Medication Management for Cardiovascular Conditions, Exams of Nursing

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2024 NURS 221 EXAM ACTUAL EXAM 2 (VERSION A

AND B) QUESTIONS WITH ANSWERS

VERSION A

"-pril" - ANSWERMedications in the antihypertensive ACE-inhibitors class have what kind of ending? Hypertension, Heart failure, Myocardial infarction, Insulin resistance - ANSWERWhat are antihypertensive ACE-inhibitors used to treat? Kidneys - ANSWERACE inhibitors are protective of what organ? Hyperkalemia, Dry cough, Angioedema - ANSWERWhat are some side effects/adverse reactions of antihypertensive ACE-inhibitors? Angioedema - ANSWERACE-inhibitors are the #1 class of medication that causes what? Discontinuing the K+ supplement - ANSWERIf a patient is taking a K+ supplement and an antihypertensive ACE-inhibitor, what should the nurse/provider recommend? They do not cause dry cough/angioedema/hyperkalemia - ANSWERAntihypertensive Angiotensin Receptor Blockers (ARBs) are similar to ACE-inhibitors except for what? "-sartan" - ANSWERWhat ending do ARBs have? Losartan (Cozaar), Olmesartan (Benicar) - ANSWERWhat are two medications in the ARBs class? Block the release of aldosterone, Promote excretion of sodium/water, Retain potassium

• ANSWERAldosterone antagonists do what? Hyperkalemia - ANSWERWhat is a side effect of aldosterone antagonists? Spironolactone (Aldactone) - ANSWERWhat aldosterone antagonist reduces testosterone?

Loop diuretics, Thiazide diuretics, Potassium-sparing diuretics - ANSWERWhat are the three types of antihypertensive diuretics? Potassium - ANSWERWhat do loop diuretics and thiazide diuretics not spare? Potassium supplement - ANSWERSince loop diuretics and thiazide diuretics do not spare potassium, what should be taken in tandem with these medications? Anuric - ANSWERDiuretics should never be given if a patient is completely what? Congestive heart failure, Hypertension, Acute/Chronic renal failure - ANSWERWhat are some clinical indications for antihypertensive diuretics? Furosemide (Lasix) - ANSWERWhat medication is an antihypertensive loop diuretic? Spironolactone (Aldactone) - ANSWERWhat medication is a potassium- sparing diuretic? Hydrochlorothiazide (HCTZ, HydroDiuril, Esidrix) - ANSWERWhat medication is a thiazide diuretic? Ototoxicity - ANSWERFurosemide may cause what? Hypokalemia, Orthostatic hypotension - ANSWERWhat are some side effects/adverse reactions for loop and thiazide diuretics? Hyperkalemia - ANSWERWhat is a side effect/adverse reaction to potassium- sparing diuretics? Digitalis - ANSWERWhat medication does not play well with loop diuretics? Mannitol (Osmitrol) - ANSWERWhat medication is used to bring down intracranial pressure? Classic angina (Exertional angina) - ANSWERWhat kind of angina is usually associated with coronary atherosclerosis, can be precipitated by cold/exertion/stress, and is characterized by pain that lasts for 15 minutes then disappears? Unstable angina (Crescendo or Pre-infarction angina) - ANSWERWhat kind of angina is progressive, more frequent, and severe? Variant angina (Prinzmetal's or Vasospastic angina) - ANSWERWhat kind of angina is associated with probable spasms of the coronary arteries, occurs at rest, and usually follows a regular pattern?

Nitrates - ANSWERWhat kind of medication is used to treat angina pectoris and PVD and causes vasodilation? Nitroglycerin - ANSWERWhat medication is sensitive to light and must be kept in amber bags? Headache - ANSWERWhat is the most common complaint for people taking nitroglycerin? 3 - ANSWERHow many doses of nitroglycerin can be given before calling 911? 8-12 hours - ANSWERThe "nitrate free" period should be how long? Head injury - ANSWERYou should be cautious with what condition when administering nitroglycerin? Erectile dysfunction medications - ANSWERWhat kind of medication should be avoided when taking nitroglycerin? Morphine, Oxygen, Nitroglycerin, Aspirin - ANSWERWhat medications should be given for chest pain? (HINT: think MONA) "-lol" - ANSWERWhat ending do beta-blocker medications have? Hypertension, Myocardial infarction, CHF - ANSWERWhat conditions are treated with beta blockers? Fatigue, Sexual dysfunction, Dizziness - ANSWERWhat are some side effects of beta blockers? Patients with heart blocks, HR <60, Systolic BP <90 mm Hg - ANSWERWhat are some contraindications for beta blockers? Rebound effect (tachycardia) - ANSWERWhat is a danger that must be considered when stopping beta blockers?

