A patient with liver failure is taking lactulose (Chronulac). ...

[clippers!]

A patient with liver failure is taking lactulose (Chronulac). Which laboratory data indicates that the medication is having the desired effect?
 
  1. increased serum ammonia level
  2. decreased serum ammonia level
  3. increased serum ALT level
  4. decreased serum ALT level

Question 2

A patient with an acutely inflamed gallbladder states that the pain has suddenly stopped. The patient wants to go home. What is the nurse's best response?
 
  1. It is your choice. You are feeling better and not required to stay.
  2. Please stay until your healthcare provider sees you tomorrow.
  3. I will inform your healthcare provider of the change in your symptoms.
  4. Yes, as soon as we perform the prescribed ultrasound of the gallbladder.

[Christopher]

Answer to Question 1

Correct Answer: 2
Ammonia, a toxic by-product of protein metabolism, is converted to urea in the liver for elimination by the kidneys. Lactulose works by acidifying the contents of the bowel, which has the effect of keeping ammonia in the bowel, where it is excreted from the body in the stools, rather than being reabsorbed into the circulation. This medication should lower the serum ammonia level. It has no effect on the ALT level.

Answer to Question 2

Correct Answer: 3
Rupture of an acutely inflamed gallbladder may be heralded by abrupt but transient pain relief as contents are released from the distended gallbladder into the abdomen. This change should be promptly reported to the healthcare provider. The patient should not go home, wait a day to be seen, or have an ultrasound before being seen by the healthcare provider.