A client with end-stage cirrhosis and hepatic encephalopathy becomes increasingly confused and drowsy.
Which intervention should the nurse implement to reduce ammonia levels?

Administer loop diuretics.

Administer lactulose as prescribed.

Restrict fluid intake.

Increase the client's intake of protein.

Answer and Explanation

The Correct Answer is B

Managing hepatic encephalopathy requires understanding the biochemical role of ammonia in brain toxicity. Knowledge of the enterohepatic circulation and the pharmacological action of osmotic laxatives is necessary to facilitate the excretion of nitrogenous wastes and improve neurological status.

Choice A rationale

Loop diuretics are used to treat ascites or edema but do not directly lower serum ammonia. Excessive diuresis can actually trigger hepatic encephalopathy by causing dehydration and electrolyte imbalances, such as hypokalemia, which increases renal ammonia production and toxicity.

Choice B rationale

Lactulose is a disaccharide that acidifies the colon, converting ammonia into non-absorbable ammonium ions. This osmotic effect also promotes bowel movements, facilitating the rapid excretion of these toxins from the gut, thereby reducing blood ammonia levels and confusion.

Choice C rationale

Restricting fluids does not lower ammonia and can worsen hepatic encephalopathy by causing dehydration and constipation. Adequate hydration and bowel motility are necessary to ensure that nitrogenous wastes are flushed from the gastrointestinal tract effectively to prevent systemic accumulation.

Choice D rationale

Protein breakdown in the gut by bacteria produces ammonia. Increasing protein intake in a client with end stage cirrhosis would likely worsen encephalopathy by providing more nitrogenous substrate for ammonia synthesis, further elevating toxic levels in the blood.

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Correct Answer is B

Explanation

Assessment of respiratory patterns in terminal patients involves identifying neurological and metabolic shifts. This scenario requires knowledge of breathing cycles, specifically the crescendo-decrescendo pattern and apnea associated with brainstem dysfunction or advanced heart failure during end-of-life care.

Choice A rationale

Kussmaul respirations involve deep, rapid breathing typically seen in metabolic acidosis. This pattern is a compensatory mechanism to expel excess carbon dioxide, lowering arterial acidity, and is distinct from the cyclic apnea seen in terminal brain injury.

Choice B rationale

Cheyne-Stokes is characterized by rhythmic waxing and waning of breathing depth followed by apnea. It occurs due to delayed feedback in the respiratory center, often seen in stroke, traumatic brain injury, or profound heart failure.

Choice C rationale

Biot respirations involve clusters of shallow breaths followed by irregular periods of apnea. This occurs with damage to the medulla oblongata and lacks the rhythmic, gradual increase and decrease in depth seen in the Cheyne-Stokes pattern.

Choice D rationale

Orthopnea is the physical inability to breathe comfortably while lying flat. It is common in congestive heart failure and pulmonary edema, requiring the patient to sit upright to decrease venous return and improve diaphragmatic excursion.

A. The client no longer remembers their name. B. The client has gained weight. C. The client complains of insomnia. D. Blood glucose level of 350 mg/dL...

Correct Answer is A

Explanation

Dexamethasone is a potent corticosteroid used to reduce cerebral edema in brain tumor patients. Prioritizing care requires identifying life-threatening neurological changes or severe medication side effects, applying knowledge of intracranial pressure, glucose metabolism, and the hierarchy of clinical needs.

Choice A rationale

Acute loss of orientation to self indicates a significant decline in neurological status or increased intracranial pressure. This is a medical emergency requiring immediate intervention to prevent brain herniation, outweighing stable physical side effects of steroid therapy.

Choice B rationale

Weight gain is a common side effect of long-term dexamethasone use due to fluid retention and increased appetite. While it requires monitoring, it is an expected systemic effect and does not represent an immediate life-threatening crisis.

Choice C rationale

Insomnia is a known side effect of corticosteroids because they can interfere with the circadian rhythm and stimulate the central nervous system. It affects the client's comfort but does not indicate immediate physiological or neurological compromise.

Choice D rationale

Glucocorticoids cause hyperglycemia; 350 mg/dL is high compared to the normal fasting range of 70 to 100 mg/dL. While it requires insulin or dosage adjustment, it is less urgent than an acute neurological deficit..

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A client with end-stage cirrhosis and hepatic encephalopathy becomes increasingly confused and drowsy. Which intervention should the nurse implement to reduce ammonia levels?

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A client with end-stage cirrhosis and hepatic encephalopathy becomes increasingly confused and drowsy.
Which intervention should the nurse implement to reduce ammonia levels?