1. Decreases the force of contraction
2. Decreases heart rate
3. Vasodilation of the coronary arteries - ANSWERWhat are the three actions of calcium channel blockers? Lower BP - ANSWERCalcium channel blockers do what? Dizziness, Headache (due to vasodilation) - ANSWERWhat is a side effect of calcium channel blockers?

"-ipine" - ANSWERWhat ending do dihydropyridines have? Amlodipine (Norvasc) - ANSWERWhat is the most common dihydropyridine? A fib, HTN, Angina Pectoris, SVT (supraventricular tachycardia) - ANSWERWhat are some clinical indications for calcium channel blockers? Ankle edema - ANSWERWhat is a side effect/adverse reaction for calcium channel blockers? HR <60, Systolic BP <90 mm Hg - ANSWERCalcium channel blockers should be held under what conditions? Hypertensive crisis - ANSWERWhat is a primary indication for vasodilators? Orthostatic hypertension, Reflex tachycardia - ANSWERWhat are some side effects of vasodilators? Expansion of blood volume - ANSWERWhat is an adverse reaction of vasodilators? RBCs (red blood cells) - ANSWERLevels of what kind of cell can rise when taking vasodilators? Systemic Lupus Erythematosus (SLE) - ANSWERThe medication hydralazine (Apresoline) can cause symptoms similar to what condition? Hypertrichosis (excessive hair growth) - ANSWERMinoxidil (Loniten) is a vasodilator that can cause what unique effect? Cyanide - ANSWERSodium nitroprusside (Nipride) is the fastest anti- hypertension medication. However, it has a dangerous end product. What is this dangerous end product? Chest pain, Peripheral pain, SOB, Dizziness, Nausea, Sweating - ANSWERWhat are some signs and symptoms of acute coronary syndrome (ACS)? <200 mg/dl - ANSWERWhat is the desirable level for total cholesterol? 200-239 mg/dl - ANSWERWhat is the at risk range for total cholesterol?

240 mg/dl - ANSWERWhat is a high risk for cholesterol? <100 mg/dl - ANSWERWhat should your LDL range be? The "-statins" - ANSWERHMG CoA Reductase Inhibitors are also known as what?

Reduce LDLs, Elevate HDLs, Promote plaque stability - ANSWERWhat do The "- statins" do? Baseline liver function test - ANSWERBefore prescribing a "-statin", what must be taken? The medication must be discontinued and no medication in this class may ever be given to the patient again - ANSWERIf a patient is experiencing myopathy (muscle pain) while on a "-statin", what must be done? Simvastatin (Zocor) - ANSWERWhat is the most common "-statin"? Bile Acid Sequestrants - ANSWERWhat is used as an adjunct therapy with the "- statins"? Cholestyramine (Questran) - ANSWERWhat is a common bile acid sequestrant? Constipation, Diarrhea, Flatulence, Dyspepsia (indigestion) - ANSWERWhat is a side effect of bile acid sequestrants? Niacin (Niaspan) - ANSWERWhat medication should only be used for those with severely elevated triglycerides (>500 mg/dL)? Flushing ("Niacin Flush"), Pruritis - ANSWERWhat is a common side effect of Niacin (Niaspan)? Widening QRS, Lengthening PR interval - ANSWERWhen taking Na+ channel blockers, what will you notice about the ECG? Procainamide (Pronestyl) - ANSWERWhat is the main Na+ channel blocker? Myasthenia gravis - ANSWERNa+ channel blockers should not be given to patients with what condition? QRS widens >25%, P-wave abolition - ANSWERWhat are some toxic effects of Na+ channel blockers? Lidocaine (Xylocaine) - ANSWERWhat is a Na+ channel blocker that is used to treat tachycardia? Prolonged PR interval, Prolonged QRS complex, Aggravation of preexisting dysrhythmia - ANSWERWhen administering Lidocaine (Xylocaine), you should stop the infusion immediately if what is noted? Amiodarone (Cordarone) - ANSWERWhat Na+ channel blocker is used to treat supraventricular tachycardia (SVT)?

