Bisacodyl (Dulcolax) has been ordered for a patient who is constipated. The nurse realizes the drug:

A. Decreased ascites

Ascites (accumulation of fluid in the abdominal cavity) is more directly related to portal hypertension and liver cirrhosis. While lactulose may contribute to fluid balance, its primary therapeutic effect in hepatic encephalopathy is the reduction of ammonia levels.

B. Decreased ammonia level

Lactulose is a medication commonly used in the treatment of hepatic encephalopathy, a condition associated with liver disease. The therapeutic effect of lactulose in this context is to reduce blood ammonia levels. Lactulose works by promoting the excretion of ammonia in the form of ammonium ions in the colon, thereby lowering ammonia concentrations in the blood.

C. Decreased jaundice

Jaundice is often associated with liver dysfunction, but lactulose is not primarily used to address jaundice. Its primary role in liver disease is in the management of hepatic encephalopathy.

D. Decreased blood pressure

Blood pressure is not a direct therapeutic target of lactulose in the context of liver disease. Lactulose's primary therapeutic effect is related to reducing ammonia levels and managing hepatic encephalopathy.

A. The importance of consuming adequate amounts of water

When instructing a patient who will take psyllium (Metamucil) to treat constipation, it is crucial to emphasize the importance of consuming adequate amounts of water. Psyllium is a bulk-forming laxative that works by absorbing water in the intestines, forming a gel-like mass that helps soften stools and promote bowel movements. Without sufficient water intake, psyllium may cause an obstruction or worsen constipation.

B. The need to monitor for systemic side effects.

Psyllium is generally well-tolerated and is not associated with significant systemic side effects. The primary consideration is ensuring proper hydration.

C. The onset of action of 30-60 minutes after administration.

Psyllium is not a fast-acting laxative. It usually takes a longer time to produce its effects, and patients should not expect an immediate response within 30-60 minutes.

D. The need to use the dry form of psyllium to prevent cramping.

Using the dry form of psyllium is not recommended, as it may increase the risk of choking or swallowing difficulties. It is typically recommended to mix psyllium with a sufficient amount of water or other liquids to prevent cramping and ensure proper absorption.