A patient with hepatic encephalopathy is receiving lactulose.
Which assessment provides the nurse with the best information to evaluate the patient’s therapeutic response to the drug?

Choice A rationale

While maintaining a healthy lifestyle and diet is generally beneficial, consuming large amounts of leafy green vegetables, which are high in vitamin K, can interfere with the effectiveness of warfarin, a medication that works by inhibiting the action of vitamin K-dependent clotting factors. Therefore, praising the patient for her healthy lifestyle without addressing the potential interaction between her diet and medication could lead to suboptimal treatment outcomes.

Choice B rationale

This statement is misleading. While a healthy diet can contribute to overall health and well- being, the patient’s dietary choices, specifically her daily consumption of leafy green

vegetables, could actually decrease the effectiveness of warfarin. Warfarin’s ability to prevent blood clots is dependent on a consistent intake of vitamin K67.

Choice C rationale

This is the most appropriate response. The healthcare provider should be informed about the patient’s current diet because it could impact the effectiveness of warfarin. The provider may need to adjust the dose of warfarin or provide additional dietary guidance to ensure the medication works as intended.

Choice D rationale

While this might seem like a reasonable suggestion, it’s important to remember that dietary changes should be made in consultation with a healthcare provider or a dietitian. Substituting leafy green vegetables with other protein sources may not be necessary or appropriate depending on the patient’s overall diet, nutritional needs, and personal preferences.

Choice A rationale

Explaining that the client needs to allow for sleep time of at least two hours after taking zolpidem is not the best action. While it’s true that zolpidem should be taken right before going to sleep, the client’s plan to take a short afternoon nap may not provide enough time for the effects of the medication to wear off, which could lead to drowsiness and potential safety issues.

Choice B rationale

Advising the client to take the medication with the noon meal is not the best action. Zolpidem should be taken on an empty stomach right before going to sleep. Taking it with food or right after a meal may decrease its effectiveness.

Choice C rationale

Encouraging the client to wait until bedtime to take the medication is the best action. Zolpidem is a sedative-hypnotic medication used to treat insomnia. It works quickly to put you to sleep and should be taken right before going to bed. Taking it during the day could lead to drowsiness and potential safety issues.

Choice D rationale

Reminding the client to drink plenty of fluids when taking the medication is not the best action. While staying hydrated is generally good advice, it’s not specifically related to the use of zolpidem. The key instruction for zolpidem is to take it right before going to bed.