The prescription reads for guaifenesin 400 mg PO every 4 hours as needed for congestion. Using the label below, how many mL will the nurse administer to the client? Enter a numeric value only. Answer to the nearest whole mL.

A) Lying flat on the back: Positioning the client flat on their back is not the most effective position for administering a rectal suppository. The correct position allows for easier insertion and proper absorption of the medication. Lying flat on the back may make it difficult for the nurse to administer the suppository in the correct manner.

B) Lying flat on the stomach: Lying flat on the stomach is not recommended for the administration of a rectal suppository, as it can be uncomfortable for the client and can impede the ability to access the rectal area. The side-lying position is more effective for both client comfort and proper placement of the suppository.

C) Left side-lying: The left side-lying position, often referred to as the Sims' position, is the most appropriate for administering a rectal suppository. This position helps to expose the rectal area, allows for easier insertion, and promotes the suppository’s absorption, as gravity can assist in its positioning within the rectum.

D) Right side-lying: The right side-lying position is not as effective as the left side-lying position for the administration of a rectal suppository. The left-side position helps to ensure the smooth placement of the suppository and promotes its absorption. Therefore, the right side is not the optimal choice.

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.