The nurse is caring for a client diagnosed with cancer of the pancreas head who is complaining of nausea, severe epigastric pain, and jaundice. Which of the following stool characteristics can the nurse anticipate?

The client's ammonia level is critically elevated (250 mcg/dL), which can lead to altered mental status, confusion, and lethargy, consistent with hepatic encephalopathy. In cirrhosis, the liver loses its ability to detoxify ammonia, leading to its accumulation in the bloodstream. This excess ammonia crosses the blood-brain barrier, impairing neuronal function and causing hepatic encephalopathy.

Incorrect answers:

DKA is characterized by high blood glucose (>250 mg/dL), metabolic acidosis, and ketonemia. This client has a moderate glucose elevation (148 mg/dL) but no signs of acidosis, Kussmaul respirations, or ketonuria.

Dehydration: While dehydration can contribute to mental status changes, severe hyperammonemia is a direct cause of hepatic encephalopathy. The client's crackles in the lungs and peripheral edema suggest fluid retention, not dehydration.

Acute kidney disease presents with rising creatinine levels, oliguria, and electrolyte imbalances. This client’s creatinine level is normal, ruling out acute kidney disease.

Malnutrition is characterized by low albumin, muscle wasting, and weight loss, but this client's elevated glucose is more likely due to diabetes mellitus rather than malnutrition.

A. "You can donate blood as long as your symptoms have resolved.": Clients with a history of hepatitis B can never donate blood, even if symptoms have resolved, due to the risk of latent infection and transmission.

B. "It is safe to consume alcohol in moderation.": Alcohol should be avoided because it worsens liver inflammation and damage in hepatitis B.

C. "You should inform your sexual partners about your diagnosis.": Hepatitis B (HBV) is a bloodborne virus transmitted through sexual contact, blood, and bodily fluids. Clients should inform sexual partners and practice safe sex to prevent transmission.

D. "You do not need to follow up with your healthcare provider once you feel better.": Follow-up is essential to monitor liver function, prevent complications, and check for chronic hepatitis B, which may lead to cirrhosis or liver cancer.