Which intervention is most important for the nurse to implement for a client who is receiving insulin lispro?

Choice A reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Stool color and character may change as a result of lactulose administration, as it is a laxative that lowers the pH of the colon and promotes the excretion of ammonia. However, these changes are not indicative of the effectiveness of lactulose in reducing the ammonia levels in the blood, which is the main goal of the therapy.

Choice B reason: This is the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Serum electrolytes and ammonia are directly affected by lactulose administration, as it lowers the blood ammonia levels by converting it to ammonium and facilitating its elimination in the stool. The nurse should monitor the serum electrolytes and ammonia levels regularly to assess the efficacy and safety of lactulose therapy, as well as to adjust the dosage as needed.

Choice C reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Serum hepatic enzymes are markers of liver function and damage, and they may be elevated in clients with hepatic encephalopathy due to cirrhosis or other liver disorders. However, lactulose does not affect the hepatic enzymes directly, and it does not reverse the underlying liver disease. The nurse should monitor the serum hepatic enzymes to assess the progression and severity of the liver condition, but not to evaluate the response to lactulose.

Choice D reason: This is not the best assessment for the nurse to use to evaluate the client's therapeutic response to lactulose. Fingerstick glucose is a measure of blood glucose levels, and it may be altered in clients with hepatic encephalopathy due to impaired glucose metabolism by the liver. However, lactulose does not affect the blood glucose levels directly, and it does not improve the liver's ability to regulate glucose. The nurse should monitor the fingerstick glucose to assess the risk of hypoglycemia or hyperglycemia, but not to evaluate the response to lactulose.

Choice A reason: This is not the best finding to indicate that the medication is effective. Reports of increased energy levels and decreased fatigue are subjective and nonspecific signs that may reflect the client's mood, activity, or sleep quality. They may also be influenced by other factors, such as nutrition, hydration, or stress. The nurse should monitor the client's subjective symptoms, but they are not the most reliable indicators of the medication's efficacy.

Choice B reason: This is not the best finding to indicate that the medication is effective. Food diary shows increased consumption of iron-rich foods, which is a positive dietary behavior that can help improve the client's iron status and prevent iron deficiency anemia. However, iron-rich foods are not sufficient to treat the anemia caused by CKD, which is due to the reduced production of erythropoietin, a hormone that stimulates the bone marrow to make red blood cells. The nurse should encourage the client to eat a balanced diet, but it is not the main factor that determines the medication's effectiveness.

Choice C reason: This is not the best finding to indicate that the medication is effective. Takes concurrent iron therapy without adverse effects, which is a recommended adjunctive treatment that can enhance the response to epoetin alfa and increase the hemoglobin levels. However, iron therapy alone is not enough to correct the anemia caused by CKD, and it may have some side effects, such as constipation, nausea, or abdominal pain. The nurse should ensure that the client takes the prescribed dose of iron and monitors for any adverse effects, but it is not the primary outcome that measures the medication's efficacy.

Choice D reason: This is the best finding to indicate that the medication is effective. Hemoglobin level increased to 12 g/dL (7.45 mmol/L), which is within the normal range for males and indicates that the anemia has improved. Hemoglobin is the main component of red blood cells that carries oxygen to the tissues, and it is the most objective and accurate indicator of the medication's efficacy. Epoetin alfa is a synthetic form of erythropoietin that stimulates the bone marrow to produce more red blood cells and increase the hemoglobin levels. The nurse should check the hemoglobin levels regularly and report any abnormal findings to the healthcare provider.