A client with ascites is at risk of developing fluid and electrolyte imbalances. Which nursing intervention should be implemented to monitor the client's fluid balance and hydration status effectively?

Weigh the client daily and record the weight in the chart.

Measure vital signs every four hours to assess for changes.

Assess urine output hourly and document the findings.

Restrict fluid intake to prevent further fluid retention.

Answer and Explanation

The Correct Answer is A

Choice A reason:

This statement is correct. Weighing the client daily and recording the weight in the chart is an essential intervention to monitor fluid balance and detect any changes in body weight, which can indicate fluid retention or loss.

Choice B reason:

Measuring vital signs every four hours is important for assessing the client's overall condition, but it does not directly monitor fluid balance or hydration status.

Choice C reason:

Assessing urine output hourly is important, especially for clients with ascites who may have altered kidney function. However, it may not provide a comprehensive assessment of the client's overall fluid balance.

Choice D reason:

Restricting fluid intake may not be appropriate for all clients with ascites, as fluid restriction could lead to dehydration and further imbalances in fluid and electrolyte levels.

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Correct Answer is D

Explanation

Choice A reason:

Administering diuretics may be part of the management plan, but it may not provide immediate relief to the client experiencing discomfort and difficulty breathing.

Choice B reason:

Elevating the head of the bed can help improve respiratory function, but placing the client in a side-lying position is more effective for facilitating fluid drainage from the abdomen and providing immediate relief to the client with ascites.

Choice C reason:

Deep breathing exercises are beneficial for improving lung capacity, but they may not provide immediate relief to the client experiencing discomfort and difficulty breathing due to ascites.

Choice D reason:

This statement is correct. Placing the client in a side-lying position helps to facilitate fluid drainage from the abdomen and can provide immediate relief to the client with ascites who is experiencing discomfort and difficulty breathing.

A. Kidney failure and fluid imbalance. B. Increased bile production and obstruction. C. Liver damage and impaired fluid regulation. D. Heart failure and cardiac fluid overload.

Correct Answer is C

Explanation

Choice A reason:

Excessive alcohol consumption can contribute to kidney damage, but it is not the primary cause of ascites in individuals with chronic alcohol abuse.

Choice B reason:

Increased bile production and obstruction are not directly related to the development of ascites in clients with alcohol abuse.

Choice C reason:

This statement is correct. Chronic alcohol abuse can lead to liver damage, particularly cirrhosis, which impairs the liver's ability to regulate fluid balance, leading to ascites.

Choice D reason:

Heart failure can result in fluid overload, but it is not directly related to the development of ascites in individuals with alcohol abuse.

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A client with ascites is at risk of developing fluid and electrolyte imbalances. Which nursing intervention should be implemented to monitor the client's fluid balance and hydration status effectively?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with ascites is experiencing discomfort and difficulty breathing due to fluid accumulation in the abdomen. What intervention should the nurse prioritize to provide immediate relief to the client?

Correct Answer is D

Explanation

A client with chronic alcohol abuse is at risk of developing ascites. The nurse explains that excessive alcohol consumption can contribute to ascites primarily by causing:

Correct Answer is C

Explanation

A nurse is assessing a client with ascites. The nurse notices that the client's abdomen is distended, and the skin over the abdomen is taut and shiny. Which intervention should the nurse prioritize based on this assessment finding?

A client with ascites is receiving paracentesis for therapeutic relief. Which action should the nurse prioritize during the procedure to ensure the client's safety and comfort?

A nurse is reviewing the results of a client's diagnostic tests to confirm the presence of ascites. Which of the following laboratory findings is commonly associated with ascites?

A nurse is caring for a client with suspected ascites. In addition to imaging tests, which of the following diagnostic procedures can help determine the underlying cause of the ascites?

A client with ascites is prescribed spironolactone, a potassium-sparing diuretic. The nurse instructs the client to monitor for which of the following adverse effects while taking this medication?

A client with ascites is being monitored for signs of fluid accumulation and complications. The nurse should assess for which of the following early signs of ascites progression?

A client with chronic kidney disease (CKD) is at risk of developing ascites due to impaired fluid regulation. The nurse explains that the kidneys' primary function related to fluid balance is:

A client with cirrhosis is undergoing diagnostic tests to assess the severity and extent of ascites. The nurse explains that an imaging test commonly used to evaluate the liver and abdominal organs in this client is: