The nurse is caring for a male client with cirrhosis. Which assessment findings indicate that the client has deficient vitamin K absorption caused by this hepatic disease?
A. Dyspnea and fatigue
B. Ascites and orthopnea
C. Purpura and petechiae
D. Gynecomastia and testicular atrophy
Correct Answer: C. Purpura and petechiae
A hepatic disorder, such as cirrhosis, may disrupt the liver’s normal use of vitamin K to produce prothrombin (a clotting factor). Consequently, the nurse should monitor the client for signs of bleeding, including purpura and petechiae. Petechiae and purpura result from a wide variety of underlying disorders and may occur at any age. Petechiae are small (1–3 mm), red, non-blanching macular lesions caused by intradermal capillary bleeding. Purpura are larger, typically raised lesions resulting from bleeding within the skin
Option A: Dyspnea and fatigue suggest anemia. When patients with severe anemia develop a high output state, cardiac failure can ensue causing them to have shortness of breath from cardiac causes as well. Diseases in other organs, such as the kidneys and the liver, may cause dyspnea by a combination of the interactions discussed.
Option B: Ascites and orthopnea are unrelated to vitamin K absorption. Patients with malignant ascites can have symptoms related to malignancy, which may include weight loss. On the other hand, patients with ascites due to heart failure may report dyspnea, orthopnea, and peripheral edema, and those with chylous ascites report diarrhea, steatorrhea, malnutrition, edema, nausea, enlarged lymph nodes, early satiety, fevers, and night sweats.
Option D: Gynecomastia and testicular atrophy result from decreased estrogen metabolism by the diseased liver. Gynecomastia is most commonly caused by an imbalance between the hormones estrogen and testosterone. Estrogen controls female traits, including breast growth. Testosterone controls male traits, such as muscle mass and body hair.
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