A nurse is caring for a client in the outpatient cardiologist's office. The client is alert and oriented. Lung sounds with crackles are heard bilaterally. Dyspnea is observed on exertion, and heart sounds reveal an S3 gallop. Which of the following findings is the nurse most likely to expect?

Choice A rationale
Chest pain that is relieved with eating or drinking water is not typically indicative of a complication from a peptic ulcer. This symptom may be related to conditions like gastroesophageal reflux disease (GERD).

Choice B rationale
Burning epigastric pain after eating is a common symptom of a peptic ulcer and, while uncomfortable, does not usually require an urgent change in the plan of care unless it significantly worsens or is accompanied by other concerning symptoms.

Choice C rationale
Back pain after eating can be associated with a peptic ulcer if the ulcer is located at the back of the stomach or the pain radiates; however, it does not typically warrant an urgent change in care without other symptoms.

Choice D rationale
A rigid abdomen and vomiting following indigestion can indicate a perforated ulcer, which is a medical emergency. This requires immediate intervention and possibly surgical consultation, thus warranting an urgent change in the nursing plan of care.

Choice A rationale
Potassium levels are not directly affected by lactulose. While cirrhosis can lead to imbalances in electrolytes, including potassium, lactulose is not used to manage potassium levels in the bloodstream.

Choice B rationale
Ammonia is produced by the breakdown of proteins in the intestines and is normally processed by the liver. In cirrhosis, the liver's ability to convert ammonia to urea is impaired, leading to increased levels in the blood. Lactulose helps reduce blood ammonia levels by converting it into ammonium, which is then excreted.

Choice C rationale
Bicarbonate levels are related to the body's pH balance and are not the target of lactulose treatment. Cirrhosis does not typically result in bicarbonate imbalances that would be treated with lactulose.

Choice D rationale
Glucose levels are managed by insulin and other metabolic processes, not lactulose. While cirrhosis can affect overall metabolism, lactulose does not have a direct effect on blood glucose levels.