Progressive Care Nursing Certification (PCCN) Practice Exam

In a patient with hepatic failure related to hepatitis B, which intervention should be anticipated?

1. Arterial blood gas monitoring BID and preparing the patient for a CT of the head

2. Checking blood sugar TID and hourly mental status assessment

3. Assessing ammonia levels BID and phosphorus levels daily

4. Preparing the patient for a liver biopsy and transfusing FFP BID

The correct answer is: Checking blood sugar TID and hourly mental status assessment

In patients with hepatic failure, particularly those suffering from complications associated with acute or chronic liver disease like hepatitis B, regular monitoring of blood sugar levels and assessment of mental status is critical. Hepatic failure can lead to altered glucose metabolism, increasing the risk of hypoglycemia, particularly in patients who may also have impaired hepatic gluconeogenesis. Therefore, checking blood sugar three times daily helps in recognizing and managing this risk effectively. Additionally, hepatic encephalopathy, a condition frequently seen in liver failure, can lead to fluctuating levels of consciousness and cognitive function. Conducting hourly mental status assessments allows for early detection of any changes in neurological status, which could indicate worsening liver function or the development of complications such as hepatic encephalopathy itself. While monitoring ammonia levels and assessing phosphorus levels may also be relevant in the care of patients with liver failure, the primary concerns in this scenario focus on glucose regulation and neurological changes. Consequently, this combination of blood sugar monitoring and regular mental status checks is paramount in managing patients with hepatic failure effectively.