NUR 432 Exam 3 questions with
complete solutions
What is the normal prothrombin time range? - correct answer ✔✔ 9.5 - 12 seconds
What are normal amylase levels? - correct answer ✔✔ 25 -125 units/L
What are normal lipase levels? - correct answer ✔✔ <10-140 units/L
What are normal Alanine Aminotransferase (ALT) levels? - correct answer ✔✔ 8 - 40 U/mL
What are normal Lactic Dehydrogenase (LDH) levels? - correct answer ✔✔ 100 - 200 units
What are normal serum bilirubin, total levels? - correct answer ✔✔ 0.3 - 1 mg/dL
What are normal serum albumin levels? - correct answer ✔✔ 3.5 - 5.2 g/dL
What are the causes of hepatic dysfunction? - correct answer ✔✔ *can be acute or chronic
- liver failure: often associated with alcohol use
- infection (bacteria and viruses)
- Wilson's disease
- toxins
- medications
- low protein intake
- hypersensitivity states
,- fatty liver disease: associated with obesity, lipids accumulate in hepatocytes (liver cells)
- nonalcoholic fatty liver disease (NAFLD)
- nonalcoholic steatohepatitis (NASH): more severe
What are the clinical manifestations of hepatic dysfunction? - correct answer ✔✔ - jaundice,
two types:
* hepatocellular: caused by damaged liver cells unable to clear bilirubin
*obstructive: occlusion of bile duct or intrahepatic bile ducts caused by gallstones or
inflammation
- portal hypertension: related to the portal vein in the liver; caused by obstruction of blood flow
through the liver; **may find splenomegaly (enlarged liver)
- ascites
- esophageal varices: increased risk for bleeding
- hepatic encephalopathy or coma
- confusion and motor disturbances due to accumulation of high serum ammonia levels
- edema and bleeding: production of blood clotting factors by the liver is reduced; decreased vit
K absorption from the GI tract and inability of the liver cells to use vit K to make prothrombin
- vit. deficiency: decreased absorption of A,D,E, K and dietary fat due to decreased bile
secretion. Others from inadequate intake: thiamine, riboflavin, pyroxidine, C,K, folic acid
- abnormally high blood glucose after meals and low blood glucose with fasting due to
decreased hepatic glycogen reserves and decreased gluconeogenesis
- pruitis (from retention of bile salts) and other skin changes (spider angiomas, associated with
cirrhosis)
What are assessment findings found with hepatic dysfunction? - correct answer ✔✔ - pallor
(due to bleeding, anemia, or chronic illness)
- jaundice and skin excoriation secondary to scratching
- muscle atrophy (due to decreased protein metabolism and nutritional deficiencies)
- petechiae or ecchymotic areas (due to decreased vit K absorption)
,- males: gynecomastia, testicular atrophy (due to altered hormone metabolism)
- females: menstrual dysfunction (due to altered hormone metabolism)
- cognitive status (recall, memory, abstract thinking) and neurologic status are assessed
- tremor, asterixis (involuntary flapping movements of the hands), weakness, and slurred speech
due to hepatic encephalopathy (elevated ammonia levels)
- abdominal assessment:
*ascites and abdominal fluid wave and edema will be present
*assess liver size and tenderness
*abnormal findings: large liver and tenderness
How is Hepatitis A transmitted? - correct answer ✔✔ - fecal-oral route, by the ingestion of food
or liquids infected with the virus
- can be transmitted during sexual activity; this is more likely with oral-anal contact or anal
intercourse and with multiple sex partners
How is Hep A prevented? - correct answer ✔✔ - safe practices for preparing and dispensing
food
- conscientious individual hygiene
- proper community and home sanitation
- mandatory reporting of viral hepatitis to local health departments
- community health education programs
- vaccination to interrupt community-wide outbreaks
- pre-exposure vaccination for all children 12-23 months of age. Continue existing immunization
programs for children 1-18 years of age.
- vaccination for travelers to developing countries, illegal drug users (injection and noninjection
drug users), men who have sex with men, people with chronic liver disease, people who work
with HAV-infected animals or work with HAV in research facilities and recipients (e.g.,
hemophiliacs) of pooled plasma products for clotting factor disorders
, - effective health supervision of schools, dormitories, extended care facilities, barracks, and
camps
How is Hepatitis B transmitted? - correct answer ✔✔ transmitted primarily through blood
(percutaneous and permucosal routes). HBV can be found in blood, saliva, semen, and vaginal
secretions and can be transmitted through mucous membranes and breaks in the skin. HBV is
also transferred from carrier mothers to their infants, especially in areas with a high incidence
How is Hep B prevented? - correct answer ✔✔ - avoidance of high-risk behaviors
- avoid multidose vials in patient care settings
- cleaning, disinfection, and sterilization of reusable devices in patient care settings
- vaccination for international travelers to regions with high or intermediate levels of endemic
hepatitis B virus infection and for persons with chronic liver disease or with human immune
deficiency virus infection
- vaccination for persons at risk for infection by sexual exposure, by percutaneous or mucosal
exposure to blood
- vaccination of all infants in the United States regardless of the mother's hepatitis B.
- use barrier precautions in situations of contact with blood or body fluids
- use needleless IV and injection systems in health care
- use standard precautions in clinical care
How is Hepatitis C transmitted? - correct answer ✔✔ blood transfusions and sexual contact
once accounted for most cases of HCV in the United States, but other parenteral means, such as
sharing of contaminated needles by those who use IV or injection drugs and unintentional
needlesticks and other injuries in health care workers now account for a significant number of
cases.
