The nurse is caring for a client diagnosed with chronic hepatitis who is receiving the medication lactulose. Which of these laboratory results would indicate the medication is achieving the desired therapeutic effect?
Increased serum albumin
Decreased serum bilirubin
Decreased serum ammonia
Decreased serum alanine aminotransferase (ALT)
The Correct Answer is C
Choice A Reason: Increased Serum Albumin
Increased serum albumin is not a direct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Albumin is a protein made by the liver, and its levels can be affected by liver function. However, lactulose primarily works by reducing ammonia levels in the blood, not by increasing albumin levels. Normal serum albumin levels range from 3.5 to 5.5 grams per deciliter (g/dL). While improved liver function might eventually lead to increased albumin levels, this is not the primary therapeutic effect of lactulose.
Choice B Reason: Decreased Serum Bilirubin
Decreased serum bilirubin is also not a direct indicator of lactulose’s therapeutic effect. Bilirubin is a byproduct of the normal breakdown of red blood cells and is processed by the liver. Elevated bilirubin levels can indicate liver dysfunction, but lactulose’s main role is to reduce ammonia levels, not bilirubin. Normal serum bilirubin levels are typically between 0.1 to 1.2 milligrams per deciliter (mg/dL). While improved liver function might reduce bilirubin levels, this is not the primary goal of lactulose therapy.
Choice C Reason: Decreased Serum Ammonia
Decreased serum ammonia is the correct indicator of the therapeutic effect of lactulose in patients with chronic hepatitis. Lactulose is used to treat hepatic encephalopathy, a condition caused by high levels of ammonia in the blood due to liver dysfunction. Lactulose works by converting ammonia into ammonium, which is then excreted from the body. Normal serum ammonia levels are less than 50 micromoles per liter (µmol/L) in adults56. A decrease in serum ammonia levels indicates that lactulose is effectively reducing the toxic levels of ammonia in the blood, thereby achieving its desired therapeutic effect.
Choice D Reason: Decreased Serum Alanine Aminotransferase (ALT)
Decreased serum alanine aminotransferase (ALT) is not a direct indicator of lactulose’s therapeutic effect. ALT is an enzyme found in the liver that helps convert proteins into energy for liver cells. Elevated ALT levels can indicate liver damage. Normal ALT levels range from 7 to 56 units per liter (U/L). While improved liver function might reduce ALT levels, lactulose’s primary role is to reduce ammonia levels, not directly affect ALT.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Place the client on aspiration precautions: Myxedema coma is a severe form of hypothyroidism that can lead to decreased mental function and a reduced level of consciousness. These conditions increase the risk of aspiration, which can lead to pneumonia and other complications. Therefore, placing the client on aspiration precautions is crucial to prevent these risks. Aspiration precautions may include elevating the head of the bed, monitoring swallowing ability, and providing thickened liquids if necessary.
Choice B Reason:
Turn the client every 4 hours: While turning the client regularly is important to prevent pressure ulcers, it is not the primary action needed for a client in a myxedema coma. The focus should be on stabilizing the client’s condition and preventing life-threatening complications such as aspiration, respiratory failure, and cardiovascular collapse.
Choice C Reason:
Check the client’s blood pressure every 2 hours: Monitoring vital signs, including blood pressure, is essential for clients in a myxedema coma. However, it is not the most critical action compared to preventing aspiration. Blood pressure should be monitored regularly, but the frequency can be adjusted based on the client’s condition and stability.
Choice D Reason:
Initiate measures to cool the client: Clients in a myxedema coma typically present with hypothermia (low body temperature), not hyperthermia (high body temperature). Therefore, initiating measures to cool the client would be inappropriate and could worsen their condition. Instead, measures to warm the client, such as using blankets and adjusting room temperature, are more appropriate.
Correct Answer is ["31"]
Explanation
Step 1: Calculate the total infusion time in minutes.
8 hours × 60 minutes/hour = 480 minutes
Result at each step = 480 minutes
Step 2: Calculate the total number of drops to be infused.
1,000 mL × 15 drops/mL = 15,000 drops
Result at each step = 15,000 drops
Step 3: Calculate the infusion rate in drops per minute.
15,000 drops ÷ 480 minutes = 31.25 drops/minute
Result at each step = 31.25 drops/minute
Step 4: Round to the nearest whole number if necessary.
31.25 drops/minute rounds to 31 drops/minute
Result at each step = 31 drops/minute
Therefore, the nurse should run the IV infusion at a rate of 31 drops per minute.
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