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?

Choice A reason: This is the correct manifestation for the nurse to identify as a reason to stop the infusion. A scratchy throat may indicate an allergic reaction to piperacillin-tazobactam, which is a penicillin derivative. The client may also develop other signs of anaphylaxis, such as rash, itching, swelling, wheezing, or difficulty breathing. The nurse should stop the infusion immediately and notify the healthcare provider.

Choice B reason: This is not a correct manifestation for the nurse to identify as a reason to stop the infusion. Pupillary constriction is not a common or serious side effect of piperacillin-tazobactam. It may be caused by other factors, such as light exposure, medication use, or neurological conditions. The nurse should monitor the client's pupils for any changes, but it is not a reason to stop the infusion.

Choice C reason: This is not a correct manifestation for the nurse to identify as a reason to stop the infusion. Bradycardia, or a slow heart rate, is not a common or serious side effect of piperacillin-tazobactam. It may be caused by other factors, such as cardiac disorders, medication use, or vagal stimulation. The nurse should monitor the client's vital signs for any changes, but it is not a reason to stop the infusion.

Choice D reason: This is not a correct manifestation for the nurse to identify as a reason to stop the infusion. Hypertension, or high blood pressure, is not a common or serious side effect of piperacillin-tazobactam. It may be caused by other factors, such as stress, pain, or renal disorders. The nurse should monitor the client's blood pressure for any changes, but it is not a reason to stop the infusion.

Choice A reason: This is not a correct action for the nurse to include in this client's plan of care. Administering sucralfate once a day, preferably at bedtime, is not the recommended dosage or timing for this medication. Sucralfate is a mucosal protectant that forms a protective barrier over the ulcer and prevents further damage from acid and pepsin. It should be taken four times a day, one hour before meals and at bedtime, to ensure optimal coverage and healing of the ulcer.

Choice B reason: This is the correct action for the nurse to include in this client's plan of care. Giving sucralfate on an empty stomach is essential for the effectiveness of this medication. Sucralfate needs an acidic environment to activate and form a complex with the ulcer site. If the client takes sucralfate with food or beverages, the pH of the stomach may increase and reduce the ability of sucralfate to bind to the ulcer. The client should take sucralfate one hour before meals and at bedtime, and avoid antacids within 30 minutes of taking sucralfate.

Choice C reason: This is not a correct action for the nurse to include in this client's plan of care. Monitoring for electrolyte imbalance is not a specific or relevant intervention for this medication. Sucralfate does not affect the electrolyte levels in the blood, as it is not absorbed systemically and does not alter the renal function. The nurse should monitor the electrolyte levels for other reasons, such as dehydration, vomiting, or diuretic use, but not because of sucralfate therapy.

Choice D reason: This is not a correct action for the nurse to include in this client's plan of care. Assessing for secondary Candida infection is not a common or necessary intervention for this medication. Sucralfate does not increase the risk of fungal infections, as it does not suppress the immune system or alter the normal flora of the GI tract. The nurse should assess for signs of infection, such as fever, leukocytosis, or purulent drainage, for other reasons, such as perforation, abscess, or sepsis, but not because of sucralfate therapy.