NSG 535 DIAGNOSTICS EXAM 1 | COMPREHENSIVE NURSING
DIAGNOSTICS STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS
2026/2027
detect presence of liver disease
distinguish different types of liver disorders
gauge extent of liver damage
follow Tx response - ANS ✔✔4 purposes of liver testing
aminotransferases (AST, ALT) - ANS ✔✔liver tests that reflect damage to hepatocytes
ALT - ANS ✔✔enzyme primarily present in liver that is a specific indicator of liver cell damage; non-
specific (can be elevated in any type of liver disorder)
AST - ANS ✔✔enzyme present in liver as well as cardiac muscle, skeletal muscle, kidneys, brain,
pancreas, lungs, leukocytes, and RBCs that can mark liver injury
ALT - ANS ✔✔aminotransferase that tends to be higher in acute hepatocellular damage
> 2:1, > 3:1 - ANS ✔✔AST:ALTs suggestive, highly suggestive of alcoholic liver disease
ALP (alkaline phosphatase) - ANS ✔✔marker of liver injury/cholestasis (seen in almost any type of liver
disease)
>4 fold increase - ANS ✔✔ALP levels indicative of cholestatic liver disorder, infiltrative liver disease
bilirubin - ANS ✔✔marker of liver injury and detoxification/excretory function
Van den Bergh assay - ANS ✔✔test that determines total, conjugated (direct) bilirubin and unconjugated
(indirect) bilirubin
<1-1.5 mg/dL - ANS ✔✔normal bilirubin
albumin - ANS ✔✔protein synthesized exclusively by hepatocytes; NOT a good indicator of acute/mild
hepatic dysfunction
coagulation factors - ANS ✔✔exclusively synthesized in the liver; rapid turnover, thus single best acute
measurement of hepatic synthetic function
prothrombin time - ANS ✔✔marker of liver function; collectively measures coagulation factors II/V/VII/X
Vitamin K - ANS ✔✔factor that biosynthesis of many coagulation factors is dependent on
hepatitis
cirrhosis
,vit K deficiency - ANS ✔✔3 liver-related causes of elevated PT
GTT
5'nucleotidase - ANS ✔✔2 other liver tests for injury
viral hepatitis
NAFLD
ALD
autoimmune
genetic or metabolic
drug/supplement induced - ANS ✔✔common causes of AST/ALT elevation
NAFLD - ANS ✔✔disorder that should be strongly considered in pts w/ mild AST/ALT elevations
GTT - ANS ✔✔elevated lab to support Dx of alcoholism in addition to AST/ALT
hemochromatosis - ANS ✔✔genetic multi-organ disorder d/t autosomal recessive defect of HFE gene,
causes excess deposition of iron --> elevated AST/ALT
Wilson's disease - ANS ✔✔genetic disorder of biliary copper excretion
statins
antiepileptic meds
NSAIDs
herbal remedies
cocaine - ANS ✔✔drug classes that cause elevated AST/ALT
ALP - ANS ✔✔lab elevated more than AST/ALT in cholestatic disease (biliary defect)
2x ULN - ANS ✔✔mild elevation of AST/ALT
up to 15x ULN - ANS ✔✔moderate elevation of AST/ALT
>15x ULN - ANS ✔✔severe elevation of AST/ALT
amylase - ANS ✔✔pancreatic enzyme that aids in hydrolysis of starch into sugar
lipase - ANS ✔✔pancreatic enzyme that hydrolyzes triglycerides into glycerol and FFAs
pancreatitis - ANS ✔✔diagnosed by acute 2x elevation of amylase and/or lipase
6-12 hrs - ANS ✔✔serum amylase elevation duration in pancreatitis
3-5 days - ANS ✔✔duration for amylase to return to normal w/ pancreatitis
amylase - ANS ✔✔pancreatic enzyme more specific for acute pancreatitis
4-8 hrs - ANS ✔✔serum lipase elevation duration in pancreatitis
, 8-14 days - ANS ✔✔serum lipase elevation duration in pancreatitis
lipase - ANS ✔✔pancreatic enzyme more sensitive for acute pancreatitis
salivary disease
GI
gyn - ANS ✔✔3 potential extrapancreatic causes of elevated amylase
HIV
HCV
inflammatory bowel disease
T2DM - ANS ✔✔4 potential extrapancreatic causes of elevated lipase
hypocalcemia, hypophosphatemia - ANS ✔✔2 electrolyte abnormalities Vit D deficiency can lead to
>20 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D sufficiency
12-20 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D insufficiency
<12 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D deficiency
meds that accelerate metabolism of Vit D
increased skin pigmentation
obesity
limited sun exposure
osteoporosis
chronic illness w/ malabsorption - ANS ✔✔6 high risk populations vit D screening is recommended for
600-800 IU daily - ANS ✔✔Vit D replenishment recommended for 25(OH)D 20-30 ng/mL
800-1000 IU daily - ANS ✔✔Vit D replenishment recommended for 25(OH)D 12-20 ng/mL
50,000 IU D2 or D3 orally once/week x6-8 wks followed by 800 IU D3 daily - ANS ✔✔Vit D replenishment
recommended for 25(OH)D <12 ng/mL
>126 - ANS ✔✔fasting plasma glucose level for DM screening
>6.5% - ANS ✔✔HbA1c level for DM screening
>200 - ANS ✔✔2 hr plasma glucose for DM screening
overweight or obese adults w/ 1+ risk factors
(first degree relative, high risk race, Hx CVD, HTN, HDL <35/triglycerides >250, PCOS, physical inactivity,
other conditions associated w/ insulin resistance) - ANS ✔✔populations DM screening is recommended
