A nurse is assessing a client with cirrhosis who has become increasingly confused and irritable.

The nurse notes tremors in the client's hands when arms are extended.

The provider suspects hepatic encephalopathy.

Highlight the portions of the passage that reflect signs, causes, and treatments of hepatic encephalopathy.

Some sentences or phrases may be unrelated or incorrect.

The client with cirrhosis appears disoriented and has difficulty answering simple asks.

The nurse observes asterixis when the client extends their arms.

Laboratory results show elevated mental status.

The provider prescribes lactulose to lower ammonia levels.

The client is placed on a high protein diet to support liver regeneration.

The nurse encourages the client to ambulate in the hallway to reduce the risk of acquiring pneumonia.

A CT scan of the brain is ordered to rule out a stroke.

The nurse monitors the client closely for worsening neurologic functions.

The nurse should recognize that the child is most likely experiencing A. Spasmodic croup as evidenced by their A. Parent’s reports.

Rationale for correct answers:
Spasmodic croup typically presents in toddlers aged 1–3 years with sudden onset of a barking, seal-like cough, often at night, without fever or signs of systemic illness. This condition is usually triggered by allergens or minor viral infections and lacks daytime respiratory distress. The child’s physical exam shows no wheezing or abnormal lung sounds, and the temperature is within normal limits (37.3°C), suggesting a non-infectious etiology like spasmodic croup rather than viral or bacterial illness.
Parent’s reports of hoarse, barking nighttime cough, normal daytime behavior, and absence of fever or appetite change are hallmark subjective cues for spasmodic croup. Objective findings during the visit are normal, so clinical suspicion relies heavily on the history provided.

Rationale for incorrect Response 1 Options:
Respiratory syncytial virus (RSV) typically presents with cough, nasal congestion, wheezing, and often respiratory distress or fever, none of which are present.
Epiglottitis presents with sudden onset of high fever, drooling, muffled voice, and severe respiratory distress, often requiring emergency airway management—not consistent with this child’s stable, playful presentation.
Acute laryngitis in toddlers is rare and typically presents with hoarseness but not the classic barking cough, and it usually follows viral upper respiratory symptoms.

Rationale for incorrect Response 2 Options:
Lung sounds are clear, so they don't support a diagnosis involving significant airway inflammation or obstruction.
Immunization history helps with disease prevention but doesn't assist in diagnosing the acute condition.
Laboratory results are normal except for mildly elevated eosinophils (780/mm³), suggesting atopy or eczema but not a direct link to the cough pattern.

Take-home points:

• Spasmodic croup is often triggered by allergies or viral irritants and is characterized by nighttime barking cough in toddlers.
• It should be differentiated from viral croup, RSV, and epiglottitis based on onset, symptoms, and physical findings.
• Clinical history from caregivers is crucial when physical signs are minimal or absent during examination.
• Absence of fever, normal labs, and clear lungs support non-infectious causes like spasmodic croup in an otherwise healthy child.

Step 1 is: 25 mg ÷ (80 mg ÷ 1 mL) = 0.3125 mL.

Step 2 is: Round 0.3125 mL to the nearest tenth, which is 0.3 mL. Answer: 0.3 mL.