A nurse is caring for a client who has a new diagnosis of liver disease. Which of the following manifestations should the nurse expect?

Night sweats

Acanthosis nigricans

Hemosiderin staining

Pruritus

Answer and Explanation

The Correct Answer is D

Choice A Reason: Night sweats

Night sweats are not typically associated with liver disease. They are more commonly linked to conditions such as infections, hormonal imbalances, or certain cancers1. While liver disease can cause a variety of symptoms, night sweats are not a primary manifestation.

Choice B Reason: Acanthosis nigricans

Acanthosis nigricans is characterized by dark, velvety patches of skin, usually in body folds and creases. It is often associated with insulin resistance, obesity, and certain endocrine disorders. It is not a common manifestation of liver disease.

Choice C Reason: Hemosiderin staining

Hemosiderin staining refers to the deposition of iron in the skin, which can cause a brownish discoloration. This condition is more commonly associated with chronic venous insufficiency or hemochromatosis, a genetic disorder that causes iron overload. It is not a typical symptom of liver disease.

Choice D Reason: Pruritus

Pruritus, or itching, is a common symptom of liver disease. It is often caused by the accumulation of bile salts in the skin due to impaired bile flow, a condition known as cholestasis. This symptom can be particularly distressing for patients and is a significant indicator of liver dysfunction.

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Correct Answer is A

Explanation

Choice A Reason: WBC Count 22,000/mm³

A white blood cell (WBC) count of 22,000/mm³ is significantly higher than the normal range, which is typically between 4,000 and 11,000/mm³. An elevated WBC count, known as leukocytosis, often indicates the presence of an infection as the body produces more white blood cells to fight off pathogens. This elevated count can also be seen in other conditions such as inflammation, stress, or bone marrow disorders, but it is a strong indicator of infection.

Choice B Reason: Hgb 15 g/dL

Hemoglobin (Hgb) levels of 15 g/dL fall within the normal range for adults, which is generally 13.8 to 17.2 g/dL for males and 12.1 to 15.1 g/dL for females. Normal hemoglobin levels indicate that the blood’s oxygen-carrying capacity is adequate and do not specifically point to an infection.

Choice C Reason: Creatine kinase 75 units/L

Creatine kinase (CK) levels of 75 units/L are within the normal range, which is typically 24 to 204 U/L. CK is an enzyme found in the heart, brain, and skeletal muscle, and elevated levels can indicate muscle damage, myocardial infarction, or other conditions affecting these tissues. However, normal CK levels do not indicate the presence of an infection.

Choice D Reason: Platelet count 200,000/mm³

A platelet count of 200,000/mm³ is within the normal range, which is generally between 150,000 and 450,000 platelets per microliter of blood. Platelets are involved in blood clotting, and normal levels do not indicate an infection. Abnormal platelet counts can be associated with bleeding disorders or thrombosis, but a normal count does not suggest an infection.

A. “It is important to follow up with a GI specialist for recommended surveillance for Barrett’s esophagus.” B. “You will need to monitor for manifestations of liver issues.” C. “Follow up with an endocrinologist as your risk for diabetes increases.” D. “It is important to watch for manifestations of pancreatic cancer.”

Correct Answer is A

Explanation

Choice A Reason:

This is the correct answer. Long-term GERD can lead to Barrett’s esophagus, a condition where the esophageal lining changes and can increase the risk of developing esophageal cancer. Regular surveillance by a GI specialist is crucial for early detection and management of Barrett’s esophagus.

Choice B Reason:

Monitoring for liver issues is not directly related to GERD. While liver health is important, it is not a primary concern for patients with long-term GERD.

Choice C Reason:

There is no direct link between GERD and an increased risk of diabetes. Therefore, follow-up with an endocrinologist for diabetes risk is not specifically relevant to GERD management.

Choice D Reason:

Pancreatic cancer is not a known complication of GERD. The primary concerns with long-term GERD are esophageal complications, such as Barrett’s esophagus and esophageal cancer.

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A nurse is caring for a client who has a new diagnosis of liver disease. Which of the following manifestations should the nurse expect?

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