A nurse is caring for a client in the gastroenterology unit.
Absence of respiratory distress
Stable vital signs
Reduced ascitic fluid volume
Decreased abdominal pressure
Improved breathing
Relief of abdominal discomfort
Correct Answer : D,E,F
Rationale:
- Improved breathing indicates that the removal of ascitic fluid has relieved diaphragmatic pressure, allowing better lung expansion.
- Decreased abdominal pressure demonstrates that fluid removal has reduced intra-abdominal tension, improving mobility and comfort.
- Relief of abdominal discomfort is a primary goal of paracentesis, as it enhances quality of life and reduces pain caused by fluid accumulation.
- Stable vital signs and absence of respiratory distress are important for monitoring safety but are not direct measures of the procedure’s effectiveness.
- Reduced ascitic fluid volume is the mechanism of action of paracentesis, while the client’s symptomatic relief is the best indicator of clinical success.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","J"]
Explanation
Rationale
- Vital signs on admission and every 4 hr → establish baseline and monitor for instability.
- NPO → prevent worsening GI distress and prepare for possible procedures.
- Dextrose 5% in 0.45% sodium chloride IV at 125 mL/hr → correct fluid volume deficit and dehydration.
Correct Answer is ["15"]
Explanation
Rationale:
Desired dose = 15 mg
Available concentration = 5 mg per 5 mL = 1 mg/mL
Volume needed = Desired dose ÷ Concentration = 15 mg ÷ 1 mg/mL = 15 mL
Rounded to nearest whole number = 15 mL
Final Answer: 15 mL
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