# Situation: A 62-year-old woman has cirrhosis caused by chronic hepatitis B. Endoscopy shows large esophageal varices that have never bled. She has moderate ascites and takes spironolactone, furosemide, and lactulose. Carvedilol has just been started. A diagnostic paracentesis is scheduled. What should the nurse do just before the procedure?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630391  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 62-year-old woman has cirrhosis caused by chronic hepatitis B. Endoscopy shows large esophageal varices that have never bled. She has moderate ascites and takes spironolactone, furosemide, and lactulose. Carvedilol has just been started.

A diagnostic paracentesis is scheduled. What should the nurse do just before the procedure?

## 보기

1. Ask her to empty her bladder **✔ 정답**
2. Place her flat on her back
3. Give intravenous albumin as ordered
4. Keep her fasting for 8 hours

**정답: 1**

## 해설

The bladder is emptied before paracentesis to lower the risk of puncturing it, and the client sits upright so fluid collects in the lower abdomen. Albumin is given after large-volume removal, not before a diagnostic tap, and prolonged fasting is not needed.

## 심화 해설

What to do just before paracentesis
A diagnostic paracentesis removes a small sample of ascitic fluid through a needle in the abdominal wall. Just before the procedure, the nurse asks the client to empty her bladder to lower the risk of puncturing it. A full bladder rises above the pubic bone into the lower abdomen, which is exactly where the needle is commonly inserted.

Preparing the client safely
Preparation also includes confirming consent, recording baseline vital signs, weight, and abdominal girth, and positioning the client upright, either sitting or in high Fowler position, so that fluid collects in the lower abdomen and the bowel floats away from the puncture site. The procedure is performed under local anesthesia with aseptic technique. After the procedure, the nurse monitors vital signs, the puncture site for leakage or bleeding, and signs of infection.

| Step | Reason |
| --- | --- |
| Empty the bladder | Prevents bladder puncture |
| Position upright | Fluid pools in the lower abdomen |
| Baseline vital signs, weight, girth | Allow comparison after fluid removal |
| Monitor after procedure | Detect hypotension, bleeding, leakage, infection |

Why the other options are wrong
Placing her flat on her back spreads the fluid out across the abdomen and makes the tap harder; the client is positioned upright instead. Intravenous albumin is given after large-volume paracentesis, when more than about 5 L is removed, to prevent circulatory dysfunction; it is not needed before a diagnostic sample. Fasting for 8 hours is unnecessary because paracentesis is done under local anesthesia, not general anesthesia.

Connecting to cirrhosis care
In a client with cirrhosis and ascites, diagnostic paracentesis is used to evaluate new ascites or to check for spontaneous bacterial peritonitis when infection is suspected. Clients with cirrhosis often have abnormal clotting tests, but the procedure is generally considered safe, and the nurse focuses on correct preparation and post-procedure monitoring.

Exam takeaway
Key point Before paracentesis: void, sit upright, and record baseline data. Albumin belongs to large-volume removal, not to a diagnostic tap.

## 임상 시나리오

Preparing for ParacentesisBladder first, then position
Before paracentesis, the client empties her bladder so the needle does not puncture it. She is positioned upright so ascitic fluid pools in the lower abdomen.

Baseline vital signs, weight, and abdominal girth are recorded. Albumin is given after large-volume paracentesis of more than about 5 L, not before a diagnostic tap, and no prolonged fast is required.

CautionAfter the procedure, monitor for hypotension, bleeding or leakage at the site, and signs of infection.

## 핵심 개념

- **Paracentesis** — Removal of fluid from the peritoneal cavity through a needle inserted in the abdominal wall.
- **Ascites** — Accumulation of fluid in the peritoneal cavity, common in cirrhosis.
- **Large-volume paracentesis** — Removal of more than about 5 L of ascitic fluid, usually followed by IV albumin.
- **High Fowler position** — Sitting upright with the head of the bed raised steeply.

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