A patient with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portacaval shunt. As a result of this procedure, what should the nurse expect the patient to experience?

Correct Answer: D

Rationale: The correct answer is D: Improved hemodynamic function and renal perfusion. A portacaval shunt is a surgical procedure that diverts blood flow from the portal vein directly into the vena cava, reducing portal hypertension. This leads to improved hemodynamic function by decreasing pressure in the portal system, which can improve renal perfusion. Choices A, B, and C are incorrect because a portacaval shunt may not necessarily improve survival rate, decrease serum ammonia levels, or improve metabolism of nutrients.

Correct Answer: B

Rationale: The correct answer is B: Metabolic acidosis. During bowel preparation for a colonoscopy, the patient may experience fluid and electrolyte imbalances, leading to metabolic acidosis. The nurse should closely monitor for signs such as confusion, weakness, and increased respiratory rate. Diarrhea (choice A) is expected during bowel preparation but does not directly lead to metabolic acidosis. Fatigue (choice C) and dyspnea (choice D) are less likely complications of bowel preparation and do not directly relate to metabolic acidosis.

Correct Answer: A

Rationale: The correct answer is A: esophageal hiatus. This is the opening in the diaphragm through which the esophagus passes, connecting the thoracic and abdominal cavities. The esophageal hiatus is specifically located at the level of the tenth thoracic vertebra. The other choices are incorrect because: B: Cardiac orifice refers to the opening of the stomach into the esophagus, not where the esophagus penetrates the diaphragm. C: Upper esophageal sphincter is a muscular valve at the upper end of the esophagus, not related to its passage through the diaphragm. D: Lower esophageal sphincter is located at the junction of the esophagus and stomach, not at the point where the esophagus penetrates the diaphragm.

Correct Answer: A

Rationale: The correct answer is A: Hyperglycemia. Long-term corticosteroid therapy can lead to insulin resistance and increased blood glucose levels. This occurs due to the corticosteroids interfering with insulin action and glucose metabolism. Hyperglycemia is a common side effect that can potentially lead to diabetes. Bradycardia (B), diarrhea (C), and decreased appetite (D) are not commonly associated with long-term corticosteroid therapy. Bradycardia is more commonly associated with medications such as beta-blockers, while diarrhea and decreased appetite are not typical side effects of corticosteroids.

Correct Answer: A

Rationale: The correct answer is A: emulsifying fats. Bile salts help emulsify fats by breaking them into smaller droplets, increasing the surface area for enzymes to act upon during digestion. This aids in the absorption of fats in the small intestine. Choices B, C, and D are incorrect because bile salts do not have a direct role in breaking down carbohydrates (choice B), activating pepsin (choice C), or digesting proteins (choice D). These functions are carried out by other digestive enzymes in the gastrointestinal tract.