A nurse is planning care for a client who has cirrhosis and ascites.
Which of the following interventions should the nurse include in the plan of care?

Choice C rationale
Hepatic encephalopathy is a condition that can cause confusion or delirium in patients with end-stage liver disease and increasing ascites. It occurs when the liver is unable to remove toxins from the blood, such as ammonia, which can then accumulate in the brain and affect mental function. This condition is common in patients with cirrhosis or end-stage liver disease, and can manifest as confusion, changes in sleep patterns, mood alterations, and, in severe cases, coma.
Choice A rationale
While dementia can cause confusion and changes in mental status, it is typically a progressive condition that develops over time. In the context of a patient with end-stage liver failure and

increasing ascites who is usually lucid, a sudden onset of confusion or delirium is more likely to be due to a condition related to their liver disease, such as hepatic encephalopathy.
Choice B rationale
Schizophrenia is a chronic mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior. It is not typically associated with end-stage liver disease or ascites. In the context of a patient with end-stage liver failure and increasing ascites who is usually lucid, a sudden onset of confusion or delirium is more likely to be due to a condition related to their liver disease, such as hepatic encephalopathy.
Choice D rationale
While a urinary tract infection (UTI) can cause confusion, especially in older adults, it would not typically be the primary suspect in a patient with end-stage liver failure and increasing ascites. In such a patient, hepatic encephalopathy is a more likely cause of confusion or delirium.

Choice A rationale
Telling the patient that their liver has been destroyed by alcohol might not be the most effective way to motivate change. It could potentially lead to feelings of hopelessness and deter the patient from seeking help.
Choice B rationale

Introducing the patient to other people might not directly motivate them to change their alcohol consumption habits. However, it could potentially provide them with a supportive network that could help them in their journey to sobriety.
Choice C rationale
Educating the patient about the disease can be very beneficial. Understanding the effects of alcohol on their liver and the potential consequences of continued drinking can motivate them to change.
Choice D rationale
Instructing the patient to cut back to drinking one drink per day might not be the best advice for a patient with cirrhosis of the liver. Complete abstinence from alcohol is usually recommended for these patients to prevent further liver damage.