A nurse is assessing a client with a temperature of 38°C (100.4°F) and notes a red, swollen area on the client’s leg. Which condition is the client most likely experiencing?

Choice A rationale
Elevated blood ammonia levels are a common consequence of liver dysfunction, particularly in conditions like cirrhosis and alcoholic liver disease. The liver is responsible for converting ammonia, a byproduct of protein metabolism, into urea, which is then excreted by the kidneys. When the liver is damaged, it cannot effectively perform this function, leading to elevated blood ammonia levels. High ammonia levels can cross the blood-brain barrier and cause hepatic encephalopathy, which manifests as confusion, memory loss, and asterixis (a flapping tremor of the hands). These neurological symptoms are consistent with the patient’s presentation.
Choice B rationale
An increased white blood cell count typically indicates an infection or inflammation. While infections can occur in patients with liver disease due to a compromised immune system, the symptoms described (increased blood glucose, blurred vision, memory loss, and asterixis) are more indicative of hepatic encephalopathy rather than an infection.
Choice C rationale
Elevated blood urea nitrogen (BUN) levels can occur in liver disease, but they are more commonly associated with kidney dysfunction. BUN is a measure of the amount of nitrogen in the blood that comes from the waste product urea. While liver dysfunction can affect BUN levels, the symptoms described are more specifically related to elevated ammonia levels and hepatic encephalopathy.
Choice D rationale
A decreased platelet count, or thrombocytopenia, is a common finding in liver disease due to splenic sequestration and decreased production of thrombopoietin. However, thrombocytopenia does not directly cause the neurological symptoms described in the patient. The symptoms of increased blood glucose, blurred vision, memory loss, and asterixis are more specifically related to elevated ammonia levels and hepatic encephalopathy.

Choice A rationale
Serum amylase is typically elevated in acute pancreatitis. It is one of the key diagnostic markers for this condition.
Choice B rationale
Serum potassium levels are not typically elevated in acute pancreatitis. Potassium levels are more commonly associated with kidney function and electrolyte balance.
Choice C rationale
Serum calcium levels are usually decreased, not elevated, in acute pancreatitis. Hypocalcemia can occur due to fat saponification in the pancreas.
Choice D rationale
Serum sodium levels are not typically elevated in acute pancreatitis. Sodium levels are more related to overall fluid balance and kidney function.