NUR 432 Exam 3 Study Questions and
Correct Answers
What is the normal prothrombin time range? ✅9.5 - 12 seconds
What are normal amylase levels? ✅25 -125 units/L
What are normal lipase levels? ✅<10-140 units/L
What are normal Alanine Aminotransferase (ALT) levels? ✅8 - 40 U/mL
What are normal Lactic Dehydrogenase (LDH) levels? ✅100 - 200 units
What are normal serum bilirubin, total levels? ✅0.3 - 1 mg/dL
What are normal serum albumin levels? ✅3.5 - 5.2 g/dL
What are the causes of hepatic dysfunction? ✅*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? ✅- 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? ✅- 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? ✅- 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? ✅- 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? ✅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? ✅- 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? ✅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? ✅- avoidance of high-risk behaviors such as IV drug use
- avoid multidose vials in patient care settings
- cleaning, disinfection, and sterilization of reusable devices in patient care settings
- 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 D transmitted? ✅because the virus requires HBsAg for its replication,
only people with hepatitis B are at risk for hepatitis D. Hepatitis D is common among
those who use IV or injection drugs, patients undergoing hemodialysis, and recipients of
multiple blood transfusions. Sexual contact with those who have hepatitis B is
considered to be an important mode of transmission of hepatitis B and D
How is Hepatitis E transmitted? ✅HEV is transmitted by the fecal-oral route, principally
through contaminated water in areas with poor sanitation
How is Hepatitis E prevented? ✅avoiding contact with the virus through good hygiene,
including handwashing, is the major method of prevention of hepatitis E.
