When flushing a feeding tube, the nurse knows to use how many mL of water?

A. Increased protein diet: Increasing protein intake can raise ammonia levels because protein metabolism produces nitrogenous waste. In cirrhosis, impaired hepatic detoxification limits conversion of ammonia to urea. Excess protein may worsen hepatic encephalopathy symptoms.

B. Decreased sodium diet: Sodium restriction is commonly used to manage ascites and edema in cirrhosis. While important for fluid balance, it does not directly reduce ammonia production or levels. This intervention addresses volume status rather than encephalopathy risk.

C. Decreased protein diet: Reducing dietary protein lowers ammonia generation from intestinal breakdown of amino acids. This approach helps decrease neurotoxic ammonia accumulation when hepatic clearance is compromised. Protein intake is often temporarily restricted during episodes of elevated ammonia.

D. Increased carbohydrate diet: Carbohydrates provide an alternative energy source and can help prevent protein catabolism. While beneficial as part of overall nutrition, increasing carbohydrates alone does not directly reduce ammonia production. It is supportive rather than primary management for hyperammonemia.

A. Nothing it is appropriate to stop the medication for 3 days: Abrupt discontinuation of long-term, high-dose glucocorticoids suppresses the hypothalamic–pituitary–adrenal (HPA) axis. The body is unable to rapidly resume endogenous cortisol production. Even a short interruption can lead to serious physiological consequences.

B. He will go into thyroid storm: Thyroid storm is associated with uncontrolled hyperthyroidism and is unrelated to glucocorticoid withdrawal. There is no mechanism linking sudden cessation of steroids to acute thyroid hormone excess.

C. Nasojejunal tube: Placement of a nasojejunal tube is a medical intervention, not a physiological consequence of stopping glucocorticoids. It has no relevance to steroid withdrawal or adrenal function.

D. He will go into adrenal crisis: Chronic glucocorticoid therapy suppresses endogenous cortisol production by the adrenal glands. Sudden withdrawal can result in acute adrenal insufficiency, leading to hypotension, hypoglycemia, weakness, and shock. This is a medical emergency requiring prompt treatment.

E. His autoimmune disease will go into remission: Glucocorticoids suppress inflammation and immune activity; stopping them abruptly increases the risk of disease flare rather than remission. Rheumatoid arthritis symptoms often worsen when anti-inflammatory therapy is withdrawn. Remission would not be expected in this context.