A nurse is caring for a 55-year-old client with a history of cirrhosis secondary to chronic alcohol use. The client is admitted with increasing abdominal swelling and confusion. For each condition below, select the nursing interventions that would be appropriate to care for the client. Each condition may have more than one nursing intervention. (Each condition must have at least 1 response selected)

Condition Nursing Interventions Hepatic Encephalopathy ✔ Administer Lactulose ✔ Assessment for asterixis and level of consciousness. ✔ Assess PT/INR ✘Administer Protonix (pantoprazole) Ascites ✔ Prepare the client for paracentesis. ✔ Monitor abdominal girth. ✘Administer Lovenox (enoxaparin sodium) Esophageal Varices ✔ Monitor for signs and symptoms or bleeding ✘Assess for jaundice. ✘Prepare the client for NG (Nasogastric) tube placement to protect the airway. ✔ Administer Nadolol (Corgard). Cirrhosis leads to impaired liver function, portal hypertension, and multiple complications including hepatic encephalopathy, ascites, and esophageal varices. Elevated ammonia contributes to neurological changes, while decreased albumin and portal hypertension lead to fluid accumulation and increased bleeding risk. Nursing care focuses on managing complications and preventing life-threatening events. Rationale: Hepatic Encephalopathy: Lactulose helps reduce ammonia levels by promoting its excretion through the gastrointestinal tract. Monitoring for asterixis and changes in level of consciousness is essential for assessing neurological status. PT/INR is evaluated because liver dysfunction impairs clotting factor production, increasing bleeding risk. Protonix is used for gastric acid reduction and is not specific to encephalopathy management. Ascites: Paracentesis is performed to remove excess fluid from the abdomen and relieve discomfort and respiratory compromise. Monitoring abdominal girth helps track fluid accumulation and treatment effectiveness. Assessing level of consciousness is more specific to encephalopathy rather than fluid overload. Lovenox is avoided due to increased bleeding risk in cirrhosis. Esophageal Varices: Monitoring for signs of bleeding (e.g., hematemesis, melena) is critical due to the risk of rupture. Nadolol, a nonselective beta-blocker, reduces portal hypertension and prevents variceal bleeding. Assessing for jaundice reflects liver dysfunction but does not directly address variceal risk. NG tube placement is generally avoided because it can rupture varices and precipitate bleeding.