A nurse is caring for a client with cirrhosis who develops confusion and asterixis (flapping tremor). The nurse recognizes these as signs of:

Confusion and ASTERIXIS (a flapping tremor of the hands) in a client with cirrhosis indicate HEPATIC ENCEPHALOPATHY — a complication caused by the failing liver's inability to clear AMMONIA (and other toxins) from the blood; elevated ammonia affects the brain, causing altered mental status, confusion, asterixis, and possibly coma. NCLEX physiological/GI. TREATMENT: LACTULOSE (reduces ammonia by promoting its excretion in stool — expect increased bowel movements); sometimes rifaximin (antibiotic); reduce protein intake (protein metabolism produces ammonia) per provider; monitor ammonia levels and mental status. Recognizing hepatic encephalopathy (confusion + asterixis from elevated ammonia) and its treatment (lactulose) is a commonly tested NCLEX concept.