HESI Case Study- Cirrhosis – Flashcards
Unlock all answers in this set
Unlock answersquestion
PN's response?
answer
There are several types of cirrhosis with differing causes
question
What additional questions should PN ask?
answer
-Have you ever been told that you have Hep C? -Have you been exposed to toxic substances at work? -Have you ever been diagnosed with Hep B? -Do you have any cardiovascular disorders?
question
What action should PN take prior to paracentesis?
answer
Instruct the client to empty the bladder
question
PN will maintain the client on bedrest for 24-48hrs following what procedure?
answer
Angiography with portal measurements
question
PN will look for decrease from the normal value in what laboratory test for a client with cirrhosis?
answer
serum albumin
question
PN should observe for which clinical manifestations as the result of the prolonged APTT and PTT/INR?
answer
epistaxis
question
PN knows which other clinical manifestation is a result of cirrhosis?
answer
fruity breath
question
PN should observe for hyperkalemia because of which med Roberta is taking?
answer
Spironolactone
question
Which action?
answer
document the finding in the client's record
question
What approach should the PN use?
answer
challenge Roberta about her denial in a nonjudgemental manner
question
What response?
answer
The type of liver damage that you have occurs after years of drinking, and that is what makes me think you are an alcoholic
question
Who should the PN notify regarding Roberta's action to leave AMA?
answer
Client's HCP
question
What action?
answer
Document that the client left the hospital AMA
question
What is the primary underlying cause of hepatic encephalopathy?
answer
increased serum albumin
question
Which outcome indicates to the PN that the lactulose and neomycin are having desired effect?
answer
increased mental altertness
question
PN initiates which activity-level during the acute phase of Roberta's cirrhosis?
answer
bedrest
question
What intervention?
answer
measure abdominal growth daily
question
What intervention?
answer
position Roberta in the bed with her feet slightly elevated
question
What action?
answer
apply O2
question
When should NS be completed?
answer
4:30PM
question
What selections?
answer
-baked chicken sandwich and fruit smoothie -grilled fish, spinach salad, apple, and iced tea
question
Lifestyle management choices?
answer
-stop alcohol consumption -stop aspirin containing meds -talk to HCP before taking OTC meds
question
Best choice for PN to contact?
answer
social worker
question
How should PN respond?
answer
I really need you to find a way to help the client
