Which of the following indicate to the nurse that lactulose is effective for an older adult who has advanced liver cirrhosis?
The client has at least one stool per day.
The client denies nausea and vomiting (N/V).
The client's bilirubin level decreases.
The client is alert and oriented (A&Ox4).
The Correct Answer is D
Choice A reason: While having at least one stool per day is a sign that lactulose is working, it does not directly indicate its effectiveness in reducing ammonia levels and improving mental status.
Choice B reason: Denial of nausea and vomiting is positive but is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice C reason: A decrease in bilirubin levels may be a positive sign, but it is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice D reason: The client being alert and oriented is a direct indicator that lactulose is effectively reducing ammonia levels and improving mental status, which is a key goal in treating hepatic encephalopathy associated with liver cirrhosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Avoiding tanning booths is correct and does not indicate a need for further teaching.
Choice B reason: Using sunscreen even on cloudy days is correct and does not indicate a need for further teaching.
Choice C reason: Checking the skin monthly for any changes is correct and does not indicate a need for further teaching.
Choice D reason: The statement about eating a high-fiber diet reducing the risk for developing skin cancer indicates a misunderstanding, as there is no direct correlation between a high-fiber diet and the prevention of skin cancer. This indicates a need for further teaching.
Correct Answer is D
Explanation
Choice A reason: This description is too clinical and not the simplest explanation.
Choice B reason: This statement is medically accurate but not the most simplistic description.
Choice C reason: Comparing Crohn's disease to a second-degree burn is not accurate as it does not only affect the colon and rectum.
Choice D reason: Describing Crohn's disease as having the appearance of a patchwork quilt with some areas clear and some with sores provides a simple visual that is easy to understand without medical knowledge.
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