A nurse is caring for an older adult client who has significant issues with ascites related to end-stage liver disease. Which of the following precautions is important for the nurse to reinforce when teaching the client?

Brief Introduction: Ascites in end-stage liver disease is caused by portal hypertension and hypoalbuminemia, leading to the accumulation of several liters of fluid within the peritoneal cavity. This significant shift in intravascular volume to the interstitial space not only causes respiratory distress but also creates a significant mechanical burden on the musculoskeletal system. Rationale: A. Suggesting that a client forgo undergarments is not a standard clinical precaution and does not address the physiological risks of the condition. Instead, the nurse should recommend loose-fitting clothing and elastic waistbands to accommodate abdominal girth while maintaining the client's dignity and comfort. B. Although heavy exertion may be difficult, complete cessation of exercise is discouraged as it leads to muscle wasting (sarcopenia) and further complicates liver failure. Clients are encouraged to engage in low-impact activity as tolerated to maintain circulation and prevent the complications of immobility. C. Using extra pillows (orthopneic positioning) helps with the dyspnea associated with ascites, but it is a comfort measure rather than a safety precaution regarding the weight mentioned in the prompt. The most critical safety risk associated with a rapidly changing, heavy abdominal profile is the threat to physical stability. D. The accumulation of ascitic fluid significantly shifts the client's center of gravity forward, which often leads to postural instability. In older adults, this mechanical shift, combined with potential muscle weakness, creates a high risk for falls and fractures, making gait safety and slow transitions the highest priority for reinforcement.