The nurse is teaching a newly diagnosed client with celiac disease. Which of the following statements made by the client indicate understanding on the teaching?

A. Ask a peer to validate the results: While confirming findings with a colleague can sometimes be helpful, it is not necessary in this case. Postoperative ileus is common, and the priority is monitoring and documentation.

B. Reassess in hours: The nurse should reassess bowel sounds periodically, but the specific timeframe should be based on hospital policy and clinical judgment. Bowel sounds may be absent for hours to days postoperatively.

C. Document the findings: Documentation is critical as absent bowel sounds are expected after abdominal surgery. However, it should be accompanied by continued monitoring.

D. Notify the healthcare provider: Absence of bowel sounds immediately post-op is not necessarily an emergency. However, if accompanied by other signs (e.g., distention, vomiting, severe pain), notifying the provider would be warranted.

The client's ammonia level is critically elevated (250 mcg/dL), which can lead to altered mental status, confusion, and lethargy, consistent with hepatic encephalopathy. In cirrhosis, the liver loses its ability to detoxify ammonia, leading to its accumulation in the bloodstream. This excess ammonia crosses the blood-brain barrier, impairing neuronal function and causing hepatic encephalopathy.

Incorrect answers:

DKA is characterized by high blood glucose (>250 mg/dL), metabolic acidosis, and ketonemia. This client has a moderate glucose elevation (148 mg/dL) but no signs of acidosis, Kussmaul respirations, or ketonuria.

Dehydration: While dehydration can contribute to mental status changes, severe hyperammonemia is a direct cause of hepatic encephalopathy. The client's crackles in the lungs and peripheral edema suggest fluid retention, not dehydration.

Acute kidney disease presents with rising creatinine levels, oliguria, and electrolyte imbalances. This client’s creatinine level is normal, ruling out acute kidney disease.

Malnutrition is characterized by low albumin, muscle wasting, and weight loss, but this client's elevated glucose is more likely due to diabetes mellitus rather than malnutrition.