The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take?

Help the client lie flat in bed on the right side.

Sterilize the site of the paracentesis with betadine.

Get the patient into a chair before the procedure.

Assist the client to void before the procedure.

Answer and Explanation

The Correct Answer is D

A paracentesis is a sterile procedure performed to remove excess peritoneal fluid (ascites) to relieve abdominal pressure or for diagnostic analysis. The procedure involves inserting a large-bore needle or catheter through the abdominal wall. Precise anatomical positioning and the protection of internal organs are paramount to prevent accidental organ perforation, particularly of the bladder which rises into the lower abdomen when full.

Rationale:

A. Lying flat in bed on the right side is not the appropriate position for a paracentesis. Typically, the patient is placed in a high-Fowler's position or sitting on the edge of the bed to allow the ascitic fluid to pool in the lower abdominal cavity. This positioning facilitates easier drainage and keeps the bowel loops floating away from the needle.

B. While the site must be cleaned, the nurse's primary responsibility in pre-procedure safety is focused on patient preparation. The provider performing the procedure usually handles the formal sterilization of the site with an antimicrobial agent like chlorhexidine or betadine. The nursing priority is ensuring the patient's bladder is empty to avoid injury during needle insertion.

C. Placing the patient in a chair before the procedure is not a standard safety intervention for paracentesis. While the patient may sit upright during the procedure, the nurse must ensure a stable environment where the patient's vitals can be monitored and the sterile field maintained. Moving a patient with severe ascites into a chair can also be physically taxing.

D. Assisting the client to void before the procedure is the most appropriate action. An empty bladder minimizes the risk of accidental puncture by the paracentesis needle during insertion into the lower abdominal wall. This is a critical safety step because a distended bladder occupies the space where the needle is typically introduced to access the peritoneal fluid.

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Correct Answer is A

Explanation

The stomach acts as a reservoir for gastric juice, which contains a high concentration of hydrochloric acid(HCl). When profuse vomiting occurs, there is a massive loss of hydrogen ions and chloride from the body. This results in a relative excess of bicarbonate in the extracellular fluid, triggering a significant shift in the blood's pH and electrolyte balance.

Rationale:

A.Metabolic alkalosisis expected because vomiting causes the loss of gastric hydrochloric acid. As hydrogen ions are depleted, the serum pH rises above 7.45. The body attempts to compensate by retaining carbon dioxide through hypoventilation, but the primary cause remains the loss of acid and the subsequent elevation of systemic bicarbonate levels.

B.Metabolic acidosis would be expected in cases of severe diarrhea rather than vomiting. Diarrhea causes the loss of alkaline intestinal secretions and bicarbonate. In contrast, vomiting specifically targets the acidic environment of the stomach, making the blood more basic (alkaline) rather than acidic, provided there is no concomitant underlying renal failure.

C.Respiratory alkalosis is caused by hyperventilation, which leads to the excessive "blowing off" of carbon dioxide. While a patient in pain may breathe faster, the primary and most significant imbalance in a patient who has been vomiting profusely is metabolic in nature, driven by the direct chemical loss of gastric acid through the esophagus.

D.Respiratory acidosis occurs when there is inadequate alveolar ventilation leading to the retention of carbon dioxide. This is typically seen in patients with respiratory failure or obstructive lung diseases. It is not a direct consequence of vomiting, which is a metabolic process involving the gastrointestinal tract and the loss of specific electrolytes and acids.

A. Joint pain and inflammation B. Lactose intolerance C. Iron deficiency anemia D. Steatorrhea

Correct Answer is D

Explanation

Celiac diseaseis an autoimmune enteropathy triggered by the ingestion of glutenin genetically predisposed individuals. The immune response causes villous atrophy in the small intestine, significantly reducing the surface area available for nutrient absorption. This leading to profound malabsorptionof fats and fat-soluble vitamins, which alters the composition and appearance of the stool as unabsorbed nutrients are excreted.

Rationale:

A.Joint pain and inflammation are extra-intestinal manifestations that can occur in celiac disease but are not considered "classic" symptoms. These systemic symptoms are common to many autoimmune disorders. The hallmark signs of celiac disease are primarily gastrointestinal, reflecting the direct damage to the intestinal mucosa and the resulting failure of the digestive process.

B.Secondary lactose intolerance often accompanies celiac disease because the damaged villi cannot produce enough lactase enzyme. However, this is a secondary effect rather than the defining classic symptom of the primary disease process. Many other conditions cause lactose intolerance, making it less specific than the malabsorption signs directly linked to gluten-induced intestinal injury.

C.Iron deficiency anemia is a frequent consequence of the malabsorption seen in celiac disease because iron is absorbed in the duodenum, where damage is often most severe. While it is a common diagnostic clue, it is a secondary complication. The most characteristic and direct clinical indicator of the intestinal failure associated with celiac disease involves the nature of the stool.

D.Steatorrheais the classic symptom of Celiac Disease. It refers to the presence of excess fat in the feces, resulting from the malabsorption caused by villous atrophy. These stools are typically foul-smelling, oily, and frothy, and they often float in the toilet. This finding directly reflects the primary pathophysiology of the disease: the inability of the small intestine to absorb lipids.

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The nurse is caring for a client who is scheduled for a paracentesis. Which action is appropriate for the nurse to take?

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