A nurse is monitoring a client with cirrhosis for signs of portal hypertension. Which finding is most indicative of this complication?

Choice A reason: Diabetic neuropathy is a common diabetes complication, resulting from chronic hyperglycemia damaging peripheral nerves. This leads to sensory loss, pain, or autonomic dysfunction, impairing sensation in extremities, increasing infection risk, and affecting quality of life, making it a significant and well-recognized complication.

Choice B reason: Nausea, vomiting, and diarrhea are not primary diabetes complications but may occur secondary to conditions like gastroparesis or infections. They are symptoms, not chronic complications, and are less specific to diabetes compared to neuropathy or vascular issues, making this incorrect.

Choice C reason: Microvascular complications, including retinopathy, nephropathy, and neuropathy, result from hyperglycemia damaging small blood vessels. This leads to retinal ischemia, kidney dysfunction, or nerve damage, contributing to blindness, renal failure, or sensory loss, making this a major category of diabetes complications requiring long-term management.

Choice D reason: Macrovascular complications, such as coronary artery disease, stroke, and peripheral artery disease, arise from hyperglycemia-induced atherosclerosis. Diabetes accelerates endothelial damage and plaque formation, increasing cardiovascular risk, making this a critical complication category, as it significantly contributes to morbidity and mortality in diabetic patients.

Choice E reason: Diabetic retinopathy, caused by hyperglycemia damaging retinal blood vessels, leads to microaneurysms, hemorrhages, and neovascularization, potentially causing blindness. It is a leading cause of vision loss in diabetes, making this a specific and severe microvascular complication requiring regular screening and intervention.

Choice A reason: Lactulose does not correct vitamin B1 (thiamine) deficiency. Thiamine deficiency, common in alcoholics with cirrhosis, is treated with thiamine supplements. Lactulose targets ammonia in hepatic encephalopathy by acidifying the colon, trapping ammonia for excretion, making this response incorrect for its mechanism.

Choice B reason: Lactulose reduces intestinal ammonia absorption in hepatic encephalopathy by acidifying the colon, converting ammonia (NH3) to ammonium (NH4+), which is less absorbable and excreted in stool. This lowers serum ammonia, alleviating neurotoxicity in cirrhosis, making this the accurate explanation for its use.

Choice C reason: Lactulose does not primarily destroy ammonia-producing bacteria. While it may alter gut flora, its main action is acidifying the colon to trap ammonia for excretion. Antibiotics like rifaximin target ammonia-producing bacteria, making this an incorrect description of lactulose’s primary mechanism.

Choice D reason: Lactulose is not used for diagnostic test preparation in this context. It is a treatment for hepatic encephalopathy, reducing ammonia levels. While used as a laxative for colonoscopy prep, this is irrelevant to managing elevated ammonia in cirrhosis, making this response incorrect.