A client has been administered lactulose for several days.
Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?

Improved mental status.

Increase in urine output.

Reduction in number of liquid stools.

Ability to ambulate independently.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Lactulose directly addresses the primary cause of hepatic encephalopathy, which is the accumulation of ammonia in the blood. Ammonia is a neurotoxin that can impair brain function, leading to confusion, lethargy, and even coma. Lactulose works by trapping ammonia in the colon, where it can be safely excreted in the stool. This decrease in ammonia levels in the blood allows for the improvement of mental status.

Studies have consistently shown that lactulose therapy can significantly improve mental function in patients with hepatic encephalopathy. This improvement is often seen within a few days of starting treatment.

The nurse should assess the client's mental status regularly to monitor for improvement. This assessment should include evaluating the client's level of consciousness, orientation, attention, memory, and speech.

Improved mental status is a critical therapeutic goal in the treatment of hepatic encephalopathy. It allows patients to regain their independence and participate more fully in their care.

Choice B rationale:

While lactulose can cause diarrhea, which may lead to a slight increase in urine output, this is not the primary therapeutic response that the nurse should expect.

The increase in urine output is typically secondary to the diarrhea and does not directly reflect a reduction in ammonia levels or improvement in mental status.

Choice C rationale:

Lactulose does cause diarrhea, which is a common side effect of the medication.

However, the goal of lactulose therapy is not to reduce the number of liquid stools but rather to trap ammonia in the colon and promote its excretion.

The nurse should monitor the client's stool frequency and consistency to ensure that they are not experiencing excessive diarrhea, which could lead to dehydration and electrolyte imbalances.

Choice D rationale:

While improved mental status may eventually lead to improved mobility, it is not the most immediate or direct therapeutic response that the nurse should expect from lactulose therapy.

The ability to ambulate independently is more likely to be a long-term goal of treatment, rather than an immediate response to lactulose.

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Correct Answer is D

Explanation

Choice A rationale:

Incorrect. Open-angle glaucoma is not characterized by an abnormally small angle.

The angle in open-angle glaucoma is open, but the drainage system is not working properly. Therefore, restoring a smaller angle would not be an effective treatment goal.

Choice B rationale:

Incorrect. Eye drops used to treat open-angle glaucoma are not typically used for pain control.

While some individuals may experience mild discomfort associated with elevated eye pressure, pain is not a common symptom of open-angle glaucoma.

Additionally, eye drops used to treat glaucoma do not have anti-inflammatory properties to address swelling.

Choice C rationale:

Incorrect. While reducing excess eye pressure is an important initial goal of treatment, long-term management of open-angle glaucoma requires ongoing maintenance of normal eye pressure.

Simply reducing pressure temporarily is not sufficient to prevent vision loss.

Choice D rationale:

Correct. The primary goal of treatment for open-angle glaucoma is to maintain normal eye pressure over the long term. This is because elevated eye pressure can damage the optic nerve, leading to vision loss.

Eye drops are often used to lower eye pressure, and they typically need to be used for life to prevent vision loss.

A. Provide suctioning so the patient does not have to cough. B. Position the patient with the head of the bed elevated. C. Encourage the patient to take breaks from the oxygen mask every few hours. D. Ask the patient to do quick, shallow breaths. E. Teach the patient to cough at least once an hour. F. Avoid treating fever with antipyretics. G. Assist the patient in ambulating safely.

Correct Answer is ["B","E","G"]

Explanation

B. Position the patient with the head of the bed elevated. Rationale:

Promotes lung expansion: Elevating the head of the bed by at least 30 degrees utilizes gravity to assist in diaphragmatic descent and lung expansion. This allows for greater intake of air, optimizing oxygen intake and facilitating better gas exchange.

Reduces work of breathing: When upright, the abdominal muscles can more effectively aid in breathing, reducing the workload on the diaphragm and accessory muscles. This conserves energy and decreases the patient's respiratory effort.

Enhances secretion drainage: Gravity also aids in the movement of secretions from the lower lobes of the lungs towards the upper airways, where they can be more easily coughed up or suctioned. This helps to clear the airways and improve ventilation.

E. Teach the patient to cough at least once an hour. Rationale:

Clears secretions: Coughing is a natural mechanism to clear secretions from the lungs and airways. It helps to prevent mucus buildup and potential obstruction, which can lead to atelectasis (collapse of lung tissue) and further compromise ventilation.

Improves gas exchange: By removing secretions, coughing allows for better airflow and gas exchange within the lungs. This enhances oxygenation and helps to prevent respiratory complications.

G. Assist the patient in ambulating safely. Rationale:

Mobilizes secretions: Ambulation encourages movement of secretions from the lower lobes of the lungs, promoting their clearance and preventing mucus buildup.

Prevents atelectasis: Walking and movement help to expand the lungs, reducing the risk of atelectasis and improving overall ventilation.

Enhances circulation: Ambulation also improves circulation, which can help to deliver oxygen to the tissues more effectively and aid in healing.

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A client has been administered lactulose for several days.Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?

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A client has been administered lactulose for several days.Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?

A client has been administered lactulose for several days.
Which therapeutic response should the nurse expect for a client with hepatic encephalopathy?