What is the primary goal of administering lactulose to a client with hepatic encephalopathy?
To decrease blood pressure
To improve liver function tests
To enhance the excretion of ammonia from the body
To increase sodium levels in the body
The Correct Answer is C
Hepatic encephalopathy is a neurologic complication of liver dysfunction caused by the accumulation of toxic substances, especially ammonia, in the bloodstream. When the liver is unable to effectively convert ammonia into urea for excretion, ammonia crosses the blood-brain barrier and affects brain function. This can lead to confusion, altered consciousness, and even coma. Lactulose is commonly administered to reduce serum ammonia levels and improve neurologic status.
Rationale:
A. Decreasing blood pressure is not the primary purpose of lactulose in hepatic encephalopathy. Lactulose acts mainly within the gastrointestinal tract and does not function as an antihypertensive medication. Although fluid shifts may occur with excessive diarrhea, blood pressure reduction is not its therapeutic target in this condition.
B. Improving liver function tests is not the direct action of lactulose. The medication does not repair hepatocytes or restore liver enzyme levels such as AST, ALT, or bilirubin. Its benefit is focused on reducing neurotoxic ammonia accumulation rather than reversing the underlying hepatic damage shown in laboratory values.
C. Enhancing the excretion of ammonia from the body is the primary goal of lactulose therapy. Lactulose acidifies the colon, converting ammonia (NH3) into ammonium (NH4+), which cannot be reabsorbed and is excreted in stool. Its laxative effect also decreases intestinal transit time, reducing ammonia production and absorption from the gut.
D. Increasing sodium levels in the body is not the intended use of lactulose. It does not act as an electrolyte replacement therapy and may actually contribute to electrolyte imbalance if excessive diarrhea occurs. Sodium management in liver disease is addressed separately, especially in clients with ascites or fluid retention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
Acute Respiratory Distress Syndrome (ARDS) is a severe inflammatory lung condition characterized by diffuse alveolar damage, increased pulmonary capillary permeability, and non-cardiogenic pulmonary edema. It results in severe hypoxemia that is often refractory to oxygen therapy. Diagnosis is based on clinical presentation, arterial blood gas findings, and characteristic imaging showing bilateral lung involvement. Identifying the underlying cause, such as infection or systemic inflammation, is essential for targeted management.
Rationale:
A. Common causes of ARDS include pneumonia and sepsis, which are among the most frequent triggers of the inflammatory cascade leading to alveolar damage. These conditions cause widespread cytokine release, increasing capillary permeability and resulting in fluid accumulation in the alveoli. Other causes include aspiration, trauma, and pancreatitis.
B. Blood gas analysis is essential to identifying the severity of ARDS because it provides information on oxygenation status and gas exchange efficiency. A hallmark finding is severe hypoxemia with a reduced PaO₂/FiO₂ ratio. ABGs help classify ARDS severity and guide ventilatory management strategies.
C. Clients with ARDS commonly present with decreased oxygen saturation that does NOT significantly improve with supplemental oxygen. This refractory hypoxemia occurs due to intrapulmonary shunting and alveolar collapse. The statement is incorrect because oxygen therapy alone is often insufficient to correct the underlying gas exchange defect.
D. Imaging must indicate bilateral lung infiltrates to support the diagnosis of ARDS. Chest X-rays or CT scans typically show diffuse, bilateral opacities consistent with pulmonary edema not explained by cardiac failure. This radiographic finding is a key diagnostic criterion for ARDS.
E. Elevated BNP is not permissible or diagnostic for ARDS. Brain natriuretic peptide (BNP) is associated with heart failure and helps differentiate cardiogenic pulmonary edema from ARDS. In ARDS, BNP is typically normal or not significantly elevated because the condition is non-cardiogenic in origin.
Correct Answer is A
Explanation
Hypercalcemia is a condition characterized by elevated serum calcium levels, which can affect neuromuscular, renal, and neurological function. Common manifestations include confusion, lethargy, dehydration, and increased thirst. Severe cases can lead to cardiac dysrhythmias and decreased level of consciousness. Management focuses on promoting calcium excretion, maintaining hydration, and preventing complications such as renal calculi and further neurological decline.
Rationale:
A. Encouraging fluid intake of 3 L daily is the priority intervention because increased hydration enhances renal perfusion and promotes urinary excretion of excess calcium. Fluids help dilute serum calcium levels and reduce the risk of kidney stone formation. Adequate hydration is one of the most effective initial strategies for managing mild to moderate hypercalcemia.
B. Obtaining blood cultures is not indicated because hypercalcemia is not primarily caused by infection. Blood cultures are used to identify bloodstream infections and guide antibiotic therapy, which is unrelated to the management of elevated calcium levels. The client’s symptoms are metabolic rather than infectious in origin.
C. Administering high-dose IV corticosteroids is not the first-line intervention for hypercalcemia. While steroids may be used in specific conditions such as malignancy-related hypercalcemia or vitamin D–mediated cases, they are not the immediate priority. Initial management focuses on hydration and promoting calcium elimination before pharmacologic escalation.
D. Placing the client in a flat position is inappropriate and does not address hypercalcemia. Positioning does not influence calcium levels or enhance renal excretion. Additionally, a flat position may worsen comfort in a confused or lethargic client and does not contribute to correcting the underlying metabolic imbalance.
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