A nurse is caring for a client who has end-stage liver disease and is undergoing a paracentesis. Which of the following actions should the nurse take to evaluate the effectiveness of the procedure?
Confirm that the client is able to urinate.
Compare the client's current weight with preprocedure weight.
Examine for leakage at the site of the procedure.
Check the client's serum albumin levels.
The Correct Answer is B
A. While urine output is important, it is not the most direct indicator of the success of a paracentesis.
B. Comparing the client's weight before and after the procedure helps to evaluate the effectiveness by showing a reduction in fluid buildup.
C. Leakage at the site could indicate a complication, but it is not the primary measure of the procedure’s
effectiveness.
D. Serum albumin levels may be monitored but are not the first indicator of success after a paracentesis.
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Related Questions
Correct Answer is B
Explanation
A. A client who has recently received pain medication should be assessed for effectiveness but is not in immediate danger.
B. A client who received orange juice for a low blood glucose level needs to be assessed for a return to normal glucose levels as hypoglycemia is a priority concern.
C. A client with 100 mL of fluid remaining in the IV bag can wait for assessment as their fluid needs can be managed once the infusion is complete.
D. A client scheduled for a procedure in 1 hour is important to assess, but their immediate clinical needs may be less critical than a client with hypoglycemia.
Correct Answer is D
Explanation
A. The client should avoid high-impact activities like jogging until cleared by the provider.
B. Resuming activities like sewing too soon can strain the eyes, especially after retinal surgery.
C. Bending at the waist should be avoided after retinal surgery, as it may increase intraocular pressure.
D. Lifting objects less than 10 pounds is generally safe after retinal surgery, but heavier lifting should be avoided until cleared by the provider.
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