ATI Pharmacology 215 | Nurselytic

Correct Answer: A

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Correct Answer: A - No action is required as this is the desired therapeutic effect.


Rationale: Lactulose is a medication commonly used to treat hepatic encephalopathy by reducing ammonia levels through promoting bowel movements. Loose, watery stools indicate that the medication is working as intended by eliminating excess ammonia.
Therefore, the nurse should recognize this as the desired therapeutic effect and continue with the scheduled dose. Withholding the medication or contacting the doctor for daily stool count parameters (Option
B) is unnecessary as the patient is responding appropriately. Administering the medication since diarrhea is a common side effect (Option
C) is incorrect as the loose stools are not due to diarrhea but rather the therapeutic action of the lactulose. Removing fall precautions (Option
D) is inappropriate and unsafe, as the patient still has hepatic encephalopathy and may be at risk for altered mental status.

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