A client is ordered to receive a laxative by rectal suppository. How should the nurse position the client during the administration of the suppository?

A) The ammonia level has decreased each day starting the lactulose: While a decrease in ammonia levels is an important indicator of improvement in hepatic encephalopathy, it is not the best assessment of the therapeutic response to lactulose. The goal of lactulose therapy is to reduce ammonia levels, but the most direct evaluation of therapeutic effect is related to the client's mental status, not just laboratory results.

B) The liver enzymes AST and ALT have decreased to normal levels: Liver enzyme levels such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are important indicators of liver function, but they do not directly reflect the effectiveness of lactulose in treating hepatic encephalopathy. These enzymes may improve as liver function improves, but they are not the most immediate or specific indicator of lactulose’s therapeutic effect.

C) The client is having 5-6 soft, non-formed stools each day: Lactulose works by drawing water into the bowel to promote stool softening and increase bowel movements, which can help lower ammonia levels in the body. While frequent soft stools can be an effect of lactulose, this is not the best measure of therapeutic response in hepatic encephalopathy. The primary goal is improvement in the client's mental status, not just bowel function.

D) The client is awake, alert, and oriented to their environment: The best assessment of the therapeutic response to lactulose is the improvement in the client’s mental status. Lactulose works by reducing the absorption of ammonia from the gastrointestinal tract, which is responsible for the cognitive impairments seen in hepatic encephalopathy. If the client is awake, alert, and oriented, this indicates that lactulose is effectively reducing the ammonia levels and improving the neurological status of the client, making it the most appropriate assessment.

A) Metoprolol XL: Metoprolol XL (extended-release) should not be crushed. Crushing extended-release formulations can result in the rapid release of the drug, leading to an overdose or adverse effects due to the immediate release of the full dose. The nurse should advise the client to swallow this medication whole.

B) Ibuprofen EC (enteric-coated): Enteric-coated medications should not be crushed. The enteric coating is designed to protect the stomach lining by preventing the medication from being released in the stomach. Crushing the tablet would destroy this protective mechanism and could irritate the stomach lining, leading to discomfort or ulceration.

C) Morphine ER (extended-release): Extended-release formulations of morphine should never be crushed. Crushing extended-release formulations can lead to a potentially fatal overdose because it releases the entire dose of medication at once. This can cause respiratory depression and other life-threatening effects.

D) Acetaminophen: Acetaminophen in its regular tablet form can be safely crushed if needed. Crushing acetaminophen does not affect its effectiveness or safety, and it is a non-extended-release formulation, making it safe for manipulation when necessary, such as for clients with difficulty swallowing. However, it's essential to verify with the specific prescription, as acetaminophen is also available in extended-release formulations, which should not be crushed.