Medical Surgical Hepatitis #4

Question

A client with severe hepatitis B will present to the emergency department with which subjective and objective assessment findings? Select all that apply.

Answers

  1. Abdominal pain
    • Rationale:

      This answer is correct because severe symptoms of hepatitis B include abdominal pain, ascites, jaundice, esophageal varices, and bleeding tendencies. Abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure.

  2. INR of 4
    • Rationale:

      This answer is correct because an INR of 4 is extremely elevated and is associated with hepatitis B. Abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure. Clotting factors are made in the liver so the client with severe hepatitis will have bleeding tendencies related to abnormal levels.

  3. Increased ALT/AST
    • Rationale:

      This answer is correct because abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure.

  4. White blood cell of 5,000
    • Rationale:

      This answer is not correct because white blood cell levels for hepatitis B will tend to be over 10,000 due to the inflammation. The client will tend to have a low-grade fever and have other flu-like symptoms including fatigue, muscle aches, fever, and headaches. Later stage, severe symptoms of hepatitis B include abdominal pain, ascites, jaundice, esophageal varices, and bleeding tendencies. Abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure.

  5. Positive HBsAg
    • Rationale:

      This answer is correct because diagnosis of hepatitis B is confirmed with a positive HBsAg test. Other abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure.

Overview

Subject and objective assessment findings that a client with severe hepatitis B will have are abdominal pain, increased INR and ALT/AST levels, increased (not decreased) white blood cells, and a positive HVsAG test.

Explanation

Learning Outcomes

Hepatitis B is a virus that attacks the liver causing inflammation. Since it is a virus, it has flu-like symptoms including fatigue, muscle aches, fever, and headaches. Later in the disease process, symptoms are similar to liver failure because the inflammation can cause similar damage as cirrhosis of the liver. Later stage, severe symptoms of hepatitis B include abdominal pain, ascites, jaundice, esophageal varices, and bleeding tendencies. Abnormal laboratory results, including decreased albumin, decreased clotting factors, increased white blood cell level, increased ALT/AST, increased PTT, PT, and INR levels, and cholesterol associated labs occur as a result of liver failure. Diagnosis of hepatitis B is confirmed with a positive HBsAg test.

Test Taking Tip

Understanding the anatomy structure and function of the liver and the pathophysiology of hepatitis will help the nursing student test-taker answer this question correctly.

Video Rationale