A nurse is planning care for a client who is receiving enteral feedings through a nasogastric (NG) tube. Which of the following actions should the nurse plan to take first?

Choice A reason:Lactulose is used in hepatic encephalopathy primarily to lower blood ammonia levels. It works by converting ammonia in the intestines into ammonium, which is then excreted³. Therefore, a decrease in ammonia levels would indicate the effectiveness of the medication.

Choice B reason:While lactulose can relieve constipation due to its laxative effect, relief of constipation is not the primary indicator of its effectiveness in treating hepatic encephalopathy³.

Choice C reason:Decreased liver enzymes are not a direct measure of lactulose's effectiveness in hepatic encephalopathy. Liver enzymes are indicators of liver function, not ammonia levels³.

Choice D reason:Relief of abdominal pain is not a specific indicator of lactulose's effectiveness in hepatic encephalopathy. The medication's primary role is to reduce ammonia levels, not to alleviate pain³.

Choice A: Topical ointment Topical ointment forms of nitroglycerin are used for their long-acting effects. The medication is absorbed slowly through the skin, providing a steady level of drug in the bloodstream. This form is not designed for rapid relief of acute angina attacks but rather for prevention.

Choice B: Sustained-release Sustained-release forms of nitroglycerin are designed to release the medication slowly over an extended period. This route is also not suitable for treating acute symptoms because it does not provide immediate relief but is used for long-term management of angina pectoris. Nitroglycerin is a medication used primarily to treat angina pectoris (chest pain) and heart failure. It works by relaxing the smooth muscles and dilating the blood vessels, which increases blood flow to the heart and decreases its workload. The route of administration can significantly affect the onset and duration of the medication’s action.

Choice C: Sublingual The sublingual route, where the medication is placed under the tongue, allows for rapid absorption into the bloodstream through the rich supply of blood vessels found in the area. This form of nitroglycerin acts quickly, usually within 1 to 3 minutes, and is the preferred choice for immediate relief of angina pain. When rapid onset is required for relief from acute angina symptoms, the sublingual route is the most appropriate choice for administering nitroglycerin. It provides quick absorption and fast action, making it an essential treatment option for patients experiencing chest pain due to angina.

Choice D: Transdermal patch Transdermal patches release nitroglycerin slowly through the skin and into the bloodstream. Like topical ointments and sustained-release forms, they are used for long-term prophylaxis of angina and not for rapid relief.