Identify two causes of ascites related to liver cirrhosis:

Choice A reason: Anticipating obtaining a throat swab for rapid streptococcus testing is not immediately related to the use of a budesonide inhaler. This test is typically done when there is a suspicion of a streptococcal infection, not specifically for managing asthma medication side effects.

Choice B reason: Offering reassurance that the symptoms are common with budesonide use may not fully address the patient’s concern or prevent potential complications. It is more effective to provide actionable advice that can help manage the symptoms.

Choice C reason: Suggesting that the patient stop using the spray until the symptoms are resolved could potentially worsen asthma control. Budesonide is an important medication for managing asthma, and discontinuing it without alternative treatment may lead to exacerbation of symptoms.

Choice D reason: Teaching the patient to gargle with water after using the budesonide inhaler is the most appropriate action. This practice helps to reduce the risk of developing oral thrush, a common side effect of inhaled corticosteroids like budesonide. Gargling with water removes any residual medication in the mouth, thereby minimizing the risk of infection.

Choice A reason: Contacting the health care provider is the most appropriate action because a change in the Doppler sound may indicate a potential complication, such as graft occlusion or compromised blood flow. Immediate assessment and intervention by the health care provider are essential to prevent further complications and ensure the patient's safety.

Choice B reason: Rechecking the pulse in another 30 minutes is not advisable in this situation because it could delay necessary medical intervention. Prompt communication with the health care provider is crucial to address the underlying issue and provide timely care.

Choice C reason: Measuring the ankle-brachial index can provide valuable information about blood flow in the lower extremities, but it is not the immediate priority when a significant change in the Doppler sound is detected. Contacting the health care provider for further assessment and instructions takes precedence.

Choice D reason: Administering an oral anticoagulant is not an appropriate action without the direct instruction from a health care provider. The nurse must first report the change in the Doppler sound to the provider and follow their specific orders regarding medication and treatment.