What unexpected finding might a nurse observe in a client receiving lactulose for hepatic encephalopathy?

In the context of a client receiving lactulose for hepatic encephalopathy, it is important to recognize the physiological effects of the drug. Lactulose is a non-absorbable synthetic sugar that functions as an osmotic laxative. It decreases the absorption of ammonia in the intestines, which helps to reduce the levels of ammonia in patients with hepatic encephalopathy.

When a client is receiving lactulose, one expected effect is increased bowel movements, which can lead to a number of metabolic changes. A possible and somewhat unexpected finding is the presence of ketones in the urine. The use of lactulose can cause diarrhea, which may lead the body to enter a state of ketosis due to insufficient carbohydrate intake or absorption.

In cases of prolonged diarrhea, the body may start breaking down fat for energy, resulting in the accumulation of ketones. Thus, finding urine positive for ketones is indicative of altered metabolism due to the effects of lactulose therapy and could be construed as an unexpected but plausible outcome in this context.

The other options relate to specific electrolyte imbalances or metabolic conditions not directly associated with the typical administration of lactulose or its side effects, making them less relevant to the scenario presented.