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

Stool color and character.

Serum electrolytes and ammonia.

Serum hepatic enzymes.

Fingerstick glucose.

Answer and Explanation

The Correct Answer is B

Choice A reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Stool color and character may change as a result of lactulose administration, as it is a laxative that lowers the pH of the colon and promotes the excretion of ammonia. However, these changes are not indicative of the effectiveness of lactulose in reducing the ammonia levels in the blood, which is the main goal of the therapy.

Choice B reason: This is the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Serum electrolytes and ammonia are directly affected by lactulose administration, as it lowers the blood ammonia levels by converting it to ammonium and facilitating its elimination in the stool. The nurse should monitor the serum electrolytes and ammonia levels regularly to assess the efficacy and safety of lactulose therapy, as well as to adjust the dosage as needed.

Choice C reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Serum hepatic enzymes are markers of liver function and damage, and they may be elevated in clients with hepatic encephalopathy due to cirrhosis or other liver disorders. However, lactulose does not affect the hepatic enzymes directly, and it does not reverse the underlying liver disease. The nurse should monitor the serum hepatic enzymes to assess the progression and severity of the liver condition, but not to evaluate the response to lactulose.

Choice D reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Fingerstick glucose is a measure of blood glucose levels, and it may be altered in clients with hepatic encephalopathy due to impaired glucose metabolism by the liver. However, lactulose does not affect the blood glucose levels directly, and it does not improve the liver's ability to regulate glucose. The nurse should monitor the fingerstick glucose to assess the risk of hypoglycemia or hyperglycemia, but not to evaluate the response to lactulose.

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Correct Answer is B

Explanation

Choice A reason: Employed as a construction worker is not the most important assessment finding for the nurse to address. Although the client's occupation may expose them to moist and warm environments that can promote fungal growth, it is not directly related to the administration of terbinafine HCL. The nurse should advise the client to wear breathable shoes and socks and keep the feet dry and clean, but it is not a priority.

Choice B reason: Reported history of alcoholism is the most important assessment finding for the nurse to address. Terbinafine HCL can cause hepatotoxicity, especially in clients with pre-existing liver disease or who consume alcohol regularly. The nurse should assess the client's liver function tests and alcohol intake before starting the medication and inform the prescriber accordingly. The nurse should also monitor the client for signs and symptoms of liver damage, such as jaundice, abdominal pain, nausea, or fatigue.

Choice C reason: White blood cell count of 8,500/mm3 (8.5 x 10^9/L) is not the most important assessment finding for the nurse to address. This value is within the normal reference range of 5,000 to 10,000/mm3 (5 to 10 x 10^9/L) and does not indicate any infection or inflammation. The nurse should check the client's baseline blood counts before starting the medication, but it is not a priority.

Choice D reason: Toenails appear thick and yellow is not the most important assessment finding for the nurse to address. This is a typical manifestation of a fungal toenail infection, which is the indication for terbinafine HCL. The nurse should expect the toenails to improve in appearance and texture after the completion of the treatment, which may take several weeks or months. The nurse should educate the client about the expected outcomes and adherence to the medication regimen, but it is not a priority.

A. Take the tablet with a daily multivitamin. B. Bedtime is the best time to take the tablet. C. Wait 2 hours after meals to take the tablet. D. Crush the tablets and mix with pudding.

Correct Answer is C

Explanation

Choice A reason: This is not a correct information for the nurse to include in the discharge instructions. Taking the tablet with a daily multivitamin is not advisable, as some vitamins and minerals, such as calcium, zinc, and vitamin C, can interfere with the absorption of iron and reduce its effectiveness. The client should take the tablet on an empty stomach or with a small amount of food that does not contain these substances.

Choice B reason: This is not a correct information for the nurse to include in the discharge instructions. Bedtime is not the best time to take the tablet, as it may cause gastrointestinal side effects, such as nausea, vomiting, constipation, or diarrhea, that can disrupt the client's sleep and comfort. The client should take the tablet at least 2 hours before or after meals, and preferably in the morning.

Choice C reason: This is a correct information for the nurse to include in the discharge instructions. Waiting 2 hours after meals to take the tablet is recommended, as it ensures that the stomach is empty and that the iron is not affected by any food or beverages that may impair its absorption. The client should also drink plenty of water with the tablet to facilitate its passage and prevent irritation of the esophagus.

Choice D reason: This is not a correct information for the nurse to include in the discharge instructions. Crushing the tablets and mixing with pudding is not appropriate, as it can damage the enteric coating of the tablets, which is designed to protect the iron from being destroyed by the stomach acid and to reduce the gastrointestinal side effects. The client should swallow the tablets whole and not chew, break, or crush them.

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

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Before administering a newly prescribed dose of terbinafine HCL to a client with a fungal toenail infection, which assessment finding is most important for the nurse to address?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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