NCLEX-RNReduction of Risk PotentialHard
A nurse is caring for a client immediately after a large-volume paracentesis (5 liters removed) for ascites. Fifteen minutes later, the client becomes dizzy, and vital signs show blood pressure 84/50 mmHg (baseline 128/76 mmHg) and heart rate 118 beats/min. What is the priority nursing action?
- APlace the client supine, increase IV fluid rate, and notify the provider
- BAssist the client to a sitting position and offer oral fluids
- CApply an abdominal binder and reassess in one hour
- DAdminister the scheduled dose of furosemide
Show answer & explanationAnswer & explanation
Correct answer: A. Place the client supine, increase IV fluid rate, and notify the provider
Rapid removal of large volumes of ascitic fluid can cause a fluid shift from the vasculature into the peritoneal space, leading to hypovolemia and hypotension. The nurse should place the client supine to improve venous return, increase IV fluids to restore volume, and notify the provider promptly to prevent hypovolemic shock.
Why the other options are wrong
- B. Sitting up worsens hypotension by reducing venous return; oral fluids act too slowly for this emergency.
- C. An abdominal binder does not treat hypovolemia and delaying action risks shock progression.
- D. A diuretic would further lower blood pressure and worsen hypovolemia.
Post-Paracentesis Hypovolemia
Fluid shift and hypotension that can occur after rapid removal of large volumes of ascitic fluid.
- Monitor vital signs closely during and after the procedure
- Signs: hypotension, tachycardia, dizziness
- Treatment: supine positioning, IV fluid/albumin replacement, notify provider
Memory trick: 'Big fluid out, big fluid shift in' — hypovolemia after paracentesis.