A client with liver cirrhosis has developed ascites. Which nursing intervention is a priority for managing this complication?

Encouraging the client to increase protein intake.

Assisting the client with frequent ambulation.

Administering diuretics as prescribed by the healthcare provider.

Teaching the client deep breathing exercises.

Answer and Explanation

The Correct Answer is C

A) While adequate protein intake is important for overall health, encouraging the client to increase protein intake is not a priority in managing ascites. The priority is to address fluid retention through diuretic therapy.

B) While ambulation can be beneficial for clients with liver cirrhosis, it is not the priority for managing ascites. Diuretic therapy is more directly targeted at reducing fluid accumulation.

C) The priority nursing intervention for managing ascites in a client with liver cirrhosis is administering diuretics as prescribed by the healthcare provider. Diuretics help reduce fluid retention and alleviate the pressure caused by the accumulation of fluid in the abdomen. This intervention aims to improve the client's comfort and prevent the development of further complications associated with ascites.

D) Deep breathing exercises can be helpful for clients with liver cirrhosis, but they are not the priority for managing ascites. The focus should be on diuretic therapy and addressing the fluid retention in the abdomen.

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Correct Answer is D

Explanation

A) Hematemesis refers to vomiting of blood and is a symptom that can occur as a result of bleeding from esophageal varices or other gastrointestinal sources.

B) Ascites is the accumulation of fluid in the abdominal cavity, leading to abdominal distension. It is not related to the presence of visible distended veins on the abdomen and chest.

C) Splenomegaly is the enlargement of the spleen and is not related to the finding of visible distended veins.

D) Varices are dilated and tortuous veins that can develop in various locations, including the esophagus (esophageal varices) and the abdomen and chest wall (caput medusae). In liver cirrhosis, portal hypertension causes increased pressure in the portal vein, leading to the development of these enlarged veins. Esophageal varices can be life-threatening if they rupture and cause severe bleeding.

A. Paracentesis B. Thoracentesis C. Pleurodesis D. Pericardiocentesis

Correct Answer is A

Explanation

A)Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity to drain the accumulated fluid in clients with ascites. This procedure is performed to relieve abdominal pressure and discomfort, as well as to facilitate diagnostic testing on the ascitic fluid.

B) Thoracentesis is a procedure to drain fluid from the pleural cavity, which is the space surrounding the lungs. It is not used to treat ascites.

C) Pleurodesis is a procedure performed to create adhesions between the two layers of the pleura to prevent recurrent pleural effusions (fluid accumulation in the pleural cavity). It is not used to treat ascites.

D) Pericardiocentesis is a procedure to drain fluid from the pericardial sac surrounding the heart. It is not used to treat ascites.

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A client with liver cirrhosis has developed ascites. Which nursing intervention is a priority for managing this complication?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with liver cirrhosis is found to have visible distended veins on the abdomen and chest. Which term should the nurse use to document this finding?

Correct Answer is D

Explanation

A client with liver cirrhosis presents with severe ascites. Which procedure should the nurse anticipate being performed to drain the accumulated fluid from the peritoneal cavity?

Correct Answer is A

Explanation

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