NSG 535 EXAM 1 | COMPREHENSIVE NURSING STUDY GUIDE,
PRACTICE QUESTIONS & ANSWERS 2026/2027
Common Liver Function Tests - correct answer ✔✔-Alanine aminotransferase (ALT)
-Aspartate aminotransferase (AST)
-Alkaline phosphatase (ALP)
-bilirubin
-albumin
-prothrombin time
-gamma-glutamyl transferase (GGT)
-5'nucleotidase
Liver functions - correct answer ✔✔-destruction of RBCs & formation of bile pigments
-protein metabolism
-synthesis of plasma proteins, fibrinogens & prothrombin
-enzyme synthesis
-conversion of ammonia to urea
-carbohydrate & fat metabolism
-excretion of drugs, hormones
-detoxifies
application of liver function tests - correct answer ✔✔-detect presence of liver disease
-distinguish among different types of liver disorders
-gauges the extent of known liver damage
-follow response to txt
LFT categories/what do they indicate? - correct answer ✔✔-tests that measure detoxification &
excretory functions
-tests for enzymes that reflect damage to hepatocytes
-tests for enzymes that reflect cholestasis (flow of bile reduced/blocked)
-tests that measure synthetic function
Tests for enzymes that reflect damage to hepatocytes - correct answer ✔✔-aminotransferases (AST &
ALT)
-AST: enzyme present in liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreases, lungs,
leukocytes, & RBCs
-ALT: primary present in the Liver; enzyme
--more specific indicator of liver cell damage
--non specific/any type of liver disorder
ALT & AST levels - correct answer ✔✔-levels >1000 --> extensive hepatocellular injury (viral hepatitis,
ischemic liver disease, drug or toxin induced)
>ACUTE hepatocellular damage: ALT > AST
>Alcoholic liver disease: AST:ALT >2:1 (suggestive); >3:1 (highly suggestive)
Tests for enzymes that reflect cholestasis - correct answer ✔✔>ALP
,- <3 fold increase: not specific for cholestasis
--seen in almost any type of liver disease
->4 fold increase: cholestatic liver disorder, infiltrative liver disease (cancer), bone conditions w/ rapid
bone turnover (Pagets disease)
-ALP is NOT useful to distinguish b/w intra & extra hepatic obstruction
-reflective of liver damage & cholestasis
Tests that measure detoxification & excretory functions - correct answer ✔✔>Bilirubin
>Van den Bergh assay: determination of total, conjugated (direct) & unconjugated (indirect) bilirubin
-normal value of total <1-1.5
-helps identify if liver is functioning the way it should
Tests that measure synthetic function - correct answer ✔✔>Serum albumin
-synthesized exclusively by hepatocytes
-NOT a good indicator of acute/mild hepatic dysfunction
-minimum change in viral hepatitis/drug induced hepatitis/obs jaundice
-other causes of decrease: protein malnutrition, protein losing enteropathies, nephrotic syndrome,
chronic infection
>Coagulation factors:
-except for factor VIII, blood clotting factors are exclusively synthesized in hepatocytes
-rapid turnover; clotting factors are single best acute measure of hepatic synthetic function**
-PT (collective measures II/V/VII/X
---may be elevated in hepatitis, cirrhosis & disorders that result in Vit K deficiency (obs. jaundice)
Tests for enzymes that reflect cholestasis - correct answer ✔✔>ALP
>5'NT
>GGT
Common reasons for abnormal LFTs - correct answer ✔✔>ALT: hepatocellular damage
>AST: hepatocellular damage
>Bilirubin: cholestasis, impair conjugation or biliary obstruction
>ALP: cholestasis, infiltrative disease, biliary obstruction
>PT: synthetic function
>Albumin: synthetic function
>GGT: cholestasis or biliary obstruction
>5' nucleotidase: cholestasis of biliary obstruction
Amylase - correct answer ✔✔-digestive enzyme
-aids in hydrolysis of starch into sugars
-main sources are the pancreas and salivary glands
