A client with severe cirrhosis presents with elevated ammonia levels. Which of the following dietary modifications should the nurse prioritize for the client to help manage ammonia levels?

Increase protein intake to promote healing and recovery.

Incorporate high-fiber foods and stop lactulose.

Reduce protein intake to minimize ammonia production during digestion.

Eliminate carbohydrates completely to decrease calorie intake.

Answer and Explanation

The Correct Answer is C

Severe cirrhosis impairs the liver’s ability to detoxify ammonia, a byproduct of protein metabolism, leading to hyperammonemia and hepatic encephalopathy. Dietary management is an important supportive strategy in reducing ammonia load and preventing neurologic deterioration. In advanced liver disease, protein metabolism must be carefully balanced to minimize toxin buildup while still supporting essential body functions. Nutrition adjustments therefore focus on controlling protein intake rather than eliminating overall nutrition.

Rationale:
A. Increasing protein intake to promote healing and recovery is inappropriate in severe cirrhosis with elevated ammonia levels. Excess protein metabolism increases ammonia production, which the damaged liver cannot effectively convert into urea. This can worsen hepatic encephalopathy, leading to confusion, lethargy, and decreased level of consciousness.

B. Incorporating high-fiber foods is beneficial for bowel health, but stopping lactulose is unsafe in this context. Lactulose helps reduce ammonia by trapping it in the gut and promoting its excretion through stool. Discontinuing it would allow ammonia levels to rise, worsening neurologic symptoms.

C. Reducing protein intake to minimize ammonia production during digestion is the priority dietary modification. Protein breakdown produces nitrogenous waste, including ammonia, which accumulates in cirrhosis due to impaired hepatic detoxification. Controlled protein restriction helps lower ammonia levels and reduces the risk of hepatic encephalopathy exacerbation while still maintaining adequate nutrition.

D. Eliminating carbohydrates completely is not appropriate because carbohydrates are an essential energy source for clients with liver disease. Removing carbohydrates can lead to muscle breakdown for energy, which paradoxically increases ammonia production. A balanced diet with adequate calories from carbohydrates is necessary to prevent catabolism and further metabolic stress.

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Correct Answer is A

Explanation

Hypovolemic shock occurs when there is a significant loss of intravascular fluid volume, leading to inadequate tissue perfusion and oxygen delivery. In acute hemorrhage, such as a ruptured aneurysm, the body attempts to compensate through sympathetic nervous system activation. This results in characteristic clinical signs as perfusion to vital organs becomes compromised. Early recognition is essential to prevent progression to irreversible shock and organ failure.

Rationale:
A. Tachycardia and hypotension are hallmark findings of hypovolemic shock. The heart rate increases as a compensatory mechanism to maintain cardiac output in response to decreased circulating blood volume. Hypotension occurs when compensatory mechanisms fail to maintain adequate vascular tone and perfusion pressure, indicating significant volume depletion and cardiovascular compromise.

B. Bradycardia and elevated blood pressure are not typical of hypovolemic shock. Instead, hypovolemia triggers sympathetic stimulation, resulting in tachycardia rather than a slowed heart rate. Blood pressure initially may be maintained but eventually decreases as volume loss progresses, not increases.

C. Normal respiratory rate and stable hemodynamics are not consistent with hypovolemic shock in a client with significant blood loss. As shock develops, the body typically responds with tachypnea due to metabolic acidosis and compensatory mechanisms. Stable vital signs would suggest compensated or absent shock, not active decompensation.

D. Hypothermia and increased urine output are not characteristic of hypovolemic shock. In fact, decreased renal perfusion leads to oliguria or decreased urine output as the body conserves fluid. Hypothermia may occur in severe shock states, but increased urine output contradicts the expected physiologic response to volume depletion.

A. A client who has requested pain medication and has been noted to have pain. B. A client who is being weaned from the ventilator and is currently stable. C. A client who has developed respiratory distress and is exhibiting agitation. D. A client who is scheduled for a chest x-ray to evaluate ventilator placement.

Correct Answer is C

Explanation

Prioritization in critically ill ventilated clients is based on airway, breathing, and circulation (ABCs), with immediate threats to oxygenation taking the highest priority. Clients on mechanical ventilation are at risk for sudden deterioration due to airway obstruction, ventilator malfunction, or worsening respiratory pathology. Signs such as respiratory distress and agitation may indicate hypoxia, hypercapnia, or ventilator asynchrony, all of which require urgent intervention to prevent respiratory failure.

Rationale:
A. A client requesting pain medication is uncomfortable but not in immediate life-threatening distress. Pain management is important in ventilated clients to promote comfort and synchrony with the ventilator, but it does not take priority over acute respiratory compromise. This client can be assessed after stabilization of higher-acuity conditions.

B. A client being weaned from the ventilator and currently stable is not showing signs of acute deterioration. Ventilator weaning is a monitored process, and stability indicates adequate oxygenation and ventilation at this time. This client requires ongoing observation but is not the highest priority compared to those with active respiratory distress.

C. A client with respiratory distress and agitation is the priority because these findings suggest possible hypoxia, ventilator dyssynchrony, or airway compromise. Agitation in ventilated clients is often an early sign of inadequate oxygenation or increased carbon dioxide levels. Immediate assessment is needed to ensure airway patency and ventilator effectiveness to prevent rapid decompensation.

D. A client scheduled for a chest x-ray to evaluate ventilator placement is stable enough to await diagnostic imaging. While confirming tube placement is important, it is not emergent in the absence of clinical signs of distress. Imaging is a routine verification step and does not take priority over acute respiratory compromise.

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A client with severe cirrhosis presents with elevated ammonia levels. Which of the following dietary modifications should the nurse prioritize for the client to help manage ammonia levels?

Nursing Test Bank

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