A patient is taking ACEl enalapril Vasotec. The nurse understands that patients taking this type of drug for hypertension need to be monitored carefully for:

Choice A reason: Hyperbilirubinemia and jaundice are common manifestations of chronic liver disease, but they are not the primary cause of hepatic encephalopathy. These conditions result from the liver's inability to process and clear bilirubin effectively, leading to its accumulation in the blood and subsequent yellowing of the skin and eyes. While these symptoms indicate liver dysfunction, they do not directly cause the neurological impairments seen in hepatic encephalopathy.

Choice B reason: Fluid and electrolyte imbalances are often associated with chronic liver disease and can contribute to various complications, including ascites and edema. However, these imbalances are not the primary cause of hepatic encephalopathy. While electrolyte disturbances, particularly hyponatremia, can exacerbate encephalopathy, the condition itself is more directly linked to the liver's inability to detoxify certain substances, such as ammonia.

Choice C reason: Decreased cerebral blood flow can lead to neurological impairments, but it is not the primary mechanism underlying hepatic encephalopathy. Hepatic encephalopathy primarily results from the accumulation of neurotoxic substances that the liver can no longer effectively process, rather than reduced blood flow to the brain.

Choice D reason: Impaired ammonia metabolism and increased ammonia levels in the blood are the main causes of hepatic encephalopathy. In chronic liver disease, the liver's ability to convert ammonia, a byproduct of protein metabolism, into urea for excretion is compromised. As a result, ammonia accumulates in the blood and crosses the blood-brain barrier, leading to neurotoxicity and the characteristic symptoms of hepatic encephalopathy, such as confusion, altered consciousness, and asterixis (flapping tremor).

Choice A reason: Hypercalcemia refers to high levels of calcium in the blood, but a positive Chvostek sign is not indicative of hypercalcemia. In fact, hypercalcemia generally results in symptoms such as muscle weakness, fatigue, and nausea rather than the specific neuromuscular irritability seen with a positive Chvostek sign.

Choice B reason: Hypocalcemia refers to low levels of calcium in the blood and is associated with a positive Chvostek sign. The Chvostek sign is a clinical test where tapping on the facial nerve triggers twitching of the facial muscles. This occurs due to increased neuromuscular excitability caused by low calcium levels.

Choice C reason: Hypophosphatemia refers to low levels of phosphate in the blood. It is not directly associated with a positive Chvostek sign. While electrolyte imbalances can affect neuromuscular function, hypocalcemia is specifically linked to the Chvostek sign.

Choice D reason: Hypermagnesemia refers to high levels of magnesium in the blood and is not related to a positive Chvostek sign. Hypermagnesemia often causes symptoms such as muscle weakness, nausea, and hypotension rather than the neuromuscular irritability seen with a positive Chvostek sign.