Lipase - correct answer ✔✔-digestive enzyme
-main function of pancreatic lipase is to hydrolyze triglycerides into glycerol & free fatty acids
Pancreatitis - correct answer ✔✔-acute 3x elevation of amylase &/or lipase
-typically extrapancreatic cause of amylase/lipase elevations are not associated with a >3fold elevation
-amylase & lipase drawn together
,-often ordered when pt has abdominal pain
Pancreatitis: Amylase - correct answer ✔✔-serum amylase rises within 6-12 hrs
-returns to normal 3-5 days
-3x elevation more specific (85-98%) & sensitive (67-83%) for acute pancreatitis
Pancreatitis: Lipase - correct answer ✔✔-rises within 4-8hrs
-peaks at 24 hr
-returns to normal 8-14 days
-3x elevation sensitive (82-100%) for acute pancreatitis
-lipase elevations occur earlier & last longer compared to amylase
Elevated amylase- extrapancreatic - correct answer ✔✔-salivary disease
-GI: appendicitis, perforated bowel, celiac disease
-GYN: ruptured ectopic pregnancy, PID
Elevated lipase- extrapancreatic - correct answer ✔✔-HIV, HCV
-inflammatory bowel disease
-T2DM
Vitamin D - correct answer ✔✔-metabolic activation of Vit D to calcitriol
-impacts Ca & phosphate homeostasis
-increase in the serum Ca & phos concentrations
Vitamin D deficiency - correct answer ✔✔-hypocalcemia &/or hypophosphatemia --> low 25(OH)D levels
leads to decrease intestinal absorption of Ca & elevated PTH
-rickets or osteomalacia (not common in developed countries)
-subclinical Vit D deficiency:
--osteoporosis/falls/fractures
--immune system
--cardiovascular benefiets
Vitamin D levels (serum 25-hydroxyvitamin D) [Calcidiol] - correct answer ✔✔-prior to be converted in
kidney to calcitriol
-sufficiency: >20ng/mL
-insufficiency: 12-20ng/mL
-deficiency: <12ng/mL
-levels lower than 20 are suboptimal for skeletal health
Vit D supplementation - correct answer ✔✔600-800 IU daily
-for adults who do not have regular effective sun exposure
->70yo (may require more)
Vit D Replenishment - correct answer ✔✔-serum 25(OH)D levels: 20-30 --> 600-800IU
-vit D levels 12-20 --> 800-1000 IU & repeat serum 25(OH)D level in 3 months
, -vit D <12 -->50,000 IU of D2 or D3 orally/week for 6-8 weeks, followed by 800 IU of D3 daily
Screening for Diabetes - correct answer ✔✔-Fasting plasma glucose
-Hemoglobin A1C
-2 hour plasma glucose
-classic sx & random glucose of >=200mg/dL
Fasting plasma glucose - correct answer ✔✔-greater or equal to 126mg/dL = diabetes
HgbA1C - correct answer ✔✔-average glucose levels over past 2-3 months
-greater than or equal to 6.5% = diabetes
-prediabetes: A1C= >= 5.7% [need to test yearly]
-used to monitor chronic glycemic control/efficacy of treatment
-used to diagnose diabetes
A1C targets for pts w/ DM - correct answer ✔✔-individualized
-goal to avoid hypoglycemic episodes w/ too stringent of control
-health adult <7.5%
-older adults w/ comorbid conditions 8-8.5%
-children <7%
-children who are nonverbal <7.5%
-pregnancy <6%
CGM ranges - correct answer ✔✔-target range: 70-180
-hypoglycemia: <70
-hyperglycemia: >180
2 hour plasma glucose - correct answer ✔✔-75g oral glucose tolerance test
-greater than or equal to 200 = diabetes
Hematopoiesis - correct answer ✔✔Formation of blood
Formed elements in blood - correct answer ✔✔>Plasma: fluid portion of whole blood minus cellular
elements; water, electrolytes, proteins, clotting factors & hormones
>cellular elements: RBC, WBC, thrombocytes
>Ratio of cellular elements: 500 RBC: 30 Platelets: 1 WBC
-Blood: 45% RBC, 54.3% plasma, 0.7% WBC
CBC: The components - correct answer ✔✔-WBC count
-RBC count
-Hgb
-Hct
-RBC Indicies
-RDW
-Platelet count
-Mean platelet volume
-Differential (auto/manual) & % vs absolute count
