The patient presents with jaundice and itching, steatorrhea, and liver enlargement. This patient has also had ulcerative colitis for several years. What diagnosis should the nurse expect for this patient?

Correct Answer: D

Rationale: The correct answer is D) Primary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic liver disease characterized by inflammation and scarring of the bile ducts inside and outside the liver. It is commonly associated with ulcerative colitis, an inflammatory bowel disease. The patient's symptoms of jaundice, itching, steatorrhea, and liver enlargement are indicative of liver dysfunction and bile duct involvement, which align with primary sclerosing cholangitis. Option A) Cirrhosis is a chronic liver disease characterized by liver scarring due to various factors such as alcoholism, viral hepatitis, or non-alcoholic fatty liver disease. While cirrhosis can present with jaundice and liver enlargement, the presence of ulcerative colitis and steatorrhea in this case points more towards primary sclerosing cholangitis. Option B) Acute liver failure is a rapid deterioration of liver function, leading to hepatic encephalopathy and coagulopathy. The patient's symptoms are more indicative of a chronic rather than acute liver condition. Option C) Hepatorenal syndrome is a condition where there is kidney failure in the setting of advanced liver disease. The patient's symptoms do not specifically point towards kidney involvement at this stage. Educationally, understanding the relationship between primary sclerosing cholangitis and ulcerative colitis is crucial for nurses caring for patients with these conditions. Recognizing the symptoms and complications of primary sclerosing cholangitis can aid in early detection and management to improve patient outcomes. Nurses should also be aware of the differential diagnoses for liver diseases to provide comprehensive care and support to patients with gastrointestinal conditions.

Correct Answer: B

Rationale: The correct answer is B) Interferon and ribavirin for treating chronic hepatitis C. Interferon helps the immune system fight the virus, while ribavirin inhibits viral replication. This combination therapy has been shown to be effective in managing chronic hepatitis C. Option A) Sulfasalazine is used for inflammatory bowel disease like ulcerative colitis and Crohn's disease, not for hepatitis C. Option C) Metronidazole and ciprofloxacin are antibiotics used for bacterial infections, not for hepatitis C caused by a virus. Option D) Acetaminophen is a pain reliever but should be used cautiously in patients with liver disease due to the risk of hepatotoxicity. Understanding the appropriate treatment for chronic hepatitis C is crucial for nurses and healthcare providers caring for patients with this condition. It is important to be aware of the medications used, their mechanisms of action, and potential side effects to provide safe and effective care. Treatment of hepatitis C has evolved over the years, so staying updated on current guidelines and recommendations is essential for providing quality patient care.

Correct Answer: B

Rationale: In an ambulatory care GI clinic, the most appropriate task to assign to the LPN/LVN would be to assist the physician in incision and drainage of a pilonidal cyst (option B). This task falls within the scope of practice for an LPN/LVN as it involves direct patient care and assistance during a procedure that does not require advanced nursing assessment or evaluation skills. Option A is incorrect because teaching self-care measures for hemorrhoids requires a higher level of nursing assessment and education, which is typically within the scope of an RN. Option C involves evaluating a client's response to treatment, which requires nursing assessment and decision-making skills beyond the scope of an LPN/LVN. Option D involves describing the basic pathophysiology of an anal fistula, which requires a higher level of understanding and knowledge dissemination than what an LPN/LVN is typically responsible for in an ambulatory care setting. Educationally, understanding the scope of practice for different levels of nursing staff is crucial in assigning tasks appropriately to ensure safe and effective patient care. LPN/LVNs play a vital role in the healthcare team but are limited in certain responsibilities compared to RNs. This question highlights the importance of delegation based on skill level and scope of practice guidelines.

Correct Answer: D

Rationale: In this scenario, the most useful assessment measure for monitoring a client with peptic ulcer disease is option D, assessing the vital signs and fluid status. Assessing vital signs and fluid status is crucial because peptic ulcer disease can lead to complications such as hemorrhage or perforation, which can result in significant changes in vital signs like tachycardia, hypotension, and signs of hypovolemic shock. Monitoring fluid status is essential to detect dehydration, a common complication of peptic ulcers due to decreased oral intake or blood loss. Option A, assessing bowel patterns and stool characteristics, may provide information about gastrointestinal bleeding, but changes in vital signs would be a more immediate and reliable indicator of complications like hemorrhage. Option B, evaluating the client's skin for signs of infection, is not directly related to monitoring for complications of peptic ulcer disease. Skin assessment is important for other conditions but is not the priority in this context. Option C, evaluating the emotional status, while important for holistic care, is not the most useful measure for monitoring medical complications in a client with peptic ulcer disease. Emotional status assessment is more relevant in assessing stress levels, coping mechanisms, or anxiety related to the illness. In an educational context, understanding the rationale behind selecting the most appropriate assessment measure helps nurses prioritize their care and interventions effectively. By emphasizing the importance of monitoring vital signs and fluid status in clients with peptic ulcer disease, nurses can improve patient outcomes and ensure timely interventions for any developing complications.

Correct Answer: B

Rationale: The correct answer is B) Report if there is resistance when the catheter reaches the nipple valve. Rationale: - When a client with an ileostomy is using a catheter, encountering resistance when the catheter reaches the nipple valve could indicate a potential blockage or complication that needs immediate attention. Reporting this resistance promptly to a healthcare provider is crucial for early intervention and prevention of further complications. - Option A) Avoid warming the catheter before inserting it into the ileal pouch is incorrect because warming the catheter can actually help make the insertion process more comfortable for the client and reduce the risk of injury. - Option C) Avoid coughing when the catheter is being inserted into the ileal pouch is incorrect as coughing should not directly impact the insertion process. However, if the client experiences coughing fits, they should pause until they are able to proceed safely. - Option D) Clean catheter with soapy water and store it in a plastic bag after use is incorrect as catheters used for ileostomy care should be cleaned with mild soap and water, rinsed thoroughly, and air-dried to maintain hygiene and prevent infections. Educational Context: Understanding the correct technique for using a catheter with an ileostomy is essential for nurses caring for clients with this condition. Recognizing signs of potential issues, such as resistance when inserting the catheter, is critical for early intervention and ensuring the client's well-being. Nurses must be knowledgeable about proper stoma care techniques to provide safe and effective care to clients with ostomies.