A patient with portal hypertension is scheduled for a rectal examination. Which nursing consideration is most important?

Correct answer: A. Clarify the procedure because trauma may cause bleeding

  • A. Clarify the procedure because trauma may cause bleeding
  • B. Proceed because rectal procedures reduce portal pressure
  • C. Give an intramuscular injection before examination
  • D. Ask the patient to strain during the examination

Explanation

Rectal trauma and straining can precipitate bleeding in a patient with portal hypertension and fragile collateral vessels. The need for the procedure should be reviewed and the least traumatic approach used.

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About Gastrointestinal and Liver Nursing

Covers nursing care for peptic ulcer disease, gastroenteritis, inflammatory bowel disease, intestinal obstruction, hepatitis, cirrhosis and portal hypertension. It includes nutrition, fluid and electrolyte management, abdominal assessment, gastrointestinal bleeding, ascites and hepatic encephalopathy, which must be distinguished from other causes of altered consciousness.

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