Identify two causes of ascites related to liver cirrhosis:
Poor nutrition related to alcoholism results in abdominal obesity.
Portal hypertension pushes proteins from the blood vessels, causing leakage into the peritoneal cavity.
Osmoreceptors in the hypothalamus stimulate thirst, which causes the patient to take in excessive fluids orally.
There is decreased colloid oncotic pressure from the liver's inability to synthesize albumin.
Correct Answer : B,D
Choice A reason: Poor nutrition related to alcoholism can lead to abdominal obesity, but it is not a direct cause of ascites in liver cirrhosis. Ascites is primarily due to factors like portal hypertension and decreased colloid oncotic pressure.
Choice B reason: Portal hypertension is a significant cause of ascites in liver cirrhosis. The increased pressure in the portal vein causes proteins to leak from the blood vessels into the peritoneal cavity, leading to fluid accumulation.
Choice C reason: Osmoreceptors in the hypothalamus stimulating thirst can lead to excessive fluid intake, but this is not a direct cause of ascites related to liver cirrhosis. Ascites is more directly linked to portal hypertension and decreased colloid oncotic pressure.
Choice D reason: Decreased colloid oncotic pressure due to the liver's inability to synthesize albumin is a key factor in the development of ascites. Albumin helps maintain fluid balance in the blood vessels, and its deficiency leads to fluid leakage into the peritoneal cavity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Contacting the health care provider is the most appropriate action because a change in the Doppler sound may indicate a potential complication, such as graft occlusion or compromised blood flow. Immediate assessment and intervention by the health care provider are essential to prevent further complications and ensure the patient's safety.
Choice B reason: Rechecking the pulse in another 30 minutes is not advisable in this situation because it could delay necessary medical intervention. Prompt communication with the health care provider is crucial to address the underlying issue and provide timely care.
Choice C reason: Measuring the ankle-brachial index can provide valuable information about blood flow in the lower extremities, but it is not the immediate priority when a significant change in the Doppler sound is detected. Contacting the health care provider for further assessment and instructions takes precedence.
Choice D reason: Administering an oral anticoagulant is not an appropriate action without the direct instruction from a health care provider. The nurse must first report the change in the Doppler sound to the provider and follow their specific orders regarding medication and treatment.
Correct Answer is C
Explanation
Choice A reason: Informing the patient that the pain medication is contraindicated and offering to dim the room lights addresses the immediate concern but does not provide an effective solution for pain management. While it's important to inform the patient, alternative pain relief should be pursued.
Choice B reason: Monitoring the patient closely after administering ibuprofen for pain does not ensure patient safety, especially since ibuprofen can worsen kidney function in patients with acute renal failure. Administering ibuprofen is contraindicated in this case.
Choice C reason: Consulting the healthcare provider about ordering a different pain medication is the safest first step. This ensures that the patient receives an appropriate pain reliever that does not further compromise their renal function. The healthcare provider can prescribe a medication that is safe for patients with acute renal failure.
Choice D reason: Administering ibuprofen as ordered since it is used to treat headaches is not appropriate in this scenario. Ibuprofen is nephrotoxic and can worsen renal function in patients with acute renal failure, making it unsafe to administer.
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