Question

37. Which of these nursing actions included in the plan of care for a patient with cirrhosis can the nurse delegate to a nursing assistant? a. Assessing the patient for jaundice b. Teaching the patient about a fluid restriction c. Palpating the abdomen for distension d. Providing oral hygiene before meals 38. When monitoring a client with cholelithiasis for signs of obstructive jaundice, the nurse would assess for: a. Yellow sclera b. Pale urine c. Dark, brown stools d. Coffee ground vomitus 39. The nurse is caring for a client with Hepatitis C. The nurse should intervene immediately upon observing the nursing assistant: a. Wearing gloves to empty a urinal b. Washing hands after assisting the client to bed c. Performing a fingerstick blood sugar without gloves d. Wearing a mask to do personal care 40. A 47-year-old female patient is transferred from the recovery room to a surgical unit after a transverse colostomy. The nurse observes the stoma to be deep pink with edema and a small amount of sanguineous drainage. The nurse should a. Place ice packs around the stoma. b. Notify the surgeon about the stoma. c. Irrigate the stoma with normal saline. d. Document the assessment findings. 41. The nurse will ask a 64-year-old patient being admitted with acute pancreatitis specifically about a history of a. Diabetes mellitus. b. High-protein diet. c. Cigarette smoking. d. Alcohol consumption

Answer 1

Answer:(A) Assesing the patient for jaundice.

( In the liver cirrhosis there is imbalance in the liver functioning which causes jaundice)

Answer:(C) Dark brown stools

Answer: (C) Performing finger stick blood sugar without gloves.

Answer: (B) Notify the surgeon about the stoma.