A nurse is educating a client about preventing skin cancer.
Which of the following client statements indicates a need for further teaching?

Choice A rationale
Limiting fluid intake to 1 liter per day is not recommended for patients who have experienced an acute gout attack. Adequate hydration is important for all individuals, especially those with gout, as it can help to prevent the formation of uric acid crystals.
Choice B rationale
Taking one aspirin every day is not typically recommended for gout patients. Aspirin can actually increase uric acid levels in the blood and potentially trigger a gout attack.
Choice C rationale
Adhering to a high-purine diet is not recommended for gout patients. Foods high in purines can increase uric acid levels in the blood, potentially triggering a gout attack.

Choice D rationale
Restricting alcohol consumption is a key part of managing gout. Alcohol, especially beer, can increase uric acid levels in the blood and trigger gout attacks.

Choice C rationale
Hepatic encephalopathy is a condition that can cause confusion or delirium in patients with end-stage liver disease and increasing ascites. It occurs when the liver is unable to remove toxins from the blood, such as ammonia, which can then accumulate in the brain and affect mental function. This condition is common in patients with cirrhosis or end-stage liver disease, and can manifest as confusion, changes in sleep patterns, mood alterations, and, in severe cases, coma.
Choice A rationale
While dementia can cause confusion and changes in mental status, it is typically a progressive condition that develops over time. In the context of a patient with end-stage liver failure and

increasing ascites who is usually lucid, a sudden onset of confusion or delirium is more likely to be due to a condition related to their liver disease, such as hepatic encephalopathy.
Choice B rationale
Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. It is not typically associated with end-stage liver disease or ascites. In the context of a patient with end-stage liver failure and increasing ascites who is usually lucid, a sudden onset of confusion or delirium is more likely to be due to a condition related to their liver disease, such as hepatic encephalopathy.
Choice D rationale
While a urinary tract infection (UTI) can cause confusion, especially in older adults, it would not typically be the primary suspect in a patient with end-stage liver failure and increasing ascites. In such a patient, hepatic encephalopathy is a more likely cause of confusion or delirium.