The nurse evaluates a client's response to lactulose treatment. Which finding indicates an expected outcome?

Rationale: A. Lactulose can cause loose stools, but diarrhea is not the desired therapeutic outcome. Excessive diarrhea can lead to dehydration, electrolyte imbalances, and worsening confusion, which are adverse effects rather than expected responses. B. Lactulose is used to reduce serum ammonia levels in clients with hepatic encephalopathy by promoting excretion of ammonia through the stool. The expected therapeutic outcome is regular, soft bowel movements, typically two to five per day, without causing excessive diarrhea. This indicates that ammonia is being cleared effectively, reducing neurotoxic effects. C. Improvement in mental status is the ultimate goal of lactulose therapy, but it may take several doses to achieve. Immediate changes in speech are not expected and do not solely indicate treatment effectiveness. D. Fetor hepaticus (a characteristic musty breath odor) and asterixis (flapping tremor of the hands) are signs of worsening hepatic encephalopathy. Their appearance would indicate treatment failure or progression of disease, not a positive response.