A client with end-stage liver failure presents with confusion, lethargy, and asterixis. Which laboratory result is most likely associated with these symptoms?

Elevated platelet count

Normal albumin levels

Elevated ammonia levels

Decreased bilirubin levels

Answer and Explanation

The Correct Answer is C

Rationale:

A. In end-stage liver failure, the liver’s ability to produce clotting factors and thrombopoietin is impaired. This often leads to thrombocytopenia (low platelet count) rather than elevated platelets. Low platelet counts can contribute to bleeding risks but are not related to neurological symptoms such as confusion or asterixis. An elevated platelet count would be unusual in this context and is not associated with hepatic encephalopathy.

B. Albumin is a protein synthesized by the liver, and in end-stage liver disease, albumin production decreases, leading to hypoalbuminemia. Low albumin contributes to edema and ascites due to decreased oncotic pressure but does not cause confusion, lethargy, or asterixis. Normal albumin levels would be unexpected in severe liver failure and do not explain the neurological findings.

C. Neurological symptoms such as confusion, lethargy, and asterixis (“flapping tremor” of the hands) are hallmark signs of hepatic encephalopathy. Hepatic encephalopathy occurs because the failing liver cannot effectively metabolize ammonia, a byproduct of protein metabolism. Elevated serum ammonia crosses the blood-brain barrier, leading to neurotoxicity, which manifests as cognitive changes and motor abnormalities. Although the severity of symptoms does not always directly correlate with ammonia levels, high ammonia is the most relevant laboratory indicator of hepatic encephalopathy in this scenario.

D. Bilirubin, a product of hemoglobin breakdown processed by the liver, is usually elevated in liver failure, leading to jaundice. A decreased bilirubin level is not typical of liver failure and does not explain neurological symptoms such as confusion, lethargy, or asterixis.

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Free Nursing Study Resources

Correct Answer is ["13"]

Explanation

Step 1: Convert weight from pounds to kilograms
Weight (kg) = 193 ÷ 2.2
Weight ≈ 87.7 kg

Step 2: Calculate the ordered dose in mcg/min
Dose (mcg/min) = 2.5 mcg/kg/min × 87.7 kg
Dose ≈ 219.25 mcg/min

Step 3: Convert mcg/min to mg/hr
219.25 mcg/min × 60 min/hr = 13,155 mcg/hr
13,155 mcg/hr ÷ 1,000 mcg/mg = 13.155 mg/hr

Step 4: Determine concentration of IV solution
250 mg in 250 mL
Concentration = 1 mg/mL

Step 5: Calculate mL/hr
mL/hr = 13.155 mg/hr ÷ 1 mg/mL
mL/hr ≈ 13.155 mL/hr

Step 6: Round to the nearest whole number
13.155 = 13 mL/hr

Final Answer: 13 mL/hr

Correct Answer is ["45"]

Explanation

Step 1: Convert grams to milligrams
2 grams = 2,000 mg

Step 2: Determine the concentration
2,000 mg in 500 mL
Concentration = 2,000 ÷ 500
Concentration = 4 mg/mL

Step 3: Convert mg/min to mg/hr
3 mg/min × 60 min/hr = 180 mg/hr

Step 4: Calculate mL/hr
mL/hr = Dose (mg/hr) ÷ Concentration (mg/mL)
mL/hr = 180 ÷ 4
mL/hr = 45

Step 5: Round to the nearest whole number
45 = 45 mL/hr

Final Answer: 45 mL/hr

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A client with end-stage liver failure presents with confusion, lethargy, and asterixis. Which laboratory result is most likely associated with these symptoms?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse prepares to administer dobutamine 2.5 mcg/kg/min IV for a client who weighs 193 pounds. The nurse receives dobutamine 250 mg in 250 mL of 5% dextrose from the pharmacy. The IV pump should be set to deliver how many mL/hr? Round to a whole number.

Correct Answer is ["13"]

Explanation

The nurse prepares to administer a lidocaine infusion to deliver 3 mg/min. The solution available contains 2 grams of lidocaine in 500 mL of 5% dextrose. How many mL/hr should the nurse set the IV pump? Round to a whole number.

Correct Answer is ["45"]

Explanation

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