Lactulose was prescribed two days ago for a client who was recently diagnosed with hepatic encephalopathy. The client is confused and experiencing frequent loose stools. Laboratory findings show an elevated serum ammonia (NH) level of 220 μg/dL (157.1 μmol/dL). Which action should the nurse take?

Reference Range:

Ammonia [10 to 80 μg/dL (6 to 47 μmol/L)]

Hold the next dose of lactulose.

Continue the prescribed dose of lactulose.

Replace total volume voided with oral or IV fluids.

Report the number of diarrhea stools to the healthcare provider (HCP).

Answer and Explanation

The Correct Answer is B

B. Lactulose works by acidifying the colonic contents, which promotes the conversion of ammonia (NH3) to ammonium (NH4+). Ammonium is less readily absorbed from the colon into the bloodstream, reducing systemic ammonia levels. This action helps alleviate the neurotoxic effects of ammonia on the brain, thereby improving neurological symptoms associated with hepatic encephalopathy.
A. Lactulose is required in clients with hepatic encephalopathy to excrete ammonia lowering its levels in blood. Holding the lactulose dose is inappropriate as the client’s ammonia levels are still high
C. Rehydrating the clients to replace lost fluids in the loose stools is important but does not address
the client’s elevated ammonia levels which may be exacerbating the client’s encephalopathy.
D. Reporting the number of diarrhea stools to the healthcare provider is important for ongoing assessment and management of the client's condition. However, it does not address the clients high ammonia levels.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

A. Rheumatoid factor (RF) is an autoantibody directed against the Fc portion of immunoglobulin G (IgG). In RA, it is an indication of the autoimmune nature of the disease, where the immune system mistakenly attacks the body's own tissues, particularly the synovial membranes in the joints, leading to inflammation, pain, and joint damage.
B. While the presence of an elevated serum rheumatoid factor is associated with the autoimmune process underlying RA, it does not necessarily correlate with disease severity or progression.
C. Rheumatoid factor has no correlation with renal involvement of RA
D. RA is an indicator of autoimmunity in the joint but not necessarily the onset of joint degeneration.

A. Teach the client about phantom pain symptoms. B. Perform a complete mental status exam. C. Determine if the client has had a shingles vaccination. D. Complete an assessment of the client's pain.

Correct Answer is D

Explanation

D. Persistent pain following the resolution of herpes zoster, known as postherpetic neuralgia (PHN), is a common complication, especially in older adults. PHN can cause significant discomfort and affect the client's quality of life. Therefore, it is essential for the nurse to conduct a comprehensive assessment of the client's pain to better understand its characteristics, severity, duration, aggravating or alleviating factors, and impact on daily activities.
A. Patient education should follow a complete assessment of the pain to ascertain the diagnosis.
B. Performing a complete mental status exam is not indicated solely based on the client's report of persistent pain from herpes zoster.
C. Determining if the client has had a shingles vaccination is important for preventive healthcare, but it is not the priority action in addressing the client's current pain concern related to PHN. The focus should be on assessing and managing the client's pain to improve their comfort and well-being.

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Naxlex Comprehensive Predictor Exams

A client with rheumatoid arthritis has an elevated serum rheumatoid factor. Which interpretation of this finding should the nurse make?

Correct Answer is A

Explanation

Five months following treatment for herpes zoster, an older adult client tells the home health nurse of continuing to experience pain where the rash occurred. Which action should the nurse implement?

Correct Answer is D

Explanation

While caring for a client with full thickness burns covering 40% of the body, the nurse observes purulent drainage from the wounds. Before reporting this finding to the healthcare provider, the nurse should evaluate which laboratory value?

After initiating a steroid nebulizer treatment for a client with asthma in respiratory distress, which intervention is most important for the nurse to implement?

A client presents with the onset of a severe headache, fever, nuchal rigidity, and a petechial rash on arms and legs. The nurse recognizes the client is exhibiting symptoms of which condition?

While completing a health assessment for a young adult female with acute appendicitis, the client informs the nurse that there is a chance that she may be pregnant. The operating team is preparing to take the client to surgery. Which intervention should the nurse implement immediately?

While assisting a client to the toilet, the client begins to have a seizure and the nurse eases the client to the floor. The nurse calls for help and monitors the client until the seizing stops. Which intervention should the nurse implement first?