be the cause.
Correct Answer: C
Rationale: Elevated AST may indicate damage in the liver or other organs as AST is not liver-specific.
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A patient with inflammatory bowel disease has a nursing diagnosis of imbalanced nutrition: less than body requirements related to decreased nutritional intake and decreased intestinal absorption. Which assessment data support this nursing diagnosis?
- A. Pallor and hair loss
- B. Frequent diarrhea stools
- C. Anorectal excoriation and pain
- D. Hypotension and urine output below 30 mL/hr
Correct Answer: A
Rationale: Pallor and hair loss indicate potential nutritional deficiencies, supporting the nursing diagnosis of imbalanced nutrition due to decreased intake and absorption.
A lipoprotein has the following components: 5% triglyceride, 20% cholesterol, 30% phospholipid, and 45% protein. This molecule would be best described as a
- A. micelle.
- B. chylomicron.
- C. low-density lipoprotein.
- D. high-density lipoprotein.
Correct Answer: D
Rationale: The correct answer is D: high-density lipoprotein (HDL). HDL is known to have a higher proportion of protein compared to other lipoproteins. In this case, with 45% protein content, it aligns with the typical composition of HDL. HDL is responsible for transporting cholesterol from peripheral tissues back to the liver for excretion, making it crucial for maintaining cardiovascular health.
A: Micelle is incorrect as it is a single-layered structure formed by amphipathic molecules in a specific environment like bile salts in the intestines.
B: Chylomicron is incorrect as it is primarily composed of triglycerides and is responsible for transporting dietary lipids.
C: Low-density lipoprotein (LDL) is incorrect as it typically has higher cholesterol content compared to HDL and is known as "bad cholesterol" due to its role in depositing cholesterol in arteries.
The duodenum and jejunum are the main site for absorption of the following except:
- A. Glucose
- B. Vitamin C
- C. Fat-soluble vitamins
- D. Bile salts
Correct Answer: D
Rationale: The correct answer is D: Bile salts. Bile salts are primarily absorbed in the terminal ileum, not in the duodenum or jejunum. The duodenum and jejunum are mainly responsible for absorbing nutrients like glucose, fat-soluble vitamins, and vitamin C. Bile salts aid in the digestion and absorption of fats, but they are reabsorbed in the ileum to be recycled. Therefore, the duodenum and jejunum are not the main sites for the absorption of bile salts.
A client underwent an exploratory laparotomy 2 days ago. The physician should be called immediately for which physical assessment finding?
- A. Abdominal distention and rigidity
- B. NG tube intentionally displaced by client
- C. Absent or hypoactive bowel sounds
- D. Nausea and occasional vomiting
Correct Answer: A
Rationale: Abdominal rigidity and distention suggest peritonitis or internal bleeding, both of which require urgent medical intervention.
The most common cause of upper gastrointestinal hemorrhage (hematemesis or melena) is:
- A. esophageal varices
- B. gastric carcinoma
- C. peptic ulcer
- D. gastritis
Correct Answer: C
Rationale: The correct answer is C: peptic ulcer. Peptic ulcers are a common cause of upper gastrointestinal hemorrhage due to erosion of the stomach lining. The acidic environment in the stomach can lead to ulcer formation. Esophageal varices are associated with liver cirrhosis, not a common cause of hemorrhage. Gastric carcinoma may cause bleeding but is less common than peptic ulcers. Gastritis is inflammation of the stomach lining and can cause bleeding but is not as common as peptic ulcers.