RN Nursing · Liver Disorders · Practice question
Which intervention should a nurse prioritize for a cirrhosis patient exhibiting signs of hepatic encephalopathy?
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Increasing fluid intake to 3L/day.
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Providing a high-protein diet.
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✓
Administering lactulose.
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Initiating aggressive sodium replacement therapy.
Answer & explanation
Correct: Administering lactulose.
Hepatic encephalopathy results from the accumulation of ammonia and other neurotoxins in the bloodstream when the damaged liver can no longer convert these substances to urea for excretion. Lactulose is the priority intervention because it acidifies the colon, trapping ammonia as ammonium ion, and acts as a cathartic to speed expulsion of nitrogenous waste from the gut, thereby reducing serum ammonia levels and improving neurological status. Increasing fluid intake to 3 liters per day is inappropriate because cirrhosis patients are typically managed with fluid restriction to control ascites and hyponatremia. A high-protein diet would worsen encephalopathy by increasing the ammonia substrate available for production; protein intake must be carefully moderated or sourced from branched-chain amino acids. Aggressive sodium replacement is contraindicated because cirrhosis-induced hyponatremia is a dilutional process related to water retention, not sodium depletion; adding sodium would exacerbate fluid overload and ascites. Lactulose is a well-established, evidence-based first-line pharmacological treatment for hepatic encephalopathy and remains the priority nursing action to lower ammonia levels and reverse the altered mental status associated with this complication.
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