PRACTICE QUESTIONS & ANSWERS 2026/2027
Common Liver Function Tests - correct answer ✔✔-Alanine aminotransferase (ALT)
-Aspartate aminotransferase (AST)
-Alkaline phosphatase (ALP)
-bilirubin
-albumin
-prothrombin time
-gamma-glutamyl transferase (GGT)
-5'nucleotidase
Liver functions - correct answer ✔✔-destruction of RBCs & formation of bile pigments
-protein metabolism
-synthesis of plasma proteins, fibrinogens & prothrombin
-enzyme synthesis
-conversion of ammonia to urea
-carbohydrate & fat metabolism
-excretion of drugs, hormones
-detoxifies
application of liver function tests - correct answer ✔✔-detect presence of liver disease
-distinguish among different types of liver disorders
-gauges the extent of known liver damage
-follow response to txt
LFT categories/what do they indicate? - correct answer ✔✔-tests that measure detoxification &
excretory functions
-tests for enzymes that reflect damage to hepatocytes
-tests for enzymes that reflect cholestasis (flow of bile reduced/blocked)
-tests that measure synthetic function
Tests for enzymes that reflect damage to hepatocytes - correct answer ✔✔-aminotransferases (AST &
ALT)
-AST: enzyme present in liver, cardiac muscle, skeletal muscle, kidneys, brain, pancreases, lungs,
leukocytes, & RBCs
-ALT: primary present in the Liver; enzyme
--more specific indicator of liver cell damage
--non specific/any type of liver disorder
ALT & AST levels - correct answer ✔✔-levels >1000 --> extensive hepatocellular injury (viral hepatitis,
ischemic liver disease, drug or toxin induced)
>ACUTE hepatocellular damage: ALT > AST
>Alcoholic liver disease: AST:ALT >2:1 (suggestive); >3:1 (highly suggestive)
Tests for enzymes that reflect cholestasis - correct answer ✔✔>ALP
,- <3 fold increase: not specific for cholestasis
--seen in almost any type of liver disease
->4 fold increase: cholestatic liver disorder, infiltrative liver disease (cancer), bone conditions w/ rapid
bone turnover (Pagets disease)
-ALP is NOT useful to distinguish b/w intra & extra hepatic obstruction
-reflective of liver damage & cholestasis
Tests that measure detoxification & excretory functions - correct answer ✔✔>Bilirubin
>Van den Bergh assay: determination of total, conjugated (direct) & unconjugated (indirect) bilirubin
-normal value of total <1-1.5
-helps identify if liver is functioning the way it should
Tests that measure synthetic function - correct answer ✔✔>Serum albumin
-synthesized exclusively by hepatocytes
-NOT a good indicator of acute/mild hepatic dysfunction
-minimum change in viral hepatitis/drug induced hepatitis/obs jaundice
-other causes of decrease: protein malnutrition, protein losing enteropathies, nephrotic syndrome,
chronic infection
>Coagulation factors:
-except for factor VIII, blood clotting factors are exclusively synthesized in hepatocytes
-rapid turnover; clotting factors are single best acute measure of hepatic synthetic function**
-PT (collective measures II/V/VII/X
---may be elevated in hepatitis, cirrhosis & disorders that result in Vit K deficiency (obs. jaundice)
Tests for enzymes that reflect cholestasis - correct answer ✔✔>ALP
>5'NT
>GGT
Common reasons for abnormal LFTs - correct answer ✔✔>ALT: hepatocellular damage
>AST: hepatocellular damage
>Bilirubin: cholestasis, impair conjugation or biliary obstruction
>ALP: cholestasis, infiltrative disease, biliary obstruction
>PT: synthetic function
>Albumin: synthetic function
>GGT: cholestasis or biliary obstruction
>5' nucleotidase: cholestasis of biliary obstruction
Amylase - correct answer ✔✔-digestive enzyme
-aids in hydrolysis of starch into sugars
-main sources are the pancreas and salivary glands
