The nurse notes new areas of ecchymosis on the arms and legs of a client with liver cirrhosis. Which laboratory test results should the nurse monitor because of this finding? Select all that apply.
serum hepatitis antibodies
complete blood count with platelets
serum ammonia levels
coagulation studies
serum albumin
Correct Answer : B,D
Rationale:
A. While hepatitis can cause liver injury, antibodies do not provide information about current clotting ability or bleeding risk. They indicate past exposure or immunity, not active coagulopathy.
B. Platelets are critical for primary hemostasis, and clients with liver cirrhosis often develop thrombocytopenia due to splenic sequestration or decreased production of thrombopoietin. Low platelet counts increase the risk of bruising and bleeding, which correlates with the observed ecchymoses.
C. Elevated ammonia is associated with hepatic encephalopathy, not directly with bleeding or bruising. Monitoring ammonia is important for neurological status but not for coagulation.
D. Liver cirrhosis impairs the synthesis of clotting factors, leading to prolonged PT, INR, and aPTT. Ecchymosis may indicate coagulopathy, so monitoring coagulation studies helps assess the severity of the bleeding risk.
E. Albumin reflects synthetic liver function and nutritional status, but low albumin itself does not directly cause bruising. While hypoalbuminemia may indicate advanced liver disease, it does not provide immediate information about bleeding risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["14"]
Explanation
Step 1: Calculate the ordered dose in units/hr
Dose (units/hr) = 18 units/kg/hr × 80 kg
Dose = 1,440 units/hr
Step 2: Determine the concentration of the IV solution
25,000 units in 250 mL
Concentration = 25,000 ÷ 250
Concentration = 100 units/mL
Step 3: Calculate mL/hr
mL/hr = Dose ÷ Concentration
mL/hr = 1,440 ÷ 100
mL/hr = 14.4 mL/hr
Step 4: Round to the nearest whole number
14.4 = 14 mL/hr
Final Answer: 14 mL/hr
Correct Answer is C
Explanation
Rationale:
A. Applying ice packs can help reduce pain, inflammation, and swelling. However, ice does not address the immediate risk of vascular compromise caused by constrictive rings. Ice packs are considered a secondary intervention after the rings have been removed.
B. Calamine lotion provides symptomatic relief of itching, but it does not prevent circulatory compromise or tissue damage. This is a low-priority comfort measure in the acute setting.
C. This is the highest-priority action. Bee stings often cause rapid localized swelling, and rings can act as constrictive bands, which may impair venous and arterial blood flow, leading to ischemia, pain, or tissue necrosis. Removing rings immediately prevents these serious complications and protects tissue viability.
D. Oral diphenhydramine can help reduce itching and mild allergic reactions, but its onset is delayed and it does not address immediate circulation concerns caused by swelling. It is a supportive intervention after urgent priorities are addressed.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
