A nurse cares for a client who is prescribed lactulose (Heptalac). The client states, "I do not want to take this medication because it causes diarrhea." How should the nurse respond?
a. "Diarrhea is expected; that's how your body gets rid of ammonia."
b. "You may take Kaopectate liquid daily for loose stools."
c. "Do not take any more of the medication until your stools firm up."
d. "We will need to send a stool specimen to the laboratory."
ANS: A
The purpose of administering lactulose to this client is to help ammonia leave the circulatory system through the colon. Lactulose draws water into the bowel with its high osmotic gradient, thereby producing a laxative effect and subsequently evacuating ammonia from the bowel. The client must understand that this is an expected and therapeutic effect for him or her to remain compliant. The nurse should not suggest administering anything that would decrease the excretion of ammonia or holding the medication. There is no need to send a stool specimen to the laboratory because diarrhea is the therapeutic response to this medication.
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