Which prescribed medication can the nurse instruct the client to crush if needed?

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.

A) Shake bottle well, pull ear outward and downward, instill drops: This method is typically used for younger children, such as infants or toddlers, as the ear canal in younger children is more horizontal. However, this is not the appropriate method for a 12-year-old.

B) Shake bottle well, pull ear outward and upward, instill drops: This method is incorrect because the ear should be pulled outward and upward for a child under 3 years old, not for a 12-year-old.

C) Warm bottle in hand, pull ear outward and upward, instill drops: This is the correct method for a 12-year-old client. The ear should be pulled outward and upward to straighten the ear canal, allowing the drops to reach the deeper parts of the ear. Additionally, warming the bottle in your hands prevents discomfort that might arise from cold drops being instilled in the ear.

D) Warm bottle in hand, pull ear outward and downward, instill drops: This method is appropriate for children under 3 years old. For children older than 3 years, the ear should be pulled upward to open the ear canal.