The nurse notes new areas of ecchymosis on the arms and legs of a patient with liver cirrhosis. Which laboratory test results should the nurse monitor because of this finding?

Question

Select all that apply.
1. complete blood count with platelets
2. coagulation studies
3. serum albumin
4. serum ammonia levels
5. serum hepatitis antibodies

Answer 1

Correct Answer: 1, 2
A CBC with platelets should be monitored. A low RBC count, hemoglobin, and hematocrit indicate anemia related to bone marrow suppression, increased RBC destruction, bleeding, and deficiencies of folic acid and vitamin B12. Platelets are low, related to increased destruction by the spleen. Leukopenia (low WBC count) also relates to splenomegaly. Coagulation studies reveal the patient's tendency to bleed and the ability of the blood to clot. These studies show a prolonged prothrombin time due to impaired production of coagulation proteins and lack of vitamin K. Both the CBC and coagulation studies are key parts of the nurse's analysis of this patient's condition. Albumin levels reflect liver impairment and/or nutritional status and are not related to risk for bleeding. Serum ammonia levels elevate during liver failure due to the liver's inability to convert ammonia to urea for renal excretion. This test does not provide information regarding bleeding risk. Testing for the presence of hepatitis antibodies in the blood does not provide information regarding coagulation.