Which topic is most important to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis?

Correct Answer: B

Rationale: The most important topic to include in patient teaching for a 41-year-old patient diagnosed with early alcoholic cirrhosis is avoiding alcohol ingestion. Alcohol abstinence is crucial in stopping or reversing the progression of the disease. While maintaining good nutrition, taking lactulose (Cephulac), and using vitamin B supplements are important interventions in managing cirrhosis, abstaining from alcohol is the priority for this patient to prevent further damage to the liver and halt disease progression.

Correct Answer: B

Rationale: To evaluate treatment effectiveness for a patient with hepatic encephalopathy, requesting the patient to walk with eyes closed is crucial. This test assesses the patient's balance, gait, and coordination, which can be impaired in hepatic encephalopathy due to altered mental status and brain function. Walking with eyes closed challenges the patient's sensory input and proprioception, providing valuable information on improvement or deterioration in neurological function. Asking the patient to extend both arms forward is used to check for asterixis, a sign often seen in hepatic encephalopathy, but it is not specific for evaluating treatment effectiveness. Performing the Valsalva maneuver is unrelated to assessing hepatic encephalopathy and is more commonly used in cardiac evaluations. Observing the patient's breathing pattern may be important in other conditions but is not directly relevant to evaluating treatment effectiveness for hepatic encephalopathy.

Correct Answer: A

Rationale: The correct answer is 'The patient is alert and oriented.' In a patient with advanced cirrhosis, lactulose is used to lower ammonia levels and prevent encephalopathy. A patient being alert and oriented indicates that the medication is effective in achieving this goal. While lactulose may help with constipation, the primary purpose in cirrhosis is to reduce ammonia levels, not to address constipation directly. Denying nausea or anorexia is not a specific indicator of lactulose's effectiveness in treating cirrhosis. Bilirubin levels decreasing are not directly related to lactulose's therapeutic effect on cirrhosis.

Correct Answer: B

Rationale: The correct nursing action for a patient with balloon tamponade for bleeding esophageal varices is to monitor the patient for shortness of breath. The most common complication of balloon tamponade is aspiration pneumonia. Additionally, if the gastric balloon ruptures, the esophageal balloon may slip upward and occlude the airway. Instructing the patient to cough every hour is incorrect as coughing increases the pressure on the varices and raises the risk of bleeding. Verifying the position of the balloon every 4 hours is unnecessary as it is typically done after insertion. Deflating the gastric balloon if the patient reports nausea is incorrect because deflating it may cause the esophageal balloon to occlude the airway, leading to complications. Therefore, monitoring for signs of respiratory distress is crucial in this situation.

Correct Answer: B

Rationale: In a patient with severe cirrhosis and bleeding esophageal varices, monitoring ammonia levels is crucial. Severe liver dysfunction impairs the metabolism of protein in the GI tract, leading to increased ammonia levels. Elevated ammonia levels can result in hepatic encephalopathy, a serious complication. Monitoring bilirubin levels is important for assessing liver function and jaundice but may not directly reflect the risk of complications from bleeding esophageal varices. Potassium levels are important but not the most critical in this scenario. Prothrombin time is essential for evaluating coagulation status but does not directly relate to the risk of complications from bleeding esophageal varices in this patient.