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Exam NCLEX-RN topic 7 question 105 discussion

Actual exam question from Test Prep's NCLEX-RN
Question #: 105
Topic #: 7
[All NCLEX-RN Questions]

During the assessment, the nurse observes a client scratching his skin. He has been admitted to rule out Laennecs cirrhosis of the liver. The nurse knows the pruritus is directly related to:

  • A. A loss of phagocytic activity
  • B. Faulty processing of bilirubin
  • C. Enhanced detoxification of drugs
  • D. The formation of collateral circulation
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Suggested Answer: B 🗳️
(A) A loss in the phagocytic activity of the Kupffer cells occurs with cirrhosis of the liver, which increases the susceptibility to infections. (B) The faulty processing of bilirubin produces bilesalts, which are irritating to the skin. (C) The detoxification of drugs is impaired with cirrhosis of the liver. (D) Collateral circulation develops due to portal hypertension. This is manifest through the development of esophageal varices, hemorrhoids, and caput medusae.
by [deleted] at March 10, 2025, 7:21 a.m.

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