Medical Surgical Labs Liver Labs #2

Question

The nurse is caring for a client who is prescribed lactulose for hepatic encephalopathy. Which assessment finding by the nurse will indicate the effectiveness of this drug?

Answers

  1. Loose stools daily.
    • Rationale:

      This answer is not correct because this is to be expected with the use of lactulose. Lactulose is a laxative that draws ammonia from the blood into the colon and excretes it.

  2. Improved abdominal distention.
    • Rationale:

      This answer is not correct because abdominal distention will not improve with the use of lactulose. Abdominal distension is increased in liver failure due to ascites, which is fluid build up into the abdominal cavity from fluid leaking from the damaged liver.

  3. Decrease in portal hypertension.
    • Rationale:

      This answer is not correct because portal hypertension is caused by liver disease or hepatic resistance. Lactulose’s function is to remove ammonia from the body through the bowels.

  4. Improved mental status.
    • Rationale:

      This answer is correct because this is the function of lactulose. It removes ammonia, which is toxic to the brain, from the body through the bowels. Once ammonia levels are decreased, the nurse will notice improved cognition from the client. Lactulose effectiveness is measured by the mental status of the client.

Overview

Lactulose is a drug used to facilitate the removal of ammonia from the body through the bowels. Ammonia is toxic to the brain and the best way to measure its effectiveness is by improved cognition.

Explanation

Learning Outcomes

Lactulose is a drug used to facilitate the removal of ammonia from the body through the bowels. The best way to monitor effectiveness is to watch for improved mental status. The nurse should expect 2-3 soft stools per day and a decrease in ammonia levels. Diarrhea and loose stools are not indicators that ammonia levels are decreasing. The best indicator is improved cognition. Abdominal distention will not improve with lactulose, nor will portal hypertension. There is no renal excretion of ammonia from lactulose. It only removes ammonia through the bowels.

Test Taking Tip

Think of lactulose as “lacta-lose” as in it “loses” ammonia, which high levels of ammonia cause mental status changes.

Video Rationale