A client has been administered lactulose for several days.
Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?
Improved mental status.
Increase in urine output.
Reduction in number of liquid stools.
Ability to ambulate independently.
The Correct Answer is A
Choice A rationale:
Lactulose directly addresses the primary cause of hepatic encephalopathy, which is the accumulation of ammonia in the blood. Ammonia is a neurotoxin that can impair brain function, leading to confusion, lethargy, and even coma. Lactulose works by trapping ammonia in the colon, where it can be safely excreted in the stool. This decrease in ammonia levels in the blood allows for the improvement of mental status.
Studies have consistently shown that lactulose therapy can significantly improve mental function in patients with hepatic encephalopathy. This improvement is often seen within a few days of starting treatment.
The nurse should assess the client's mental status regularly to monitor for improvement. This assessment should include evaluating the client's level of consciousness, orientation, attention, memory, and speech.
Improved mental status is a critical therapeutic goal in the treatment of hepatic encephalopathy. It allows patients to regain their independence and participate more fully in their care.
Choice B rationale:
While lactulose can cause diarrhea, which may lead to a slight increase in urine output, this is not the primary therapeutic response that the nurse should expect.
The increase in urine output is typically secondary to the diarrhea and does not directly reflect a reduction in ammonia levels or improvement in mental status.
Choice C rationale:
Lactulose does cause diarrhea, which is a common side effect of the medication.
However, the goal of lactulose therapy is not to reduce the number of liquid stools but rather to trap ammonia in the colon and promote its excretion.
The nurse should monitor the client's stool frequency and consistency to ensure that they are not experiencing excessive diarrhea, which could lead to dehydration and electrolyte imbalances.
Choice D rationale:
While improved mental status may eventually lead to improved mobility, it is not the most immediate or direct therapeutic response that the nurse should expect from lactulose therapy.
The ability to ambulate independently is more likely to be a long-term goal of treatment, rather than an immediate response to lactulose.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The correct answer is Choice D.
Choice A rationale: Auscultating bowel sounds and measuring abdominal girth are not directly related to the management of erosive esophagitis and GERD symptoms. These actions are more pertinent to assessing gastrointestinal motility and distension, not the effectiveness of lansoprazole.
Choice B rationale: Lansoprazole is a proton pump inhibitor that should be taken before meals to reduce stomach acid production effectively. Confirming that the patient is taking the medication before meals could help optimize its efficacy but is not the most immediate step.
Choice C rationale: Notifying the healthcare provider about a potential need for a dosage change may be considered if symptoms persist. However, since healing with proton pump inhibitors can take several weeks, this action may be premature after only one week of use.
Choice D rationale: It is appropriate to inform the patient that healing of erosive esophagitis and symptom relief from GERD can take several weeks with lansoprazole. This education helps set realistic expectations and encourages adherence to the prescribed treatment.
Correct Answer is A
Explanation
Choice A rationale:
Lactulose is a non-absorbable disaccharide that is metabolized by bacteria in the colon to produce lactic acid and acetic acid. These acids acidify the colon, which traps ammonia (NH3) in the colon and converts it to ammonium (NH4+). Ammonium is not absorbed by the colon and is excreted in the stool. This ammonia-lowering effect is the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.
Hepatic encephalopathy is a neuropsychiatric syndrome that occurs in patients with severe liver disease. It is caused by the buildup of ammonia in the blood, which can cross the blood-brain barrier and cause cerebral edema and impaired brain function.
The clinical manifestations of hepatic encephalopathy range from mild confusion and personality changes to coma. Improved mental status is a key therapeutic goal in the treatment of hepatic encephalopathy.
Studies have shown that lactulose can improve mental status in patients with hepatic encephalopathy. A meta-analysis of 11 randomized controlled trials found that lactulose was associated with a significant improvement in mental status compared to placebo.
The improvement in mental status is typically seen within 24 to 48 hours of starting lactulose therapy.
Choice B rationale:
Increased urine output is not a direct therapeutic effect of lactulose. Lactulose can cause diarrhea, which can lead to increased urine output due to fluid loss. However, this is not the primary mechanism by which lactulose improves mental status in patients with hepatic encephalopathy.
Choice C rationale:
Reduction in the number of liquid stools is a common side effect of lactulose. However, it is not a therapeutic goal in the treatment of hepatic encephalopathy. The goal of lactulose therapy is to improve mental status by lowering ammonia levels in the blood.
Choice D rationale:
Ability to ambulate independently is not a direct therapeutic effect of lactulose. Lactulose can improve mental status, which may indirectly lead to improved ambulation in some patients. However, this is not the primary mechanism by which lactulose works.
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