During morning rounds, the nurse notices that a client admitted 3 days ago with hepatic encephalopathy is sleepy and confused. The client is scheduled for discharge later today. Which interventions are appropriate for the nurse to implement? Select all that apply.

Rationale: A. Lactulose is a first-line treatment for hepatic encephalopathy, used to reduce ammonia levels. Holding the medication could worsen the client’s mental status and precipitate further encephalopathy. B. This is an assessment for asterixis (“liver flap”), a classic sign of hepatic encephalopathy. Evaluating neuromuscular function helps determine the severity of encephalopathy and guides clinical decisions regarding treatment and discharge readiness. C. The client is sleepy and confused, indicating impaired cognition and risk for falls. Ambulation is unsafe until mental status improves and the patient is able to follow instructions and maintain balance. D. Monitoring changes in mental status is essential in hepatic encephalopathy because subtle declines can signal worsening disease or precipitating factors such as infection, gastrointestinal bleeding, or electrolyte imbalance. Trend comparison guides timely intervention. E. Although ammonia levels do not always correlate perfectly with severity of encephalopathy, they are commonly used to assess and monitor treatment response and can help identify the need for adjustments in therapy such as lactulose or rifaximin dosing.