Which of the following complications can arise after a Trans jugular Intrahepatic Portosystemic Shunt (TIPS) procedure?

Cholecystitis

Biliary obstruction

Ascites

Hepatic encephalopathy

Answer and Explanation

The Correct Answer is D

A Transjugular Intrahepatic Portosystemic Shunt (TIPS) is a procedure used to manage complications of portal hypertension, especially in clients with advanced liver disease such as cirrhosis. It creates a channel between the portal vein and hepatic vein to reduce portal pressure and decrease problems such as variceal bleeding and refractory ascites. Although effective, this diversion of blood flow reduces the liver’s ability to filter toxins from the bloodstream. As a result, one of the most common complications after TIPS is the development of hepatic encephalopathy.

Rationale:
A. Cholecystitis is inflammation of the gallbladder and is not a typical complication directly associated with a TIPS procedure. It is more commonly related to gallstones, infection, or biliary stasis rather than portal venous shunting. While clients with liver disease may have multiple abdominal issues, cholecystitis is not the expected post-TIPS complication being assessed here.

B. Biliary obstruction is not a common complication of TIPS because the procedure primarily involves vascular structures rather than the biliary tract. Although rare technical complications may affect nearby structures, routine concern after TIPS is not obstruction of bile flow. Monitoring usually focuses more on bleeding, shunt patency, and neurologic changes rather than biliary blockage.

C. Ascites is often one of the reasons TIPS is performed rather than a complication caused by it. By lowering portal venous pressure, TIPS helps reduce fluid accumulation in the abdomen and is commonly used for refractory ascites management. Persistent or worsening ascites may indicate shunt dysfunction, but ascites itself is not the classic expected complication after the procedure.

D. Hepatic encephalopathy is a common complication after TIPS because blood from the portal circulation bypasses the liver’s detoxification process. Substances such as ammonia are not adequately metabolized and can accumulate in the bloodstream, affecting brain function. Clients may develop confusion, altered mental status, asterixis, and decreased level of consciousness, requiring close neurologic monitoring.

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Correct Answer is A

Explanation

Hemodynamic instability in a postoperative client showing a progressive decline in level of consciousness and urine output can occur as a result of postoperative complications which include fluid volume loss, bleeding, or impaired perfusion leading to decreased cardiac output. Blood pressure trends are critical indicators of circulatory status. A falling blood pressure accompanied by bradycardia, decreased urine output, and altered mental status strongly suggests reduced tissue perfusion and shock-like physiology rather than elevated blood pressure states.

Rationale:

• Hypotension: The client’s blood pressure has dropped significantly from 124/78 mmHg to 88/56 mmHg, indicating decreased vascular perfusion and possible reduced cardiac output. This is supported by worsening mental status, bradycardia, and decreased urine output, which are classic signs of poor systemic perfusion. In postoperative clients, hypotension may result from hypovolemia, bleeding, or distributive causes. The downward trend in vital signs confirms a hypotensive state requiring urgent intervention.

• Hypertension: Hypertension would present with elevated blood pressure readings and is not consistent with the documented trend in this client. Instead of an increase, the client’s blood pressure has progressively decreased to hypotensive levels. Additionally, hypertension would not explain decreased urine output, worsening consciousness, or bradycardia in this context. Therefore, hypertension is not supported by the clinical findings.

A. Reinforce the dressing at the connection between the chest tube and the drainage system tubing. B. Strip the tube. C. Check for kinks in the tubing. D. Disconnect the chest tube from the drainage system.

Correct Answer is A

Explanation

A chest tube drainage system is used to remove air, blood, or fluid from the pleural space and restore negative intrathoracic pressure. Continuous bubbling in the water seal chamber indicates an air leak in the system. Identifying and correcting the source of the leak is essential to maintain effective lung re-expansion and prevent complications such as tension pneumothorax. Nursing interventions focus on systematically locating the leak starting from the patient site moving toward the drainage system.

Rationale:
A. Reinforcing the dressing at the connection between the chest tube and drainage system tubing is the priority action because persistent bubbling after clamping near the dressing suggests a leak at or near the insertion site or tubing connection. This area is a common source of air leaks. Securing and reinforcing the connection helps restore system integrity and prevents further air entry into the pleural space.

B. Stripping the tube is not recommended because it can create excessively negative pressure within the pleural space. This may lead to tissue trauma, bleeding, or re-expansion pulmonary edema. Current best practice discourages routine stripping or milking of chest tubes as it can worsen patient outcomes rather than resolve air leaks.

C. Checking for kinks in the tubing is an appropriate general assessment, but it does not address the specific finding of continuous bubbling after clamping near the insertion site. Kinks typically result in impaired drainage or lack of fluctuation rather than persistent air leak. Since bubbling continues, the issue is more likely a loose connection or insertion site leak.

D. Disconnecting the chest tube from the drainage system is unsafe and contraindicated. This action can introduce air directly into the pleural space, worsening the pneumothorax and potentially causing tension pneumothorax. Any suspected disconnection should be corrected using sterile technique rather than separating the system entirely.

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Which of the following complications can arise after a Trans jugular Intrahepatic Portosystemic Shunt (TIPS) procedure?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a postoperative client who has shown a gradual decline in level of consciousness and reduced urine output over the past few hours. The client is most likely experiencing: Select answer choice

Correct Answer is A

Explanation

A client with a chest tube shows excessive continuous bubbling in the water seal chamber. After clamping the tube near the dressing, the bubbling continues. What should the nurse do next?

Correct Answer is A

Explanation

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