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.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is A

Explanation

A. Meningococcal meningitis is a bacterial infection of the meninges (the protective membranes covering the brain and spinal cord) caused by the bacterium Neisseria meningitidis. It is characterized by symptoms such as severe headache, fever, nuchal rigidity (stiff neck), and a petechial rash on the skin. The petechial rash is a distinguishing feature of meningococcal meningitis and is caused by bleeding into the skin due to disseminated intravascular coagulation (DIC) associated with the infection.
B. A cerebrovascular accident, commonly known as a stroke, occurs when blood flow to a part of the brain is interrupted, leading to tissue damage and neurological deficits. While a stroke can cause symptoms such as headache and neurological deficits, it typically does not present with fever, nuchal rigidity, or a petechial rash.

C. Intracerebral hemorrhage is bleeding within the brain tissue, often due to the rupture of a blood vessel. It can cause symptoms such as headache, neurological deficits, and alterations in consciousness, but it typically does not present with fever, nuchal rigidity, or a petechial rash.
D. Rocky mountain spotted fever (RMSF) is a bacterial infection caused by the bacterium. While RMSF can present with fever and rash, it typically does not present with nuchal rigidity, and the petechial rash associated with RMSF tends to start on the extremities rather than the arms and legs.

A. Notify the healthcare provider of any change in sputum color. B. Stay in the house if the outdoor temperature is hot and humid. C. Avoid going outdoors whenever the pollen count is high. D. Keep a food diary for one week and bring to next appointment.

Correct Answer is A

Explanation

A. Changes in sputum color can indicate exacerbations of COPD, such as infection or increased inflammation in the airways. Darker or greenish sputum may suggest the presence of infection, while changes in consistency or volume can also indicate worsening respiratory status. Promptly notifying the healthcare provider of any change in sputum color allows for timely assessment and appropriate management.
B. Staying indoors during hot and humid temperature is relevant for minimizing exposure to environmental triggers that can exacerbate COPD symptoms, but it may not be as immediately critical
C. Avoiding allergens is important for clients with asthma who are sensitive to allergens but not COPD
D. Foods taken are more relevant in asthmatic patients as opposed to those with COPD.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

In providing discharge teaching to a client with chronic obstructive pulmonary disease (COPD), which instruction is most important for the nurse to emphasize?

Correct Answer is A

Explanation

Patient Data Exhibits Based on the laboratory data, the client has dropdown related to dropdown

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

The nurse is caring for a client with chemotherapy induced mucositis who is describing soreness of the tongue and oral tissues. Which is the best initial nursing action?

A postoperative client reports incisional pain. The client has two prescriptions for PRN analgesia that accompanied the client from the postanesthesia unit. Before selecting which medication to administer, which action should the nurse implement?

A client with type 2 diabetes mellitus arrives to the clinic reporting episodes of weakness and palpitations. Which finding is most important for the nurse to monitor?

Patient Data Exhibits What finding(s) are cues for a respiratory problem? Select all that apply.

The nurse is evaluating a client's understanding of diet teaching about the DASH (Dietary Approaches to Stop Hypertension) eating plan. Which behavior indicates that the dient is adhering to the eating plan?