A registered nurse (RN) assesses a patient with cirrhosis and finds ascites with pitting edema of the feet and legs. Which factor contributes to edema and ascites in patients with cirrhosis?
Diminished serum albumin levels causes water to shift from blood to tissue.
Portal hypotension causes a fluid shift from the abdominal cavity into the portal veins.
Hypoaldosteronism causes a fluid volume deficit: shifting water from blood into tissue.
Aberrations of the portal system cause a back-up of blood that leads to hydronephrosis.
The Correct Answer is A
A. Diminished serum albumin levels cause water to shift from blood to tissue: In cirrhosis, liver dysfunction leads to decreased production of albumin, a protein that helps maintain oncotic pressure. Low albumin levels cause fluid to shift from the vascular space into the tissues, resulting in ascites and peripheral edema.
B. Portal hypotension causes a fluid shift from the abdominal cavity into the portal veins: Portal hypertension, not hypotension, is a common feature of cirrhosis, but it leads to ascites by increasing pressure in the portal venous system, not by shifting fluid into the portal veins.
C. Hypoaldosteronism causes a fluid volume deficit: shifting water from blood into tissue: Cirrhosis often leads to hyperaldosteronism, not hypoaldosteronism, resulting in sodium and water retention, which contributes to edema.
D. Aberrations of the portal system cause a back-up of blood that leads to hydronephrosis: Hydronephrosis is related to obstruction of the urinary tract, not a complication of portal hypertension or cirrhosis.
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Related Questions
Correct Answer is C
Explanation
A. Administer some insulin: Insulin is not appropriate unless there is evidence of hyperglycemia, which is not suggested by the symptoms described.
B. Prepare the patient to receive a blood transfusion: The symptoms described are not indicative of a need for a blood transfusion but rather suggest adrenal insufficiency.
C. Administer IV glucose: Addisonian crisis can be triggered by stress and dehydration, leading to low blood sugar and symptoms such as weakness and confusion. Administering IV glucose can help manage hypoglycemia and provide immediate support.
D. Collect some urine and assess for glucosuria: The symptoms are more acute and related to adrenal insufficiency rather than glucosuria.
Correct Answer is A
Explanation
A. Paralytic ileus: Paralytic ileus is a common complication of major abdominal surgery and prolonged bed rest. It is a temporary cessation of normal bowel peristalsis, leading to a lack of bowel sounds and the inability to pass gas or stool.
B. Esophageal dysplasia: This condition refers to abnormal changes in the cells of the esophagus, typically related to chronic gastroesophageal reflux disease (GERD), not prolonged bed rest.
C. Gastroparesis: This is a condition in which the stomach cannot empty itself of food in a normal fashion, often related to diabetes or damage to the vagus nerve. It is not a direct result of prolonged bed rest.
D. Paralytic ileum: This should refer to "paralytic ileus."
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