How is Hep C prevented? - correct answer ✔✔ - avoidance of high-risk behaviors such as IV
drug use
- avoid multidose vials in patient care settings
complete solutions
What is the normal prothrombin time range? - correct answer ✔✔ 9.5 - 12 seconds
What are normal amylase levels? - correct answer ✔✔ 25 -125 units/L
What are normal lipase levels? - correct answer ✔✔ <10-140 units/L
What are normal Alanine Aminotransferase (ALT) levels? - correct answer ✔✔ 8 - 40 U/mL
What are normal Lactic Dehydrogenase (LDH) levels? - correct answer ✔✔ 100 - 200 units
What are normal serum bilirubin, total levels? - correct answer ✔✔ 0.3 - 1 mg/dL
What are normal serum albumin levels? - correct answer ✔✔ 3.5 - 5.2 g/dL
What are the causes of hepatic dysfunction? - correct answer ✔✔ *can be acute or chronic
- liver failure: often associated with alcohol use
- infection (bacteria and viruses)
- Wilson's disease
- toxins
- medications
- low protein intake
- hypersensitivity states
,- fatty liver disease: associated with obesity, lipids accumulate in hepatocytes (liver cells)
- nonalcoholic fatty liver disease (NAFLD)
- nonalcoholic steatohepatitis (NASH): more severe
What are the clinical manifestations of hepatic dysfunction? - correct answer ✔✔ - jaundice,
two types:
* hepatocellular: caused by damaged liver cells unable to clear bilirubin
*obstructive: occlusion of bile duct or intrahepatic bile ducts caused by gallstones or
inflammation
- portal hypertension: related to the portal vein in the liver; caused by obstruction of blood flow
through the liver; **may find splenomegaly (enlarged liver)
- ascites
- esophageal varices: increased risk for bleeding
- hepatic encephalopathy or coma
- confusion and motor disturbances due to accumulation of high serum ammonia levels
- edema and bleeding: production of blood clotting factors by the liver is reduced; decreased vit
K absorption from the GI tract and inability of the liver cells to use vit K to make prothrombin
- vit. deficiency: decreased absorption of A,D,E, K and dietary fat due to decreased bile
secretion. Others from inadequate intake: thiamine, riboflavin, pyroxidine, C,K, folic acid
- abnormally high blood glucose after meals and low blood glucose with fasting due to
decreased hepatic glycogen reserves and decreased gluconeogenesis
- pruitis (from retention of bile salts) and other skin changes (spider angiomas, associated with
cirrhosis)
What are assessment findings found with hepatic dysfunction? - correct answer ✔✔ - pallor
(due to bleeding, anemia, or chronic illness)
- jaundice and skin excoriation secondary to scratching
- muscle atrophy (due to decreased protein metabolism and nutritional deficiencies)
- petechiae or ecchymotic areas (due to decreased vit K absorption)
,- males: gynecomastia, testicular atrophy (due to altered hormone metabolism)
- females: menstrual dysfunction (due to altered hormone metabolism)
- cognitive status (recall, memory, abstract thinking) and neurologic status are assessed
- tremor, asterixis (involuntary flapping movements of the hands), weakness, and slurred speech
due to hepatic encephalopathy (elevated ammonia levels)
- abdominal assessment:
*ascites and abdominal fluid wave and edema will be present
*assess liver size and tenderness
*abnormal findings: large liver and tenderness
How is Hepatitis A transmitted? - correct answer ✔✔ - fecal-oral route, by the ingestion of food
or liquids infected with the virus
- can be transmitted during sexual activity; this is more likely with oral-anal contact or anal
intercourse and with multiple sex partners
How is Hep A prevented? - correct answer ✔✔ - safe practices for preparing and dispensing
food
- conscientious individual hygiene
- proper community and home sanitation
- mandatory reporting of viral hepatitis to local health departments
- community health education programs
- vaccination to interrupt community-wide outbreaks
- pre-exposure vaccination for all children 12-23 months of age. Continue existing immunization
programs for children 1-18 years of age.
- vaccination for travelers to developing countries, illegal drug users (injection and noninjection
drug users), men who have sex with men, people with chronic liver disease, people who work
with HAV-infected animals or work with HAV in research facilities and recipients (e.g.,
hemophiliacs) of pooled plasma products for clotting factor disorders
, - effective health supervision of schools, dormitories, extended care facilities, barracks, and
camps
How is Hepatitis B transmitted? - correct answer ✔✔ transmitted primarily through blood
(percutaneous and permucosal routes). HBV can be found in blood, saliva, semen, and vaginal
secretions and can be transmitted through mucous membranes and breaks in the skin. HBV is
also transferred from carrier mothers to their infants, especially in areas with a high incidence
How is Hep B prevented? - correct answer ✔✔ - avoidance of high-risk behaviors
- avoid multidose vials in patient care settings
- cleaning, disinfection, and sterilization of reusable devices in patient care settings
- vaccination for international travelers to regions with high or intermediate levels of endemic
hepatitis B virus infection and for persons with chronic liver disease or with human immune
deficiency virus infection
- vaccination for persons at risk for infection by sexual exposure, by percutaneous or mucosal
exposure to blood
- vaccination of all infants in the United States regardless of the mother's hepatitis B.
- use barrier precautions in situations of contact with blood or body fluids
- use needleless IV and injection systems in health care
- use standard precautions in clinical care
How is Hepatitis C transmitted? - correct answer ✔✔ blood transfusions and sexual contact
once accounted for most cases of HCV in the United States, but other parenteral means, such as
sharing of contaminated needles by those who use IV or injection drugs and unintentional
needlesticks and other injuries in health care workers now account for a significant number of
cases.
How is Hep C prevented? - correct answer ✔✔ - avoidance of high-risk behaviors such as IV
drug use
- avoid multidose vials in patient care settings
