Medical Surgical Labs Liver Labs #1

Question

The nurse is evaluating lab studies on her newly admitted client. Labs reveal albumin 3.0, calcium 8.1 mg/dL, bilirubin 1.7 mg/dL. She also notes bruising on the client’s arms. Based on the findings, which will the nurse suspect?

Answers

  1. Pancreatic injury
    • Rationale:

      This answer is not correct because these ranges are conducive of liver function, not pancreatic. Amylase and lipase is what would be drawn to check the pancreas.

  2. Hepatic failure
    • Rationale:

      This answer is correct because in liver failure albumin will be low, calcium low, increased coagulation times, low platelets, and bilirubin high. The client is experiencing pruritis due to the toxins and bile salts building up inside the body from poor liver function. Bruising is very common in clients with liver failure due to higher PT, PTT, and INR since the liver produces coagulation factors.

  3. Gallbladder disease
    • Rationale:

      This answer is not correct because with gallbladder disease, the labs that will be monitored will be amylase, lipase, ALT and AST, as well as CBC to check for infection. Gallbladder disease does not affect coagulation so bruising is not a symptom.

  4. Splenic trauma
    • Rationale:

      This answer is not correct because these are not the appropriate tests to monitor for the spleen. A complete blood count to check the number of red cells, white cells and platelets, since the spleen stores these cells, play an important role in the immune response.

Overview

Hepatic failure will be evidenced in lab studies by albumin under 3.5, low calcium value, increased coagulation, and high bilirubin.

Explanation

Learning Outcomes

The labs associated with liver function are AST/ALT, ammonia, albumin, calcium, platelets, PT, PTT, INR, and bilirubin. Ammonia will be elevated because of the liver’s failure to excrete it from the body through urine. Albumin and calcium will be low. Platelets will be low and PT, PTT, INR will be high since the liver is where coagulation factors are produced. Bruising is a potential symptom. Bilirubin will be high because the liver is unable to metabolize bile appropriately, causing it to build up in the blood. Increased toxins and bile salts within the body from liver damage can cause pruritus.

Test Taking Tip

The question gives a clue with the statement, “She notes bruising on the client’s arms.” With that hint, the student can rule out the other answer choices since one of the functions of the liver is regulating blood coagulation.

Video Rationale