A client with end stage liver disease, cirrhosis, and ascites is scheduled for a paracentesis. Which of the following interventions can be anticipated related to care of this patient?

Void prior to the paracentesis

Ask about family history of malignant hyperthermia.

Place the patient in the prone position for the procedure

Administer metronidazole prophylactically for infection

Answer and Explanation

The Correct Answer is A

A. Void prior to the paracentesis: Before a paracentesis, the patient is typically instructed to void to reduce the risk of puncturing the bladder during the procedure. It is an essential preparatory step.

B. Ask about family history of malignant hyperthermia: Malignant hyperthermia is related to anesthetic agents, not paracentesis.

C. Place the patient in the prone position for the procedure: The correct position for paracentesis is high Fowler’s (sitting upright at 45–90°) to allow fluid to collect in the lower abdomen for easier drainage.

D. Administer metronidazole prophylactically for infection: This is not a routine intervention before a paracentesis, as the risk of infection is managed with sterile technique during the procedure.

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Correct Answer is B

Explanation

A. Hang IV fluids of CSNS with 20 mEq of potassium chloride at 125 ml/hr: Fluid resuscitation is important, but potassium should not be administered until electrolyte levels are assessed. Also, potassium administration in a client with a bowel obstruction requires caution due to the risk of hyperkalemia if renal function is impaired.

B. Insert a nasogastric tube: A nasogastric (NG) tube is essential in managing bowel obstruction as it helps decompress the stomach, relieve pressure, and prevent aspiration. This should be done first to stabilize the client.

C. Draw a basic metabolic panel: Checking electrolyte imbalances is important but should be done after stabilizing the client with NG tube insertion.

D. Ambulate in the hallway: Ambulation is contraindicated in acute bowel obstruction due to the risk of worsening symptoms such as nausea, vomiting, and severe pain.

A. "This condition is correlated to chronic blood loss.” B. "Villi within my intestine are damaged.” C. “Poor nutrition is a causative factor.” D. "The ferrous sulfate is prescribed will replace the lost iron.”

Correct Answer is B

Explanation

A. "This condition is correlated to chronic blood loss.” : Chronic inflammation and ulceration in Crohn’s disease can cause occult GI bleeding, leading to iron-deficiency anemia.

B. "Villi within my intestine are damaged.”: Crohn’s disease affects the entire intestinal wall, but it does not damage villi specifically. Villi damage occurs in celiac disease, not Crohn’s disease.

C. "Poor nutrition is a causative factor.": Malabsorption of iron, vitamin B12, and folate due to inflammation contributes to anemia in Crohn’s disease.

D. "The ferrous sulfate prescribed will replace the lost iron.": Iron supplements (ferrous sulfate) are commonly prescribed for anemia in Crohn’s disease due to chronic blood loss.

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A client with end stage liver disease, cirrhosis, and ascites is scheduled for a paracentesis. Which of the following interventions can be anticipated related to care of this patient?

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