Lipase - correct answer ✔✔-digestive enzyme
-main function of pancreatic lipase is to hydrolyze triglycerides into glycerol & free fatty acids
Pancreatitis - correct answer ✔✔-acute 3x elevation of amylase &/or lipase
-typically extrapancreatic cause of amylase/lipase elevations are not associated with a >3fold elevation
-amylase & lipase drawn together
,-often ordered when pt has abdominal pain
Pancreatitis: Amylase - correct answer ✔✔-serum amylase rises within 6-12 hrs
-returns to normal 3-5 days
-3x elevation more specific (85-98%) & sensitive (67-83%) for acute pancreatitis
Pancreatitis: Lipase - correct answer ✔✔-rises within 4-8hrs
-peaks at 24 hr
-returns to normal 8-14 days
-3x elevation sensitive (82-100%) for acute pancreatitis
-lipase elevations occur earlier & last longer compared to amylase
Elevated amylase- extrapancreatic - correct answer ✔✔-salivary disease
-GI: appendicitis, perforated bowel, celiac disease
-GYN: ruptured ectopic pregnancy, PID
Elevated lipase- extrapancreatic - correct answer ✔✔-HIV, HCV
-inflammatory bowel disease
-T2DM
Vitamin D - correct answer ✔✔-metabolic activation of Vit D to calcitriol
-impacts Ca & phosphate homeostasis
-increase in the serum Ca & phos concentrations
Vitamin D deficiency - correct answer ✔✔-hypocalcemia &/or hypophosphatemia --> low 25(OH)D levels
leads to decrease intestinal absorption of Ca & elevated PTH
-rickets or osteomalacia (not common in developed countries)
-subclinical Vit D deficiency:
--osteoporosis/falls/fractures
--immune system
--cardiovascular benefiets
Vitamin D levels (serum 25-hydroxyvitamin D) [Calcidiol] - correct answer ✔✔-prior to be converted in
kidney to calcitriol
-sufficiency: >20ng/mL
-insufficiency: 12-20ng/mL
-deficiency: <12ng/mL
-levels lower than 20 are suboptimal for skeletal health
Vit D supplementation - correct answer ✔✔600-800 IU daily
-for adults who do not have regular effective sun exposure
->70yo (may require more)
Vit D Replenishment - correct answer ✔✔-serum 25(OH)D levels: 20-30 --> 600-800IU
-vit D levels 12-20 --> 800-1000 IU & repeat serum 25(OH)D level in 3 months
, -vit D <12 -->50,000 IU of D2 or D3 orally/week for 6-8 weeks, followed by 800 IU of D3 daily
Screening for Diabetes - correct answer ✔✔-Fasting plasma glucose
-Hemoglobin A1C
-2 hour plasma glucose
-classic sx & random glucose of >=200mg/dL
Fasting plasma glucose - correct answer ✔✔-greater or equal to 126mg/dL = diabetes
HgbA1C - correct answer ✔✔-average glucose levels over past 2-3 months
-greater than or equal to 6.5% = diabetes
-prediabetes: A1C= >= 5.7% [need to test yearly]
-used to monitor chronic glycemic control/efficacy of treatment
-used to diagnose diabetes
A1C targets for pts w/ DM - correct answer ✔✔-individualized
-goal to avoid hypoglycemic episodes w/ too stringent of control
-health adult <7.5%
-older adults w/ comorbid conditions 8-8.5%
-children <7%
-children who are nonverbal <7.5%
-pregnancy <6%
CGM ranges - correct answer ✔✔-target range: 70-180
-hypoglycemia: <70
-hyperglycemia: >180
2 hour plasma glucose - correct answer ✔✔-75g oral glucose tolerance test
-greater than or equal to 200 = diabetes
Hematopoiesis - correct answer ✔✔Formation of blood
Formed elements in blood - correct answer ✔✔>Plasma: fluid portion of whole blood minus cellular
elements; water, electrolytes, proteins, clotting factors & hormones
>cellular elements: RBC, WBC, thrombocytes
>Ratio of cellular elements: 500 RBC: 30 Platelets: 1 WBC
-Blood: 45% RBC, 54.3% plasma, 0.7% WBC
CBC: The components - correct answer ✔✔-WBC count
-RBC count
-Hgb
-Hct
-RBC Indicies
-RDW
-Platelet count
-Mean platelet volume
-Differential (auto/manual) & % vs absolute count
