Nursing II - Chapter 35
"Hold out your arms and hands." - ANS-The nurse is collecting data from a patient with liver
failure to detect hepatic encephalopathy. Which instruction does the nurse give to the patient to
collect the data?
"I need to get my extra weight off as quick as possible." - ANS-A patient is being treated for
acute cholecystitis. The patient is instructed on dietary measures to reduce the possibility of
recurrent episodes. Which patient comment indicates a need to reinforce teaching?
Abdominal distention, respiratory distress, and midepigastric pain - ANS-The nurse is collecting
data from a patient with acute pancreatitis. Which symptoms should
the nurse anticipate?
Amylase - ANS-The nurse is caring for a patient with chronic pancreatitis. While reviewing
laboratory data, the nurse would expect an elevation in which serum laboratory value?
Answer: _____0.25_________ mL - ANS-The nurse is to administer promethazine 12.5 mg
intramuscularly and has 50 mg/mL on hand. How many milliliters should be drawn up? Fill in the
blank.
Bile duct obstruction - ANS-The nurse is collecting data for a patient who develops jaundice and
dark-colored urine. The nurse recognizes that which of the following is most likely the cause of
these clinical manifestations?
Decrease in the amount of bile in the T-tube - ANS-The nurse is assisting with the care of a
patient following a liver transplant for cirrhosis. Which finding will the nurse report immediately to
the RN or HCP?
Gallstones and inflammations - ANS-The nurse is reinforcing patient teaching regarding the
causes of gallbladder disorders.
Which condition does the nurse present as being a common cause?
Get adequate rest.
Ingest nutritious foods.
Abstain from all alcohol. - ANS-A patient recovering from hepatitis is concerned about liver
damage from the infection. Which instructions does the nurse provide the patient to prevent
long-term liver damage? (Select all that apply.)
Headache
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