The nurse is caring for a 58-year-old client who was admitted to the medical unit with liver cirrhosis. Based on the client’s assessment findings, laboratory results, and vital signs, the nurse should prioritize monitoring the client for _____ as evidenced by _____ .

Liver cirrhosis leads to impaired synthesis of clotting factors, thrombocytopenia, and portal hypertension, all of which significantly increase the risk of bleeding. Clients often present with anemia, low albumin, ascites, and jaundice due to progressive liver failure. Monitoring for hemorrhagic complications is essential because bleeding can become life-threatening quickly in cirrhosis. Rationale for correct choices: • Bleeding: Bleeding is a major and life-threatening complication of liver cirrhosis due to reduced production of clotting factors (II, VII, IX, X) by the damaged liver. Portal hypertension can also lead to variceal formation, increasing the risk of gastrointestinal hemorrhage. The client already shows signs of anemia and low protein levels, indicating impaired liver synthetic function. Therefore, bleeding risk is the highest priority concern. • Hemoglobin and red blood cell count: Low hemoglobin and RBC count indicate anemia, which is common in liver cirrhosis due to chronic disease, nutritional deficiencies, and possible occult bleeding. Monitoring these values helps detect early blood loss or worsening anemia. The client’s current hemoglobin is already decreased (10.8 g/dL), suggesting reduced oxygen-carrying capacity. These labs are essential for identifying bleeding trends and guiding intervention. Rationale for incorrect choices: • Infection: Although clients with advanced liver cirrhosis are at increased risk for infection due to impaired immune function and poor protein synthesis (especially low albumin), there is no evidence of active infection. The client’s temperature is 99.2°F, which is not diagnostic systemic infection. Therefore, infection is a possible risk in general but not the most immediate priority compared to bleeding. • Dysrhythmia: Dysrhythmia is not supported by the client’s current assessment findings. The vital signs show a regular heart rate of 96/min, and there are no reported palpitations, chest pain, or ECG abnormalities. While electrolyte imbalances in liver disease can contribute to cardiac rhythm disturbances, no laboratory or clinical evidence indicates this complication here. • Temperature of 99.2°F: A temperature of 99.2°F is within the upper range of normal or represents a mild elevation that does not meet criteria for fever. While infection is a possible complication in cirrhosis, this isolated value does not indicate acute infectious deterioration. There are no additional systemic signs of infection such as high-grade fever or elevated WBC provided. Therefore, this finding is not the most reliable indicator of priority risk in this context. • Irregular heart rhythm and palpitations: There is no evidence in the assessment data indicating dysrhythmia, palpitations, or abnormal cardiac rhythm. The vital signs show a regular heart rate of 96 bpm without reported arrhythmias. Therefore, this is not supported by the client’s current condition.