A client with cirrhosis and severe ascites is scheduled for a paracentesis. Post-procedure, the client develops signs of tachycardia, hypotension, and mild fever.
Which conditions could cause these symptoms? Select all that apply.
Fluid overload.
Cardiac decompensation.
Hypovolemia.
Paracentesis-induced peritonitis.
Anxiety.
Correct Answer : C,D
Post-paracentesis complications require understanding fluid dynamics and infection risks. Rapid removal of ascitic fluid can cause massive fluid shifts, leading to circulatory collapse. Knowledge of sterile technique and hemodynamics is essential to differentiate between hypovolemia and peritonitis following the procedure.
Choice A rationale
Fluid overload would typically manifest as hypertension, neck vein distention, and crackles in the lungs. Tachycardia and hypotension are classic signs of volume depletion rather than an excess of fluid within the intravascular space following paracentesis.
Choice B rationale
While cardiac issues can cause hypotension, the specific context of post-paracentesis points toward volume shifts. Cardiac decompensation often involves fluid backup and pulmonary congestion, which does not align with the sudden loss of high volume peritoneal fluid.
Choice C rationale
Rapid removal of large volumes of ascitic fluid (often > 5 liters) causes shift from the intravascular space to the interstitium. This leads to decreased circulating volume, manifesting as tachycardia and hypotension (systolic < 90 mm Hg).
Choice D rationale
Peritonitis is a risk when the peritoneal cavity is punctured. Clinical signs include fever (normal range 36.5 to 37.5 degrees Celsius), abdominal pain, and tachycardia. Fever in this client suggests a potential inflammatory or infectious process.
Choice E rationale
Anxiety can cause tachycardia, but it rarely causes significant hypotension and fever. The nurse must prioritize physiological causes like fluid shifts or infection over psychological distress when vital signs are significantly altered after an invasive procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Post stroke education focuses on secondary prevention through risk factor modification. Applying knowledge of pharmacology and lifestyle changes is necessary to ensure the patient understands how to manage hypertension, smoking cessation, and safe medication use to avoid recurrence.
Choice A rationale
Daily exercise is a recommended lifestyle modification that helps manage weight and lower blood pressure. It improves cardiovascular health and reduces the risk of recurrent ischemic events by enhancing vascular tone and reducing systemic inflammation.
Choice B rationale
Smoking cessation is critical because nicotine causes vasoconstriction and accelerates atherosclerosis. Stopping tobacco use significantly lowers the risk of thrombus formation and further ischemic damage to the cerebral vasculature in post stroke patients.
Choice C rationale
Reducing high fat intake and increasing fruits and vegetables helps manage cholesterol levels. Lowering low density lipoprotein levels prevents the progression of carotid artery plaque, which is a major contributor to the occurrence of ischemic strokes.
Choice D rationale
While aspirin is often prescribed for its antiplatelet properties, clients should not self medicate with over the counter versions without clinical supervision. Aspirin increases bleeding risks, and its use must be coordinated with other prescribed anticoagulants..
Correct Answer is B
Explanation
Managing increased intracranial pressure requires applying knowledge of osmotic therapy, cerebral perfusion, and neurological positioning. Nurses must prioritize interventions that rapidly reduce cerebral edema while maintaining physiological stability and preventing herniation in patients with traumatic brain injuries or intracranial hypertension.
Choice A rationale
Pentobarbital is a barbiturate used for medically induced comas to reduce cerebral metabolic demand. While effective for refractory intracranial hypertension, it is typically a secondary or tertiary intervention rather than the immediate priority for an upward trend in pressure.
Choice B rationale
Mannitol is an osmotic diuretic that creates an osmotic gradient, pulling fluid from the cerebral interstitial space into the vascular compartment. This rapidly reduces brain volume and intracranial pressure, making it the first-line pharmacological priority for acute elevations.
Choice C rationale
Hyperventilation decreases PaCO2, causing cerebral vasoconstriction and reduced blood volume. However, excessive hyperventilation can cause cerebral ischemia. Increasing the rate to 20 should only be done under specific medical direction and is not the primary nursing priority here.
Choice D rationale
Proper positioning, such as head of bed elevation and avoiding neck flexion, facilitates venous drainage from the brain. While important, it is a supportive measure and less effective than osmotic diuretics for treating an acute, upward trend.
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