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 B

Explanation

B. Changes in hematocrit (red blood cell count) and blood pressure can indicate potential complications or changes in the client's condition, such as internal bleeding or rupture of the aneurysm. Therefore, communicating hematocrit and blood pressure values would be important for the healthcare provider to assess in this situation.
A. While calcium level and skin condition are important aspects of overall health, they may not be directly relevant to the assessment of low back pain in a client with an abdominal aortic aneurysm. Therefore, this information may not be the most critical for the healthcare provider to assess in this specific situation.
C. These parameters are also important for assessing a client's condition, especially in the context of potential infection or systemic inflammation. However, they may not be directly related to the specific symptom of low back pain in a client with an abdominal aortic aneurysm. While changes in white blood cell count and pulse rate could indicate infection or other complications, they may not be the most critical information to communicate in this scenario.
D. While serum amylase levels and level of consciousness are important indicators of pancreatic function and neurological status, respectively, they may not be directly related to the symptom of low back pain in a client with an abdominal aortic aneurysm. Therefore, these parameters may not be the most critical information to communicate in this situation.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Explanation

Option 1-prediabetes

Option 2- impaired glucose tolerance

Rationale

Prediabetes is a condition characterized by higher than normal blood sugar levels, but not high enough to be classified as type 2 diabetes. It's considered a warning sign that indicates an increased risk of developing type 2 diabetes, heart disease, and stroke if left unmanaged.

Prediabetes is diagnosed if FPG levels are between 100-125 mg/dL, OGTT levels are between 140-199 mg/dL, or HbA1c levels are between 5.7-6.4%.

It occurs due to impaired glucose tolerance in insulin resistance. In individuals with insulin resistance, cells, particularly muscle, liver, and fat cells, become less sensitive to insulin's actions. As a result, glucose uptake by cells is impaired, leading to higher blood sugar levels. Hypoglycemia refers to a condition characterized by abnormally low blood sugar levels, typically below 70 mg/dL (3.9 mmol/L). It occurs when there is an imbalance between the amount of glucose in the bloodstream and the body's requirements for energy.

Gestational diabetes mellitus (GDM) is a type of diabetes that develops during pregnancy. It is characterized by high blood sugar levels that occur for the first time during pregnancy and typically resolves after childbirth.

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Naxlex Comprehensive Predictor Exams

The nurse calls the healthcare provider because a client diagnosed with an abdominal aortic aneurysm (AAA) is reporting low back pain. Which additional information about the client would be important for the nurse to tell the healthcare provider?

Correct Answer is B

Explanation

Patient Data Exhibits Based on the laboratory data, the client has dropdown related to dropdown

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Explanation

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