Lactulose was prescribed two days ago for a client who was recently diagnosed with hepatic encephalopathy. The client is confused and experiencing frequent loose stools. Laboratory findings show an elevated serum ammonia (NH) level of 220 μg/dL (157.1 μmol/dL). Which action should the nurse take?

Reference Range:

Ammonia [10 to 80 μg/dL (6 to 47 μmol/L)]

Hold the next dose of lactulose.

Continue the prescribed dose of lactulose.

Replace total volume voided with oral or IV fluids.

Report the number of diarrhea stools to the healthcare provider (HCP).

Answer and Explanation

The Correct Answer is B

B. Lactulose works by acidifying the colonic contents, which promotes the conversion of ammonia (NH3) to ammonium (NH4+). Ammonium is less readily absorbed from the colon into the bloodstream, reducing systemic ammonia levels. This action helps alleviate the neurotoxic effects of ammonia on the brain, thereby improving neurological symptoms associated with hepatic encephalopathy.
A. Lactulose is required in clients with hepatic encephalopathy to excrete ammonia lowering its levels in blood. Holding the lactulose dose is inappropriate as the client’s ammonia levels are still high
C. Rehydrating the clients to replace lost fluids in the loose stools is important but does not address
the client’s elevated ammonia levels which may be exacerbating the client’s encephalopathy.
D. Reporting the number of diarrhea stools to the healthcare provider is important for ongoing assessment and management of the client's condition. However, it does not address the clients high ammonia levels.

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Correct Answer is C

Explanation

C. Elevating the head of the bed to 90 degrees (semi-Fowler's position) can help improve respiratory mechanics and lung expansion, making breathing easier for the client. This position can also help reduce the risk of aspiration and improve oxygenation in clients with respiratory distress.
A. Identifying and addressing triggers that exacerbate asthma symptoms is crucial for managing asthma effectively. By determining the client's exposure to triggers such as allergens, pollutants, or irritants, the nurse can help prevent future asthma exacerbations and tailor the client's management plan accordingly. However, this is done after the client is stabilized.
B. While teaching proper inhaler technique is an essential aspect of asthma management, the priority in this scenario is addressing the client's immediate respiratory distress. The client is already receiving a steroid nebulizer treatment, which is aimed at providing rapid relief and improving lung function. Teaching proper inhaler technique can be addressed later once the client's respiratory distress is stabilized.
D. While monitoring pulse oximetry is essential for assessing oxygenation and respiratory status, the frequency of monitoring may need to be increased in a client with asthma in respiratory distress. Clients experiencing respiratory distress may have rapid changes in oxygen saturation levels, necessitating more frequent monitoring to ensure timely intervention if oxygenation deteriorates.

A. Confirmation of the autoimmune disease process. B. Representative of a decline in the client's condition. C. Evidence of spread of the disease to the kidneys. D. Indication of the onset of joint degeneration.

Correct Answer is A

Explanation

A. Rheumatoid factor (RF) is an autoantibody directed against the Fc portion of immunoglobulin G (IgG). In RA, it is an indication of the autoimmune nature of the disease, where the immune system mistakenly attacks the body's own tissues, particularly the synovial membranes in the joints, leading to inflammation, pain, and joint damage.
B. While the presence of an elevated serum rheumatoid factor is associated with the autoimmune process underlying RA, it does not necessarily correlate with disease severity or progression.
C. Rheumatoid factor has no correlation with renal involvement of RA
D. RA is an indicator of autoimmunity in the joint but not necessarily the onset of joint degeneration.

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Naxlex Comprehensive Predictor Exams

After initiating a steroid nebulizer treatment for a client with asthma in respiratory distress, which intervention is most important for the nurse to implement?

Correct Answer is C

Explanation

A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

Correct Answer is A

Explanation

A client with type 2 diabetes mellitus arrives to the clinic reporting episodes of weakness and palpitations. Which finding is most important for the nurse to monitor?

Two weeks after returning home from traveling, a client presents to the clinic with conjunctivitis and describes a recent loss in the ability to taste and smell. The nurse obtains a nasal swab to test for COVID 19 Which action is most important for the nurse to take?

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