Nokea
In discussing long-term management with the patient with alcoholic cirrhosis, what should the nurse advise the patient?
- A. A daily exercise regimen is important to increase the blood flow through the liver.
- B. Cirrhosis can be reversed if the patient follows a regimen of proper rest and nutrition.
- C. Abstinence from alcohol is the most important factor in improvement of the patient's condition.
- D. The only over-the-counter analgesic that should be used for minor aches and pains is acetaminophen.
Correct Answer: C
Rationale: The correct answer is C: Abstinence from alcohol is the most important factor in improvement of the patient's condition. This is because alcohol is the primary cause of alcoholic cirrhosis, and continued consumption can worsen liver damage. Abstinence allows the liver to heal and potentially improve function.
Explanation of why the other choices are incorrect:
A: A daily exercise regimen is important for overall health but may not specifically increase blood flow through the liver in alcoholic cirrhosis.
B: Cirrhosis is irreversible, although proper rest and nutrition can help manage symptoms and prevent further damage.
D: Acetaminophen can be harmful to the liver in high doses and should be used cautiously in patients with cirrhosis.
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What is the fate of any excess glucose that goes to the liver that is not required for energy and not stored as glycogen?
- A. it is converted into fat
- B. it is converted into protein
- C. it is immediately released back into the bloodstream
- D. it is degraded
Correct Answer: A
Rationale: The correct answer is A: it is converted into fat. Excess glucose not needed for immediate energy or stored as glycogen is converted into fat through a process called de novo lipogenesis in the liver. This occurs when glucose levels are high and glycogen stores are full. The liver converts the excess glucose into fatty acids and then into triglycerides for storage in adipose tissue. This process helps regulate blood glucose levels and prevents hyperglycemia.
Other choices are incorrect:
B: Glucose is not directly converted into protein. Proteins are synthesized from amino acids, not glucose.
C: Releasing excess glucose back into the bloodstream would lead to high blood sugar levels, which is not a typical physiological response.
D: Glucose is not simply degraded; it is either used for energy, stored as glycogen, or converted into fat when in excess.
What causes the systemic effects of viral hepatitis?
- A. Cholestasis
- B. Impaired portal circulation
- C. Toxins produced by the infected liver
- D. Activation of the complement system by antigen-antibody complexes
Correct Answer: D
Rationale: Step-by-step rationale for why choice D is correct: Activation of the complement system by antigen-antibody complexes leads to systemic effects in viral hepatitis. This process triggers inflammation, tissue damage, and immune responses that contribute to the systemic effects seen in viral hepatitis. The other choices (A, B, and C) do not directly cause systemic effects in viral hepatitis. Cholestasis and impaired portal circulation are more localized effects, while toxins produced by the infected liver may contribute to liver damage but not necessarily systemic effects.
A two-week-old boy develops persistent projectile vomiting. The most likely diagnosis is:
- A. pyloric stenosis
- B. esophageal atresia
- C. annular pancreas
- D. incomplete rotation of the gut
Correct Answer: A
Rationale: The correct answer is A: pyloric stenosis. In pyloric stenosis, there is hypertrophy of the pyloric sphincter muscle, leading to gastric outlet obstruction and projectile vomiting. This typically presents in infants around 2-6 weeks of age. Other choices (B) esophageal atresia presents with difficulty feeding and choking, (C) annular pancreas with duodenal obstruction, and (D) incomplete rotation of the gut with volvulus or obstruction due to malrotation. Pyloric stenosis is the most likely diagnosis in this scenario based on the age of the infant and the symptom of projectile vomiting.
Which female patient is most likely to have metabolic syndrome?
- A. BP 128/78 mm Hg, triglycerides 160 mg/dL, fasting blood glucose 102 mg/dL
- B. BP 142/90 mm Hg, high-density lipoproteins 45 mg/dL, fasting blood glucose 130 mg/dL
- C. Waist circumference 36 in, triglycerides 162 mg/dL, high-density lipoproteins 55 mg/dL
- D. Waist circumference 32 in, high-density lipoproteins 38 mg/dL, fasting blood glucose 122 mg/dL
Correct Answer: B
Rationale: The correct answer is B because the patient's blood pressure, HDL levels, and fasting blood glucose levels all indicate a higher likelihood of metabolic syndrome. High blood pressure, low HDL levels, and elevated blood glucose are key components of metabolic syndrome.
Option A has normal blood pressure and slightly elevated triglycerides and blood glucose, but not as concerning as choice B.
Option C has a normal blood pressure, slightly elevated triglycerides, and good HDL levels, which lowers the likelihood of metabolic syndrome.
Option D has a normal blood pressure, very low HDL levels, and slightly elevated blood glucose, but the blood pressure is not in the hypertensive range as in choice B.
Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her care?
- A. Low-fiber diet and fluid restrictions.
- B. Total parenteral nutrition and bed rest.
- C. High-fiber diet and administration of psyllium.
- D. Administration of analgesics and antacids.
Correct Answer: C
Rationale: Rationale:
C is correct as high-fiber diet helps prevent diverticulitis episodes. Psyllium adds bulk to stool, reducing strain on the colon. A is incorrect as low-fiber diet worsens diverticulosis. B is inappropriate as TPN is not first-line and bed rest can worsen symptoms. D is incorrect as analgesics and antacids do not address the underlying cause.