How should the nurse assess for the presence of asterixis in a client with cirrhosis?

• A. Instruct the client to lean forward.
• B. Dorsiflex the client's foot.
• C. Ask the client to extend the arms.
• D. Measure the abdominal girth.

Answer: (C)

Asterixis is the flapping tremor associated with hepatic encephalopathy in liver failure. To elicit it, have the client extend the arms, keep the wrists dorsiflexed, and hold the position for about 10–20 seconds. If the sign is present, the hands will irregularly and briefly lapse into a flapping movement as the patient tries to maintain the posture. This positive sign indicates impaired cerebral function due to ammonia and other toxins not being properly cleared by the cirrhotic liver.

Leaning forward, dorsiflexing the foot, or measuring abdominal girth do not assess asterixis or hepatic encephalopathy; they relate to posture/orthopnea, peripheral nerve or reflex testing, and ascites assessment, respectively.