Case Study PPT

A 59-year-old patient with a history of alcohol abuse spanning 15 years has been diagnosed with cirrhosis. The patient will be undergoing abdominal paracentesis today. Which assessment finding alerts the nurse that the paracentesis has been successful?

A. Decrease in post-procedure weight
B. No residual obtained during procedure
C. Substantial decrease in blood pressure
D. Immediate sensation of a need to urinate

Answer: A. Decrease in post-procedure weight
Rationale: Paracentesis removes ascitic fluid, leading to weight loss. A blood pressure drop (C) suggests hypovolemia/complication. "No residual obtained" (B) indicates failure. Urinary urge (D) is unrelated.

The patient’s assessment reveals yellowish coloration of skin and sclerae. Which laboratory values does the nurse anticipate?

A. Increased urine bilirubin, decreased direct bilirubin
B. Increased direct bilirubin, increased indirect bilirubin
C. Decreased direct bilirubin, increased indirect bilirubin
D. Increased direct bilirubin, decreased indirect bilirubin

Answer: B. Increased direct bilirubin, increased indirect bilirubin
Rationale: Cirrhosis impairs both conjugation (↑ indirect/unconjugated bilirubin) and excretion (↑ direct/conjugated bilirubin), so both rise.

When a complete assessment of this patient is performed, what other signs and symptoms does the nurse expect? (Select all that apply.)

A. Muscle twitching
B. Dry skin with rash
C. Personality changes
D. Peripheral dependent edema
E. Ecchymosis, spider angiomas

Answer: A, C, D, E
Rationale:

• A. Muscle twitching → sign of hepatic encephalopathy.

• C. Personality changes → linked to ammonia buildup.

• D. Peripheral edema → from hypoalbuminemia/portal hypertension.

• E. Ecchymosis & spider angiomas → due to impaired clotting factor production and hormonal imbalance.

• B. Dry skin with rash is not characteristic of cirrhosis.

The patient tells the nurse that once he is discharged to home, he has no intention to stop drinking alcohol. What is the appropriate nursing response?

A. “Why do you continue to drink?”
B. “It’s your choice to drink or not to drink.”
C. “Does it frighten you to consider quitting?”
D. “If you continue to drink, you are going to die.”

Answer: C. “Does it frighten you to consider quitting?”
Rationale: This response is therapeutic and open-ended, encouraging reflection without judgment. Options A and D are confrontational, while B is dismissive.

The nurse is caring for a client who is being prepared for a paracentesis. Which of the following actions is the most important for the nurse to take at this time?

A. Place the client in a sitting position.
B. Have the client void before the procedure.
C. Weigh the client prior to the procedure.
D. Provide supplemental oxygen.

Answer: B. Have the client void before the procedure.
Rationale: Voiding reduces the risk of bladder puncture during paracentesis, which is the most immediate safety concern. Weighing (C) is done for baseline comparison, and positioning (A) is correct but comes after voiding. Oxygen (D) is not routinely required for this procedure.

The nurse is caring for a client who has stage II hepatic encephalopathy as a result of late-stage cirrhosis. Which of the following is the priority for the client’s care at this time?

A. Reorient the client to reality frequently.
B. Monitor the client’s serum bilirubin level.
C. Keep the patient safe and free from injury.
D. Administer antibiotic therapy.

Answer: C. Keep the patient safe and free from injury.
Rationale: In stage II hepatic encephalopathy, patients have confusion, disorientation, and risk for falls or injury. Safety is the priority (Airway, Breathing, Circulation, Safety framework). Reorientation (A) and antibiotics (D) may be part of care, but preventing harm comes first.

The nurse is caring for a client who had a liver transplant yesterday. What is the priority nursing assessment for the client at this time?

A. Monitor for symptoms of infection.
B. Assess for neurologic status changes.
C. Observe for signs of internal hemorrhage.
D. Assess for indications of organ transplant rejection.

Answer: C. Observe for signs of internal hemorrhage.
Rationale: The greatest immediate risk within the first 24 hours after liver transplant is hemorrhage due to the liver’s vascularity and surgical site. Infection (A) and rejection (D) are critical concerns but occur later. Neurologic changes (B) are also important but not as urgent as identifying life-threatening bleeding.