Which of the following indicate to the nurse that lactulose is effective for an older adult who has advanced liver cirrhosis?

Choice A reason: Genetics play a significant role in the development of multiple sclerosis (MS). While MS is not directly inherited, certain genetic markers can increase susceptibility. Studies have shown that individuals with a first-degree relative with MS have a higher risk compared to the general population.

Choice B reason: Environmental factors, such as low vitamin D levels, smoking, and possibly viral infections, are believed to contribute to the risk of developing MS. Geographic location, particularly living further from the equator, has also been associated with a higher incidence of MS, which may be related to sun exposure and vitamin D synthesis.

Choice C reason: While upper respiratory infections can trigger exacerbations in individuals with existing MS, they are not identified as a direct contributing factor to the development of the disease itself.

Choice D reason: MS is considered an autoimmune disorder where the immune system mistakenly attacks the central nervous system. This immune-mediated process targets the myelin sheath, leading to inflammation and characteristic lesions.

Choice E reason: Urinary tract infections are a common complication in individuals with MS due to bladder dysfunction, but they are not a contributing factor to the development of MS.

Choice A reason : A renal biopsy is an invasive procedure that can directly assess the extent of glomerular damage and is considered the gold standard for diagnosing the cause of abnormal GFR.

Choice B reason : Routine urinalysis can detect abnormalities in the urine but cannot quantify GFR or directly assess glomerular damage.

Choice C reason : A renal scan can evaluate renal perfusion and function but is less specific for glomerular damage compared to a biopsy.

Choice D reason : Creatinine clearance can estimate GFR but does not provide information on the specific cause of glomerular damage.