A nurse is caring for a client who has end-stage liver disease and is undergoing a paracentesis. Which of the following actions should the nurse take to evaluate the effectiveness of the procedure?
Confirm that the client is able to urinate.
Compare the client's current weight with preprocedure weight.
Examine for leakage at the site of the procedure.
Check the client's serum albumin levels.
The Correct Answer is B
A. While urine output is important, it is not the most direct indicator of the success of a paracentesis.
B. Comparing the client's weight before and after the procedure helps to evaluate the effectiveness by showing a reduction in fluid buildup.
C. Leakage at the site could indicate a complication, but it is not the primary measure of the procedure’s
effectiveness.
D. Serum albumin levels may be monitored but are not the first indicator of success after a paracentesis.
Nursing Test Bank
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Related Questions
Correct Answer is D
Explanation
A. Smacking lips is a sign of tardive dyskinesia, not pseudoparkinsonism.
B. Serpentine limb movement is not a typical manifestation of pseudoparkinsonism.
C. Nonreactive pupils are not associated with pseudoparkinsonism but may be seen in other neurological conditions.
D. A shuffling gait is a classic manifestation of pseudoparkinsonism, a side effect of haloperidol (an antipsychotic medication).
Correct Answer is B
Explanation
A. Applying intermittent pressure may not effectively stop bleeding from a cardiac catheterization site, as continuous pressure is typically more effective in controlling post-procedural bleeding.
B. Applying continuous pressure 2.5 cm above the percutaneous site is the appropriate action to stop bleeding from the catheterization site.
C. Applying pressure below the site may not effectively control bleeding and could compromise the site.
D. Continuous pressure should be applied above the percutaneous site, not below, to control bleeding.
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