The nurse is caring for client with liver failure admitted with hepatic encephalopathy, Lactulose is ordered Q2 hours. What assessment finding should the nurse use to best evaluate therapeutic response of the medication?
The ammonia level has decreased each day starting the lactulose
The liver enzymes AST and ALT. have decreased to normal levels
The client is having 5-6 soft, non-formed stools each day
The client is awake, alert and oriented to their environment
The Correct Answer is D
A) The ammonia level has decreased each day starting the lactulose: While a decrease in ammonia levels is an important indicator of improvement in hepatic encephalopathy, it is not the best assessment of the therapeutic response to lactulose. The goal of lactulose therapy is to reduce ammonia levels, but the most direct evaluation of therapeutic effect is related to the client's mental status, not just laboratory results.
B) The liver enzymes AST and ALT have decreased to normal levels: Liver enzyme levels such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are important indicators of liver function, but they do not directly reflect the effectiveness of lactulose in treating hepatic encephalopathy. These enzymes may improve as liver function improves, but they are not the most immediate or specific indicator of lactulose’s therapeutic effect.
C) The client is having 5-6 soft, non-formed stools each day: Lactulose works by drawing water into the bowel to promote stool softening and increase bowel movements, which can help lower ammonia levels in the body. While frequent soft stools can be an effect of lactulose, this is not the best measure of therapeutic response in hepatic encephalopathy. The primary goal is improvement in the client's mental status, not just bowel function.
D) The client is awake, alert, and oriented to their environment: The best assessment of the therapeutic response to lactulose is the improvement in the client’s mental status. Lactulose works by reducing the absorption of ammonia from the gastrointestinal tract, which is responsible for the cognitive impairments seen in hepatic encephalopathy. If the client is awake, alert, and oriented, this indicates that lactulose is effectively reducing the ammonia levels and improving the neurological status of the client, making it the most appropriate assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Here's the process for calculating the drug concentration after multiple half-lives:
First half-life: After 1 half-life, 50% of the original dose remains in the body.
200 mg x 0.50 = 100 mg remains after 1 half-life.
Second half-life: After 2 half-lives, 50% of the remaining drug will be eliminated.
100 mg x 0.50 = 50 mg remains after 2 half-lives.
Third half-life: After 3 half-lives, 50% of the remaining drug will be eliminated again.
50 mg x 0.50 = 25 mg remains after 3 half-lives.
Fourth half-life: After 4 half-lives, 50% of the remaining drug will be eliminated once more.
25 mg x 0.50 = 12.5 mg remains after 4 half-lives.
Now, we need to sum up the amount of drug remaining in the body at each half-life:
After 4 half-lives, there are 12.5 mg left from the original dose.
Total drug in the body after 4 half-lives = 200 mg - 12.5 mg = 375 mg.
Correct Answer is A
Explanation
A) The client flushes the medication down the toilet: Flushing medication down the toilet is not recommended unless it is explicitly stated on the medication packaging or insert. Many medications, especially controlled substances, may be harmful to the environment if disposed of in this way. Environmental regulations discourage flushing medications unless instructed by the manufacturer, as it can contribute to water contamination. Therefore, this action indicates a need for additional education on proper medication disposal.
B) The client removes identifying information from the medication container: This is an appropriate action. Removing identifying information from the medication container before disposal helps ensure privacy and confidentiality, preventing unauthorized individuals from accessing personal health information. This is part of safe and secure medication disposal practices.
C) The client reads the medication insert to determine the disposal method: This is an appropriate action. Reading the medication insert is the best way for a client to understand the recommended disposal method for their specific medication. Many medications have detailed instructions on how to dispose of them safely and environmentally.
D) The client mixes the medication with coffee grounds: This is an appropriate action. Mixing medications with coffee grounds, cat litter, or dirt is recommended for medications that should not be flushed or thrown in the trash. This helps make the medication less appealing to children, pets, or others who may come across it and ensures safe disposal. This action is consistent with the guidance for non-hazardous medications.
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