Which of the following indicate to the nurse that lactulose is effective for an older adult who has advanced liver cirrhosis?
The client has at least one stool per day.
The client denies nausea and vomiting (N/V).
The client's bilirubin level decreases.
The client is alert and oriented (A&Ox4).
The Correct Answer is D
Choice A reason: While having at least one stool per day is a sign that lactulose is working, it does not directly indicate its effectiveness in reducing ammonia levels and improving mental status.
Choice B reason: Denial of nausea and vomiting is positive but is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice C reason: A decrease in bilirubin levels may be a positive sign, but it is not a direct indicator of lactulose's effectiveness in treating hepatic encephalopathy.
Choice D reason: The client being alert and oriented is a direct indicator that lactulose is effectively reducing ammonia levels and improving mental status, which is a key goal in treating hepatic encephalopathy associated with liver cirrhosis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Inadequate retention of serum sodium is not typically associated with anemia in chronic renal failure.
Choice B reason: Inadequate production of erythropoietin is the correct answer because the kidneys produce erythropoietin, which stimulates the bone marrow to produce red blood cells. In chronic renal failure, the kidneys cannot produce enough erythropoietin, leading to anemia.
Choice C reason: While blood loss in the urine can occur, it is not the primary cause of anemia in chronic renal failure.
Choice D reason: Renal desensitization to Vitamin D affects bone health and calcium levels but is not the primary cause of anemia in chronic renal failure.
Correct Answer is D
Explanation
Choice A reason: Lethargy implies a state of sluggishness, drowsiness, or fatigue, not the inability to respond to stimuli.
Choice B reason: Stupor refers to a state of near-unconsciousness or insensibility, but the patient may respond to vigorous stimulation.
Choice C reason: Obtundation describes a state of consciousness characterized by a reduced alertness and a slow response to stimuli, but not complete unresponsiveness.
Choice D reason: Comatose is the correct term for a state of deep unconsciousness in which a patient cannot be aroused, fitting the description of the patient's condition.
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