# A client with cirrhosis and hepatic encephalopathy is receiving lactulose 30 mL PO TID. Which outcome best indicates effective therapy?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391814&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## Question

A client with cirrhosis and hepatic encephalopathy is receiving lactulose 30 mL PO TID. Which outcome best indicates effective therapy?

## Option

1. Watery diarrhea 10 times per day
2. 2-3 soft stools per day with improved mental status and decreasing serum ammonia **✔ Correct answer**
3. Constipation with one stool every 2-3 days
4. No bowel movements with stable ammonia

**Correct answer: 2**

## Explanation

Correct (2): Lactulose targets 2-3 soft stools per day — this clears ammonia-producing bacteria and acidifies the colon to trap NH4+. Effective therapy is reflected in improved mental status and decreasing ammonia. (1) Under-treatment. (3) Over-treatment risks dehydration. (4) Not effective.

## In-depth explanation

Memory Tip Lactulose = "2-3 stools/day, alert mind, lower ammonia." Combined with rifaximin for recurrent hepatic encephalopathy.

## Clinical scenario

Scenario 62-year-old male with cirrhosis and hepatic encephalopathy on lactulose 30 mL PO TID. Baseline ammonia 110, confusion grade 2.

## Key concepts

- **Lactulose** — Non-absorbable disaccharide; acidifies colon, traps NH4+, treats hepatic encephalopathy.
- **Hepatic encephalopathy** — Reversible neuropsychiatric syndrome from hyperammonemia in cirrhosis.
- **Rifaximin add-on** — Non-absorbable antibiotic added to lactulose to reduce recurrent encephalopathy.

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