Nokea
The nurse is reviewing the health history of the client hospitalized with nonalcoholic fatty liver disease (NAFLD). Which finding should the nurse associate with this disease process?
- A. 70 years old at diagnosis
- B. Body mass index of 35
- C. History of recent antibiotic use
- D. Living in a colder climate
Correct Answer: B
Rationale: A. Adults in their forties are most at risk for NAFLD, not someone 70 years of age. B. The client’s BMI is 35; a BMI of greater than 30 indicates obesity. The risk for developing NAFLD is directly related to body weight and is a major complication of obesity. C. Antibiotic use has no influence on NAFLD development. D. Climate has no influence on NAFLD development.
You may also like to solve these questions
The nurse identifies the client problem 'excess fluid volume' for the client in liver failure. Which short-term goal would be most appropriate for this problem?
- A. The client will not gain more than two (2) kg a day.
- B. The client will have no increase in abdominal girth.
- C. The client's vital signs will remain within normal limits.
- D. The client will receive a low-sodium diet.
Correct Answer: B
Rationale: No increase in abdominal girth indicates stable ascites, directly addressing excess fluid volume. Weight gain limits, vital signs, and diet are related but less specific.
The nurse is caring for a client diagnosed with bulimia nervosa. Which nursing intervention should the nurse implement after the client's evening meal?
- A. Praise the client for eating all the food on the tray.
- B. Stay with the client for 45 minutes to an hour.
- C. Allow the client to work out on the treadmill.
- D. Place the client on bedrest until morning.
Correct Answer: B
Rationale: Staying with the client prevents purging, a key behavior in bulimia, post-meal. Praising eating, exercise, or bedrest does not address purging.
The client presents to the outpatient clinic complaining of diarrhea for two (2) days. Which laboratory data should the nurse monitor?
- A. The sodium level.
- B. The albumin level.
- C. The potassium level.
- D. The glucose level.
Correct Answer: C
Rationale: Potassium is critical to monitor in diarrhea due to risk of hypokalemia from losses, which can cause arrhythmias. Sodium is also relevant, but potassium is priority.
The female nurse sticks herself with a contaminated needle. Which action should the nurse implement first?
- A. Notify the infection control nurse.
- B. Cleanse the area with soap and water.
- C. Request postexposure prophylaxis.
- D. Check the hepatitis status of the client.
Correct Answer: B
Rationale: Cleansing the area with soap and water immediately reduces infection risk, including hepatitis. Notification, prophylaxis, and checking status follow after initial decontamination.
The nurse assesses the client previously diagnosed as having an inguinal hernia. The nurse considers that the client’s hernia may be strangulated when which assessment findings are noted?
- A. Abdominal distention
- B. Dyspnea with exertion
- C. Severe abdominal pain
- D. No stool for the past week
- E. Hyperactive bowel sounds
Correct Answer: A, C, D
Rationale: Abdominal distention occurs because the bowel is obstructed when the hernia is strangulated. B. Dyspnea with exertion is not associated with strangulation of an inguinal hernia. C. Lack of blood supply from strangulation causes severe abdominal pain. D. A bowel obstruction prevents the passage of stool. E. Bowel sounds with strangulation and bowel obstruction would be hypoactive or absent, not hyperactive.