NCLEX-PN® ExaminationPhysiological AdaptationMedium
A client with a history of liver cirrhosis is admitted with ascites and reports increasing shortness of breath. The nurse assesses the client and notes diminished breath sounds at the lung bases, dullness to percussion, and oxygen saturation of 90% on room air. Which of the following is the most likely cause of the client's respiratory distress?
- APleural effusion
- BAcute bacterial pneumonia
- CPulmonary embolism
- DAsthma exacerbation
Show answer & explanationAnswer & explanation
Correct answer: A. Pleural effusion
Clients with liver cirrhosis and ascites often develop pleural effusions, particularly right-sided, due to fluid shifting from the peritoneal cavity through diaphragmatic defects (hepatic hydrothorax). Diminished breath sounds and dullness to percussion at the bases are classic signs of fluid accumulation in the pleural space, leading to respiratory distress and hypoxemia.
Why the other options are wrong
- B. Pneumonia would typically present with crackles, fever, and productive cough, not primarily dullness to percussion and diminished breath sounds at the bases due to fluid accumulation.
- C. Pulmonary embolism presents with sudden-onset pleuritic pain and dyspnea, often without specific signs of fluid accumulation like dullness to percussion.
- D. Asthma exacerbation is characterized by wheezing, prolonged expiration, and air trapping, not diminished breath sounds and dullness to percussion from fluid.
Cirrhosis & Respiratory Complications
Clients with liver cirrhosis, especially with ascites, are prone to respiratory complications such as pleural effusions (hepatic hydrothorax) due to fluid shifting into the pleural space.
- Ascites leads to increased intra-abdominal pressure.
- Fluid can migrate from the peritoneal cavity to the pleural space.
- Symptoms include dyspnea, diminished breath sounds, and dullness to percussion.
Memory trick: Cirrhosis' fluid, lungs get filled, breathing's tough, a battle willed!