A nurse is caring for a client who has cirrhosis of the liver with ascites. Which of following interventions should the nurse take?
Increase fluid intake.
Increase daily calorie intake.
Increase foods high in sodium.
Restrict foods high in protein.
The Correct Answer is B
A. Increase fluid intake: Increasing fluids may worsen ascites because cirrhosis already causes fluid retention due to portal hypertension and decreased albumin. Clients may also have dilutional hyponatremia, making fluid limitation more appropriate.
B. Increase daily calorie intake: Clients with cirrhosis are often malnourished due to altered metabolism and reduced nutrient storage. Increased calories help maintain muscle mass, support healing, and prevent complications such as muscle wasting and weakness.
C. Increase foods high in sodium: Sodium contributes to fluid retention and will worsen ascites, edema, and portal hypertension. Clients with ascites are typically placed on a low-sodium diet (usually 2 grams/day or less).
D. Restrict foods high in protein: Protein restriction used to be recommended, but it is now known to worsen malnutrition. Protein is only restricted in cases of severe hepatic encephalopathy; otherwise, normal to high protein intake is needed.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Weight loss of 2 lb (0.91 kg) from baseline:Unintentional weight loss can indicate chronic illness or poor intake, but a 2-lb loss is relatively small and not an immediate sign of complication.
B. Dyspepsia:Dyspepsia (indigestion) is a common symptom of gastric ulcers and while important to manage, it is not an acute red flag requiring immediate notification.
C. Reports being thirsty:Thirst suggests dehydration or inadequate fluid intake; it is addressable and not a specific sign of a life-threatening ulcer complication.
D. Abdominal pain radiating to the shoulder:Shoulder pain with abdominal pathology suggests diaphragmatic irritation from perforation or intra-abdominal hemorrhage (referred pain via phrenic nerve) - this can indicate a surgical emergency and must be reported immediately.
Correct Answer is B
Explanation
A. Decreased liver enzymes: Liver enzymes may initially be elevated due to liver inflammation, but in end-stage cirrhosis they may appear normal or even low due to massive hepatocyte loss. A decreased enzyme level does not reliably indicate improved liver function.
B. Decreased platelets:Thrombocytopenia occurs because portal hypertension causes splenic enlargement, leading to platelet sequestration. In addition, reduced hepatic production of thrombopoietin further lowers platelet count, making this a common finding.
C. Elevated sodium levels:Cirrhosis commonly leads to low sodium (hyponatremia) due to fluid retention, activation of antidiuretic hormone, and impaired renal function. Elevated sodium would not typically be expected in advanced liver disease.
D. Elevated albumin level:Because the liver synthesizes albumin, cirrhosis results in decreased production. This leads to low albumin levels, contributing to edema and ascites due to reduced oncotic pressure. Elevated albumin is not consistent with cirrhosis.
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