A client with liver failure is at an increased risk of bleeding due to the inability to synthesize prothrombin in the liver. What factor most likely contributes to this loss of function?

Correct Answer: D

Rationale: The correct answer is D: Inability of the liver to use vitamin K. Vitamin K is essential for the synthesis of clotting factors, including prothrombin. In liver failure, impaired function leads to reduced production of bile, which is necessary for the absorption of fat-soluble vitamins like vitamin K. This results in inadequate activation of clotting factors and increased risk of bleeding. Choices A, B, and C are incorrect as alterations in glucose metabolism, retention of bile salts, and inadequate albumin production do not directly impact the synthesis and activation of clotting factors like prothrombin in liver failure.

Correct Answer: A

Rationale: The correct answer is A: Immunization. Hepatitis B is a viral infection transmitted through exposure to infected blood or body fluids. Immunization with the hepatitis B vaccine is the most effective preventative measure, providing long-term protection against the virus. Chronic tonsillitis (B) is unrelated to hepatitis B prevention. Consumption of a vitamin-rich diet (C) and annual vitamin K injections (D) do not offer protection against hepatitis B. Immunization is the best choice due to its proven efficacy in preventing hepatitis B transmission.

Correct Answer: D

Rationale: The correct answer is D: IV administration of octreotide. Octreotide is indicated for variceal bleeding as it reduces portal venous pressure, decreases blood flow to varices, and inhibits release of vasoactive substances. It helps control bleeding and stabilize the patient. Heparin (A) is not indicated for variceal bleeding. Albumin (B) may be used for volume resuscitation but does not address the bleeding. Vitamin K (C) is used for coagulation disorders, not variceal bleeding.

Correct Answer: B

Rationale: The correct answer is B because adhering to dosing recommendations of over-the-counter analgesics can help prevent drug-induced hepatitis by avoiding potential liver damage from excessive doses. Over-the-counter analgesics like acetaminophen can be hepatotoxic if taken in high amounts. Finishing all prescribed courses of antibiotics (A) is important for antibiotic resistance but does not specifically prevent drug-induced hepatitis. Ensuring safe disposal of expired medications (C) is crucial for environmental safety but does not directly prevent drug-induced hepatitis. Having pharmacists review drug regimens for potential interactions (D) is important for overall medication safety but does not specifically address the prevention of drug-induced hepatitis.

Correct Answer: C

Rationale: The correct answer is C: Stage 3. In hepatic encephalopathy, Stage 3 is characterized by severe confusion, difficulty arousing from sleep, and potential development of rigid extremities due to worsening brain function. This stage indicates significant impairment and requires immediate medical attention. Stage 1 and 2 are milder forms with less severe symptoms, while Stage 4 represents coma and severe neurological dysfunction, which is beyond the presented symptoms. Therefore, based on the client's clinical findings of confusion, difficulty arousing from sleep, and rigid extremities, Stage 3 is the most appropriate stage to document.