A client with cirrhosis and severe ascites is scheduled for a paracentesis. Post-procedure, the client develops signs of tachycardia, hypotension, and mild fever.
Which conditions could cause these symptoms? Select all that apply.

Fluid overload.

Cardiac decompensation.

Hypovolemia.

Paracentesis-induced peritonitis.

Anxiety.

Answer and Explanation

Correct Answer : C,D

Post-paracentesis complications require understanding fluid dynamics and infection risks. Rapid removal of ascitic fluid can cause massive fluid shifts, leading to circulatory collapse. Knowledge of sterile technique and hemodynamics is essential to differentiate between hypovolemia and peritonitis following the procedure.

Choice A rationale

Fluid overload would typically manifest as hypertension, neck vein distention, and crackles in the lungs. Tachycardia and hypotension are classic signs of volume depletion rather than an excess of fluid within the intravascular space following paracentesis.

Choice B rationale

While cardiac issues can cause hypotension, the specific context of post-paracentesis points toward volume shifts. Cardiac decompensation often involves fluid backup and pulmonary congestion, which does not align with the sudden loss of high volume peritoneal fluid.

Choice C rationale

Rapid removal of large volumes of ascitic fluid (often > 5 liters) causes shift from the intravascular space to the interstitium. This leads to decreased circulating volume, manifesting as tachycardia and hypotension (systolic < 90 mm Hg).

Choice D rationale

Peritonitis is a risk when the peritoneal cavity is punctured. Clinical signs include fever (normal range 36.5 to 37.5 degrees Celsius), abdominal pain, and tachycardia. Fever in this client suggests a potential inflammatory or infectious process.

Choice E rationale

Anxiety can cause tachycardia, but it rarely causes significant hypotension and fever. The nurse must prioritize physiological causes like fluid shifts or infection over psychological distress when vital signs are significantly altered after an invasive procedure.

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Correct Answer is D

Explanation

Full thickness burns trigger massive systemic inflammatory responses and capillary leak syndrome. The clinical priority is addressing hypovolemic shock through aggressive fluid resuscitation to maintain organ perfusion, particularly when large surface areas like both legs are involved.

Choice A rationale

Sterile environments prevent secondary infections and sepsis in denuded skin areas. While infection control is vital in burn management, it is a secondary goal compared to the immediate physiological threat of hypovolemic shock and cardiovascular collapse.

Choice B rationale

Pain assessment is standard nursing practice, yet full thickness burns often destroy nerve endings, potentially resulting in less pain than partial thickness burns. Regardless, physiological stabilization and fluid replacement take precedence over subjective pain scaling in emergencies.

Choice C rationale

Prophylactic antibiotics are not typically the initial priority in acute burn care. Fluid resuscitation and airway management are paramount. Systemic antibiotics are usually reserved for documented infections rather than immediate emergency department stabilization of fluid status.

Choice D rationale

Burn injuries cause significant fluid shifts from the intravascular to the interstitial space. Administering Lactated Ringer solution is the gold standard for restoring volume and preventing acute tubular necrosis or organ failure during the first 24 hours.

A. It reduces the client's blood pressure. B. It decreases the client's level of anxiety. C. It facilitates the client's deep breathing. D. It enhances the client's ability to sleep.

Correct Answer is C

Explanation

Postoperative care for cardiac surgery requires balancing pain management with respiratory function. Knowledge of pulmonary mechanics and the risks of atelectasis is necessary to identify how analgesia facilitates deep breathing and coughing to prevent pneumonia and improve oxygenation.

Choice A rationale

Opioids can cause vasodilation and subsequent hypotension, but reducing blood pressure is not the therapeutic goal of analgesia in this context. While beneficial for cardiac workload, it is not the most critical recovery factor here.

Choice B rationale

Anxiety reduction is a secondary benefit of pain control that improves patient comfort. However, physiological stabilization and the prevention of respiratory complications take precedence over psychological comfort in the immediate postoperative phase after a bypass.

Choice C rationale

Postoperative pain causes guarded, shallow respirations, increasing the risk of lung collapse. Effective analgesia allows the client to perform deep breathing and incentive spirometry, which are vital for maintaining alveolar expansion and preventing secondary infections.

Choice D rationale

Sleep is necessary for cellular repair and overall recovery. While opioids help a patient rest, the primary physiological priority for a bypass patient is maintaining adequate gas exchange through effective ventilation, which requires active respiratory effort.

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A client with cirrhosis and severe ascites is scheduled for a paracentesis. Post-procedure, the client develops signs of tachycardia, hypotension, and mild fever. Which conditions could cause these symptoms? Select all that apply.

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A client with cirrhosis and severe ascites is scheduled for a paracentesis. Post-procedure, the client develops signs of tachycardia, hypotension, and mild fever.
Which conditions could cause these symptoms? Select all that apply.