The laboratory findings of a client with cirrhosis of the liver indicate high serum ammonia levels. As a result of this increased ammonia level, which symptom is this client likely to exhibit?

Choice A reason: Insulin reduces serum glucose in diabetes mellitus, not water loss in diabetes insipidus (DI). DI results from vasopressin deficiency, causing excessive urination. Insulin is irrelevant, as DI is a fluid balance disorder, not a glucose metabolism issue, making this response incorrect and misleading for the client.

Choice B reason: Assessing dietary habits and glucose levels pertains to diabetes mellitus, not diabetes insipidus. DI involves water loss due to vasopressin deficiency, not glucose dysregulation. This response misaligns with DI’s pathophysiology, as insulin or glucose monitoring is unnecessary, and vasopressin therapy is the standard treatment.

Choice C reason: Maintaining normal serum glucose is a goal for diabetes mellitus, not diabetes insipidus, which involves water loss from vasopressin deficiency. DI treatment focuses on fluid balance via vasopressin, not glucose control. This response is incorrect, as it conflates DI with an unrelated metabolic condition.

Choice D reason: Diabetes insipidus is managed with vasopressin (ADH) therapy to reduce excessive urination and conserve water, addressing the underlying deficiency. This response accurately explains DI’s treatment, distinguishing it from diabetes mellitus and clarifying that insulin is not needed, aligning with evidence-based endocrinology practice for fluid balance.

Choice A reason: In CKD, impaired kidneys produce less erythropoietin, reducing red blood cell production and causing anemia. Pallor results from decreased hemoglobin, a hallmark of CKD-related anemia. This manifestation aligns with the kidney’s role in erythropoiesis, making it the primary clinical sign the nurse should assess in this client.

Choice B reason: Petechiae, small skin hemorrhages, result from platelet dysfunction or vascular issues, not directly from reduced erythropoietin in CKD. While CKD may cause uremic bleeding tendencies, petechiae are less specific than pallor, which directly reflects anemia due to impaired erythropoietin production, a core pathophysiological feature.

Choice C reason: Jaundice, caused by bilirubin accumulation, indicates liver dysfunction or hemolysis, not erythropoietin deficiency. CKD does not typically cause jaundice unless complicated by unrelated conditions. Pallor from anemia is a more direct consequence of reduced erythropoietin, making it the priority manifestation for assessment in CKD.

Choice D reason: Pruritus in CKD results from uremic toxin accumulation or calcium-phosphate imbalances, not erythropoietin deficiency. While common, it is unrelated to the kidney’s erythropoiesis role. Pallor, linked to anemia from low erythropoietin, is the most relevant clinical sign for the nurse to assess in this context.