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?
Increased urine output and dehydration.
Weight loss and decreased abdominal girth.
Visible abdominal swelling and distention.
Reduced ankle edema and lower extremity swelling.
The Correct Answer is C
Choice A reason:
Increased urine output and dehydration are not early signs of ascites progression. Ascites involves fluid accumulation in the abdominal cavity, not fluid loss through the urinary system.
Choice B reason:
Weight loss and decreased abdominal girth are not early signs of ascites progression. Ascites typically leads to increased abdominal girth and swelling.
Choice C reason:
This statement is correct. Visible abdominal swelling and distention are early signs of ascites progression. As fluid accumulates in the abdominal cavity, the abdomen may become visibly swollen and distended.
Choice D reason:
Reduced ankle edema and lower extremity swelling are not early signs of ascites progression. Ascites primarily affects the abdominal cavity, not the extremities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason:
Mild ankle edema is not uncommon in clients with fluid retention, such as ascites. While it requires monitoring, it does not indicate an immediate need for intervention.
Choice B reason:
Moderate abdominal distention is a common finding in clients with ascites and should be monitored, but it does not require immediate intervention.
Choice C reason:
Complaints of thirst and dry mouth may indicate dehydration, which should be addressed, but it does not require immediate intervention as other options.
Choice D reason:
This statement is correct. Respiratory distress and cyanosis are concerning findings in a client with ascites, as they may indicate severe pulmonary edema or other respiratory complications that require immediate intervention and medical attention.
Correct Answer is A
Explanation
Choice A reason:
This statement is correct. Avoiding alcoholic beverages is essential for clients with cirrhosis to prevent further liver damage and fluid accumulation leading to ascites.
Choice B reason:
Increasing sodium intake is not recommended for clients with ascites, as excess sodium can contribute to fluid retention.
Choice C reason:
Engaging in strenuous physical activities may not be appropriate for clients with cirrhosis and ascites, as excessive exertion can worsen fluid retention and increase the risk of complications.
Choice D reason:
A high-fat diet is not recommended for clients with cirrhosis and ascites. A balanced diet with appropriate protein and carbohydrate intake is more appropriate for managing this condition.
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