a client with cirrhosis of the liver is experiencing pruritus which intervention should the nurse implement to help relieve the clients symptoms
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Nursing Elites

ATI LPN

ATI PN Adult Medical Surgical 2019

1. A client with cirrhosis of the liver is experiencing pruritus. Which intervention should the nurse implement to help relieve the client's symptoms?

Correct answer: B

Rationale: Pruritus is a common symptom in clients with cirrhosis due to bile salts accumulating in the skin. Applying lotion to the skin helps soothe the itching and can prevent skin breakdown. Acetaminophen can worsen liver damage in clients with cirrhosis as it is metabolized in the liver. Encouraging a high-protein diet is not directly related to relieving pruritus. Providing a warm bath may further dry the skin, exacerbating the itching. Therefore, the most appropriate intervention to help relieve pruritus in a client with cirrhosis is to apply lotion to the skin.

2. A client with chronic obstructive pulmonary disease (COPD) is experiencing respiratory distress. Which intervention should the nurse implement first?

Correct answer: C

Rationale: In a client with COPD experiencing respiratory distress, the priority intervention should be to position the client in a high Fowler's position. This position helps optimize lung expansion, improve oxygenation, and reduce the work of breathing. Administering bronchodilators and encouraging pursed-lip breathing are important interventions but positioning the client to enhance respiratory function takes precedence in this situation. Obtaining an ABG sample may provide valuable information but is not the initial priority when addressing respiratory distress.

3. A client with type 2 diabetes mellitus is prescribed metformin (Glucophage). Which instruction should the nurse provide?

Correct answer: C

Rationale: Monitoring blood glucose levels regularly is crucial for clients with type 2 diabetes who are taking metformin. This helps assess the effectiveness of the medication in managing blood sugar levels and allows for timely adjustments in the treatment plan if needed. By monitoring blood glucose levels, the client and healthcare team can work together to achieve optimal diabetes control and prevent complications associated with uncontrolled blood sugar levels.

4. A client with Parkinson's disease is being cared for by a nurse. Which intervention should be included to address the client's bradykinesia?

Correct answer: A

Rationale: Encouraging daily walking is an essential intervention to address bradykinesia in clients with Parkinson's disease. Walking helps improve mobility, flexibility, and coordination, which can help manage the slowness of movement associated with bradykinesia. Providing thickened liquids (Choice B) is more relevant for dysphagia, not bradykinesia. Offering small, frequent meals (Choice C) is related to managing dysphagia and nutritional needs but does not specifically address bradykinesia. Teaching the client to use adaptive utensils (Choice D) is more focused on addressing fine motor skills and grip strength, which are not the primary concerns in bradykinesia.

5. A 60-year-old male client is admitted to the hospital with the complaint of right knee pain for the past week. His right knee and calf are warm and edematous. He has a history of diabetes and arthritis. Which neurological assessment action should the nurse perform for this client?

Correct answer: B

Rationale: In this scenario, the nurse should assess pulses, paresthesia, and paralysis distal to the right knee to evaluate for neurovascular compromise. This assessment helps determine the perfusion and sensation of the lower extremity, which is crucial in identifying potential vascular or nerve damage that may be causing the client's symptoms.

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