Patient Data

The client has been receiving care on the medical unit for two days. The nurse completes a physical assessment and records the client's vital signs.
The client is being evaluated to determine his response to treatment. Which indicates that the client is responding to care? Select all that apply.

Rationale:

• Hepatitis: The client’s elevated liver enzymes (AST 48 U/L, ALT 59 U/L), elevated bilirubin (3 mg/dL), and clinical signs such as jaundice and spider angiomas indicate liver inflammation and damage. These findings are consistent with alcoholic hepatitis, a condition caused by chronic alcohol consumption. The combination of laboratory abnormalities and physical assessment strongly supports hepatitis as the primary risk.

• Nephritis: There is no evidence of renal inflammation in the assessment. The client’s genitourinary function is within normal limits, and there are no laboratory findings suggesting elevated creatinine or hematuria.

• Cholecystitis: Although the client has jaundice, there is no reported right upper quadrant pain, fever, or Murphy’s sign, which are typical for gallbladder inflammation. Abdominal distension is more likely related to liver disease or ascites rather than cholecystitis.

• Chronic alcohol abuse: The client reports long-term, heavy alcohol use (12–16 beers daily for 2 years), which is the leading cause of hepatocellular injury in adults. Chronic alcohol intake disrupts liver metabolism, causes fat accumulation in hepatocytes, and increases the risk of alcoholic hepatitis, fibrosis, and cirrhosis. This risk factor directly explains the lab and clinical findings, making it the most relevant cause.

• Unmanaged hypertension: While the client has a history of untreated hypertension, it does not explain the elevated liver enzymes or jaundice. Hypertension increases cardiovascular risk but is not the primary factor causing hepatic injury.

• Viral infection: Viral hepatitis could cause similar laboratory and clinical findings, but there is no evidence of recent viral illness or laboratory confirmation. Chronic alcohol abuse is a more consistent explanation for the constellation of findings in this client.

Rationale:
A. Suppression: Suppression is the conscious effort to avoid thinking about distressing thoughts or feelings. The client is not consciously avoiding emotions; instead, the client is actively expressing anger.

B. Displacement: Displacement involves redirecting emotions or impulses from a threatening or unavailable target to a safer or more accessible one. The client is upset about the absence of family or friends but directs anger toward the nurse, a safer target, which is characteristic of displacement.

C. Rationalization: Rationalization involves creating logical or socially acceptable explanations to justify unacceptable feelings or behaviors. The client is not providing justifications but expressing anger outwardly.

D. Conversion: Conversion is the unconscious expression of psychological distress as physical symptoms. The client’s shouting and throwing objects reflect emotional expression, not somatic manifestations, so conversion is not occurring.