CMSRN Medical-Surgical Nursing

Category - Gastrointestinal

Paracentesis is part of the treatment plan for Mr. Raj, who was diagnosed with cirrhosis, to remove ascitic fluid. After explaining the procedure to the client, the next nursing action would be to:
  1. Position the client in a chair or in high-Fowler’s position
  2. Instruct the client to void
  3. Take vital signs
  4. Drape the abdomen with sterile towels
Explanation
Answer - B - After explaining the procedure to the client, the nurse should then instruct the client to void. This prevents accidental nicking or perforation of the bladder during the procedure. The client is positioned in a chair or in high-Fowler’s position in bed (Choice A) after the vital signs have been taken to establish baseline information (Choice C) and the abdomen is prepared (Choice D).
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