A nurse is completing an admission assessment for a client who has bacterial meningitis. Which of the following personal protective equipment should the nurse use while caring for the client?

Rationale:

A. The nurse provides wound care to a client at the time promised to the client: Providing care as scheduled reflects reliability and professionalism, but it does not involve speaking up for or securing specific services in the client's best interest, which defines advocacy.

B. The nurse refers a client who has chronic obstructive pulmonary disease for palliative care services: This demonstrates advocacy by ensuring the client has access to specialized care that supports comfort, dignity, and symptom management—especially important in progressive, life-limiting illness.

C. The nurse declines to inform a client's neighbor about the client's prognosis: This action protects client confidentiality and privacy, which is ethically correct, but it does not represent active support or promotion of the client's needs or preferences.

D. The nurse files an incident report regarding a medication error: Filing an incident report supports patient safety and institutional accountability. However, it does not reflect direct advocacy, as it does not involve pursuing specific care or services for the client.

Rationale:

• Place on a Low-protein diet: A low-protein diet is often prescribed in clients with hepatic encephalopathy to reduce ammonia production from protein metabolism. With an ammonia level of 150 mcg/dL and signs of chronic liver disease, this is appropriate.
• Daily abdominal girth measurements: This client has a distended abdomen with dullness to percussion, suggesting ascites. Measuring abdominal girth daily helps monitor fluid accumulation and response to diuretics or fluid restriction.
• Daily weights: Weight tracking is essential in clients with ascites or fluid imbalance, common in cirrhosis. It provides a sensitive indicator of fluid retention or loss over time.
• Liver biopsy: With thrombocytopenia (platelets 120,000/mm³), active GI bleeding, and coagulopathy likely due to cirrhosis, liver biopsy poses a high bleeding risk and is not appropriate in this unstable condition.
• Administer lactulose: Lactulose is a first-line treatment for hepatic encephalopathy. It works by trapping ammonia in the colon and promoting its excretion. This is essential given the client's elevated ammonia level and risk for mental status changes.
• Liver ultrasound: A liver ultrasound is a non-invasive imaging tool to evaluate liver size, structure, and presence of masses or ascites. It is safe and appropriate in this client's condition and can guide further management.