A patient with a history of chronic alcohol abuse has been admitted to the unit with cirrhosis. Upon review of the patient's laboratory test results, the nurse notes that the patient's ammonia level is elevated at 218 mcg/dL. What medication should the nurse prepare to administer?

Choice A reason:
Bowel obstruction can cause abdominal pain, but it typically presents with symptoms such as vomiting, absence of bowel movements, and abdominal distention rather than localized right lower quadrant pain and rebound tenderness. Therefore, this choice is less likely.
Choice B reason:
Hepatitis usually presents with symptoms like jaundice, fatigue, and generalized abdominal discomfort rather than localized right lower quadrant pain with rebound tenderness. This makes hepatitis an unlikely diagnosis in this case.
Choice C reason:
Appendicitis is characterized by right lower quadrant pain, rebound tenderness, and low-grade fever, making it the most likely diagnosis for this patient. These symptoms are classic for appendicitis, a common surgical emergency in young adults.
Choice D reason:
Colon cancer can cause abdominal pain, but it is typically associated with older age, changes in bowel habits, and weight loss. The presentation of right lower quadrant pain and rebound tenderness with fever is not typical for colon cancer, making it an unlikely diagnosis in this young patient.

Choice A reason:
Lactulose is the medication of choice for treating elevated ammonia levels, commonly seen in hepatic encephalopathy associated with cirrhosis. It works by reducing the absorption of ammonia from the intestines, converting ammonia to ammonium, which is then excreted. Administering lactulose helps in lowering blood ammonia levels and improving mental status in affected patients.

Choice B reason:
Polyethylene glycol (MiraLax) is a laxative used to treat constipation. It does not have any role in reducing ammonia levels or treating hepatic encephalopathy. Therefore, it is not appropriate for this patient's elevated ammonia condition.

Choice C reason:
0.9% NS (normal saline) is primarily used for fluid resuscitation and electrolyte balance. While essential in managing cirrhotic patients with fluid imbalances, it does not address the elevated ammonia levels directly. Therefore, it is not the treatment of choice for this specific situation.

Choice D reason:
Docusate sodium (Colace) is a stool softener used to treat constipation. It does not have any effect on ammonia levels or the treatment of hepatic encephalopathy. Thus, it is not appropriate for managing elevated ammonia in this patient.