A nurse is preparing a client who has advanced cirrhosis for an abdominal paracentesis. Which of the following actions should the nurse take?

Place the client on his back.

Have the client increase ﬂuid intake after the procedure.

Assure the client that the procedure is painless.

Instruct the client to empty his bladder.

Answer and Explanation

The Correct Answer is D

Choice A: Place the client on his back. This is incorrect because the client should be placed in a sitting position with the head of the bed elevated to 30 to 45 degrees. This allows the ﬂuid to accumulate in the lower abdomen and reduces the risk of puncturing the diaphragm.

Choice B: Have the client increase ﬂuid intake after the procedure. This is also incorrect because the client should restrict ﬂuid intake after the procedure to prevent ﬂuid overload and electrolyte imbalance. The nurse should monitor the client’s intake and output, weight, and vital signs.

Choice C: Assure the client that the procedure is painless. This is not true because the client may experience some discomfort or pressure during the insertion of the needle or catheter. The nurse should administer analgesics as prescribed and provide emotional support.

Choice D: Instruct the client to empty his bladder. This is correct because this reduces the risk of bladder injury during the procedure. The nurse should also measure and record the amount of urine voided.

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Correct Answer is A

Explanation

Choice A reason: A fruity odor in the breath is a symptom of hyperglycemia, especially when it is severe and causes ketoacidosis. Ketoacidosis is a condition where the body produces ketones, which are acidic substances that result from the breakdown of fat for energy when there is not enough insulin or glucose available. Ketones can make the breath smell fruity or like nail polish remover.

Choice B reason: A decreased appetite is not a symptom of hyperglycemia. On the contrary, an increased appetite or hunger is a symptom of hyperglycemia, as the body tries to compensate for the lack of glucose in the cells by stimulating the hunger center in the brain.

Choice C reason: An increased thirst is a symptom of hyperglycemia, as the body tries to ﬂush out the excess glucose and ketones in the blood through urine. This leads to dehydration and thirst signals in the brain.

Choice D reason: A blurry vision at times is a symptom of hyperglycemia, as high blood glucose levels can cause swelling and damage to the lens of the eye, aﬀecting its ability to focus light properly. This can lead to temporary or permanent vision problems.

A. Phosphate 5.7 mg/dL B. Vitamin D 25 ng/mL C. Calcium 9.8 mg/dL D. Magnesium 1.8 mEq/L

Correct Answer is A

Explanation

Choice A reason: Phosphate 5.7 mg/dL is an elevated value, as the normal range is 2.5 to 4.5 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood.

Choice B reason: Vitamin D 25 ng/mL is a normal value, as the normal range is 20 to 50 ng/mL. Hypoparathyroidism does not directly aﬀect vitamin D levels, but vitamin D supplements may be given to help increase calcium absorption and lower phosphorus levels in the blood.

Choice C reason: Calcium 9.8 mg/dL is a normal value, as the normal range is 8.6 to 10.2 mg/dL. Hypoparathyroidism causes low levels of parathyroid hormone (PTH), which regulates calcium and phosphorus balance in the body. Low PTH leads to low calcium and high phosphorus levels in the blood. However, calcium levels may be normal or near- normal in some cases of hypoparathyroidism, especially if the condition is mild or well-controlled with treatment.

Choice D reason: Magnesium 1.8 mEq/L is a normal value, as the normal range is 1.5 to 2.5 mEq/L. Hypoparathyroidism does not directly aﬀect magnesium levels, but magnesium deficiency can cause or worsen hypoparathyroidism, as magnesium is needed for PTH secretion and action. Magnesium supplements may be given to correct magnesium deficiency and improve PTH function.

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A nurse is preparing a client who has advanced cirrhosis for an abdominal paracentesis. Which of the following actions should the nurse take?

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