for
>5.7% - ANS ✔✔HbA1c for pre-DM
DIAGNOSTICS STUDY GUIDE, PRACTICE QUESTIONS & ANSWERS
2026/2027
detect presence of liver disease
distinguish different types of liver disorders
gauge extent of liver damage
follow Tx response - ANS ✔✔4 purposes of liver testing
aminotransferases (AST, ALT) - ANS ✔✔liver tests that reflect damage to hepatocytes
ALT - ANS ✔✔enzyme primarily present in liver that is a specific indicator of liver cell damage; non-
specific (can be elevated in any type of liver disorder)
AST - ANS ✔✔enzyme present in liver as well as cardiac muscle, skeletal muscle, kidneys, brain,
pancreas, lungs, leukocytes, and RBCs that can mark liver injury
ALT - ANS ✔✔aminotransferase that tends to be higher in acute hepatocellular damage
> 2:1, > 3:1 - ANS ✔✔AST:ALTs suggestive, highly suggestive of alcoholic liver disease
ALP (alkaline phosphatase) - ANS ✔✔marker of liver injury/cholestasis (seen in almost any type of liver
disease)
>4 fold increase - ANS ✔✔ALP levels indicative of cholestatic liver disorder, infiltrative liver disease
bilirubin - ANS ✔✔marker of liver injury and detoxification/excretory function
Van den Bergh assay - ANS ✔✔test that determines total, conjugated (direct) bilirubin and unconjugated
(indirect) bilirubin
<1-1.5 mg/dL - ANS ✔✔normal bilirubin
albumin - ANS ✔✔protein synthesized exclusively by hepatocytes; NOT a good indicator of acute/mild
hepatic dysfunction
coagulation factors - ANS ✔✔exclusively synthesized in the liver; rapid turnover, thus single best acute
measurement of hepatic synthetic function
prothrombin time - ANS ✔✔marker of liver function; collectively measures coagulation factors II/V/VII/X
Vitamin K - ANS ✔✔factor that biosynthesis of many coagulation factors is dependent on
hepatitis
cirrhosis
,vit K deficiency - ANS ✔✔3 liver-related causes of elevated PT
GTT
5'nucleotidase - ANS ✔✔2 other liver tests for injury
viral hepatitis
NAFLD
ALD
autoimmune
genetic or metabolic
drug/supplement induced - ANS ✔✔common causes of AST/ALT elevation
NAFLD - ANS ✔✔disorder that should be strongly considered in pts w/ mild AST/ALT elevations
GTT - ANS ✔✔elevated lab to support Dx of alcoholism in addition to AST/ALT
hemochromatosis - ANS ✔✔genetic multi-organ disorder d/t autosomal recessive defect of HFE gene,
causes excess deposition of iron --> elevated AST/ALT
Wilson's disease - ANS ✔✔genetic disorder of biliary copper excretion
statins
antiepileptic meds
NSAIDs
herbal remedies
cocaine - ANS ✔✔drug classes that cause elevated AST/ALT
ALP - ANS ✔✔lab elevated more than AST/ALT in cholestatic disease (biliary defect)
2x ULN - ANS ✔✔mild elevation of AST/ALT
up to 15x ULN - ANS ✔✔moderate elevation of AST/ALT
>15x ULN - ANS ✔✔severe elevation of AST/ALT
amylase - ANS ✔✔pancreatic enzyme that aids in hydrolysis of starch into sugar
lipase - ANS ✔✔pancreatic enzyme that hydrolyzes triglycerides into glycerol and FFAs
pancreatitis - ANS ✔✔diagnosed by acute 2x elevation of amylase and/or lipase
6-12 hrs - ANS ✔✔serum amylase elevation duration in pancreatitis
3-5 days - ANS ✔✔duration for amylase to return to normal w/ pancreatitis
amylase - ANS ✔✔pancreatic enzyme more specific for acute pancreatitis
4-8 hrs - ANS ✔✔serum lipase elevation duration in pancreatitis
, 8-14 days - ANS ✔✔serum lipase elevation duration in pancreatitis
lipase - ANS ✔✔pancreatic enzyme more sensitive for acute pancreatitis
salivary disease
GI
gyn - ANS ✔✔3 potential extrapancreatic causes of elevated amylase
HIV
HCV
inflammatory bowel disease
T2DM - ANS ✔✔4 potential extrapancreatic causes of elevated lipase
hypocalcemia, hypophosphatemia - ANS ✔✔2 electrolyte abnormalities Vit D deficiency can lead to
>20 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D sufficiency
12-20 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D insufficiency
<12 ng/mL - ANS ✔✔serum 25-hydroxyvitamin D deficiency
meds that accelerate metabolism of Vit D
increased skin pigmentation
obesity
limited sun exposure
osteoporosis
chronic illness w/ malabsorption - ANS ✔✔6 high risk populations vit D screening is recommended for
600-800 IU daily - ANS ✔✔Vit D replenishment recommended for 25(OH)D 20-30 ng/mL
800-1000 IU daily - ANS ✔✔Vit D replenishment recommended for 25(OH)D 12-20 ng/mL
50,000 IU D2 or D3 orally once/week x6-8 wks followed by 800 IU D3 daily - ANS ✔✔Vit D replenishment
recommended for 25(OH)D <12 ng/mL
>126 - ANS ✔✔fasting plasma glucose level for DM screening
>6.5% - ANS ✔✔HbA1c level for DM screening
>200 - ANS ✔✔2 hr plasma glucose for DM screening
overweight or obese adults w/ 1+ risk factors
(first degree relative, high risk race, Hx CVD, HTN, HDL <35/triglycerides >250, PCOS, physical inactivity,
other conditions associated w/ insulin resistance) - ANS ✔✔populations DM screening is recommended
for
>5.7% - ANS ✔✔HbA1c for pre-DM
