A client with liver cirrhosis presents with severe ascites. Which procedure should the nurse anticipate being performed to drain the accumulated fluid from the peritoneal cavity?
Paracentesis
Thoracentesis
Pleurodesis
Pericardiocentesis
The Correct Answer is A
A)Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity to drain the accumulated fluid in clients with ascites. This procedure is performed to relieve abdominal pressure and discomfort, as well as to facilitate diagnostic testing on the ascitic fluid.
B) Thoracentesis is a procedure to drain fluid from the pleural cavity, which is the space surrounding the lungs. It is not used to treat ascites.
C) Pleurodesis is a procedure performed to create adhesions between the two layers of the pleura to prevent recurrent pleural effusions (fluid accumulation in the pleural cavity). It is not used to treat ascites.
D) Pericardiocentesis is a procedure to drain fluid from the pericardial sac surrounding the heart. It is not used to treat ascites.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A) Hematemesis refers to vomiting of blood and is a symptom that can occur as a result of bleeding from esophageal varices or other gastrointestinal sources.
B) Ascites is the accumulation of fluid in the abdominal cavity, leading to abdominal distension. It is not related to the presence of visible distended veins on the abdomen and chest.
C) Splenomegaly is the enlargement of the spleen and is not related to the finding of visible distended veins.
D) Varices are dilated and tortuous veins that can develop in various locations, including the esophagus (esophageal varices) and the abdomen and chest wall (caput medusae). In liver cirrhosis, portal hypertension causes increased pressure in the portal vein, leading to the development of these enlarged veins. Esophageal varices can be life-threatening if they rupture and cause severe bleeding.
Correct Answer is C
Explanation
A) Iron supplements are not a priority intervention for a client with hepatic encephalopathy. In fact, administering iron supplements without proper indication can be harmful, as excessive iron can worsen liver damage in cirrhosis.
B) While monitoring fluid intake and output is important in managing various aspects of liver cirrhosis, it is not the essential intervention for hepatic encephalopathy. The priority in hepatic encephalopathy is to ensure seizure precautions and address the client's altered mental status.
C) Hepatic encephalopathy is a neuropsychiatric complication of liver cirrhosis that can lead to altered mental status, confusion, and potential seizures. Implementing seizure precautions is essential in the care of this client to ensure their safety and prevent injury during any potential seizure activity. Seizure precautions may include padding the side rails of the bed, ensuring a clear and clutter-free environment, and providing close supervision to the client. In severe cases, the healthcare provider may prescribe antiepileptic medications to manage and prevent seizures.
D) Encouraging a high-protein diet is not appropriate for a client with hepatic encephalopathy. High-protein diets can exacerbate hepatic encephalopathy by increasing ammonia production in the intestines. Instead, the client should be prescribed a controlled-protein diet and, in some cases, given lactulose to help reduce ammonia levels.
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