Ventricular tachycardia (V-tach), Ventricular fibrillation (V-fib) - ANSWERK+ channel blockers are often used for what conditions? Prolong rest period of the heart - ANSWERWhat do K+ channel blockers do? Adenosine (Adenocard) - ANSWERWhat is an unclassified antidysrhythmic medication that has a half life of 6-10 seconds? Two nurses (at least must be present), Must give three doses, The first dose should be 6 mg, Second dose must be 12 mg, Third dose must be 12 mg, Flush must be done immediately, All injections must be done immediately after each other - ANSWERWhat are some specific procedures that must be undertaken when giving Adenosine? About 1.5 hours - ANSWERHeparin has a half-life of how long? PE, DVT, DIC - ANSWERWhat is heparin used for? Hemorrhage, Heparin-induced thrombocytopenia (HIT) - ANSWERWhat are some side effects/adverse reactions of heparin? Protamine sulfate - ANSWERWhat is the antidote of heparin? PTT - ANSWERWhat is used to monitor heparin's effectiveness? PT - ANSWERWhat is used to monitor warfarin (coumadin)'s effectiveness? Enoxaparin (Lovenox) - ANSWERWhat is the most popular low-molecular- weight heparin? Vitamin K - ANSWERWhat is the antidote for warfarin (coumadin)? Delay in action - ANSWERWhat is the drawback of warfarin? Hemorrhage, Red-orange color of urine - ANSWERWhat are some side effects of warfarin? Treats pain, Suppresses cough, Vasodilates - ANSWERWhat are some effects of morphine? Respiratory depression - ANSWERWhen dealing with an opioid analgesic, what should you monitor for in patients? Narcan (Naloxone) - ANSWERWhat is a common opioid antagonist? GI upset - ANSWERWhat is a common side effect of long-term opioid analgesic use?

Increased capillary permeability, Bronchoconstriction, Increased mucus production - ANSWERWhat effects do histamines have on the body? Decrease edema, suppress mucus production - ANSWERWhat do antihistamines do? SNS - ANSWERAdrenergic medication can cause similar reactions to activating what system? Epinephrine - ANSWERWhat is a common adrenergic medication? Suppress inflammation, Suppress pain, Suppress fever - ANSWERCOX inhibitors do what? Tinnitus - ANSWERA hallmark sign that the level of COX inhibitors in the body becomes supratherapeutic is what? Acetylcysteine (Mucomyst) - ANSWERWhat is an antidote for acetaminophen? Ibuprofen (Advil, Motrin), Naproxen (Naprosyn, Aleve) - ANSWERWhat are two common first generation non-selective COX inhibitor NSAIDs? C. 119/52 - ANSWERWhich of the following blood pressure readings is considered normal? A. 126/ B. 180/ C. 119/ D. 142/ A. Hyperkalemia - ANSWERA side effect of furosemide (Lasix) includes all of the following except? A. Hyperkalemia B. Increased urination C. Increased thirst D. Dizziness A. - Chronotropic effect - ANSWERA unique feature of dihydropyridine calcium channel blockers is that they lack which effect compared to non- dihydropyridine calcium channel blockers? A. - Chronotropic effect B. - Inotropic effect C. Vasodilation

B - ANSWERA patient who was newly prescribed atorvastatin for hyperlipidemia calls the family practitioner requesting an appointment for body aches that started three days after beginning the medication. Which of the following statements made by the provider would be correct in this situation? A. "Have you received your flu shot this year?" B. "You may be experiencing a side effect of the atorvastatin." C. "Take 650 mg of Tylenol and call me back in four hours." D. "Try doubling your water intake."

2. +chronotropic - ANSWERWhich medication is appropriate for a patient who is systematically bradycardic?
3. +dromotrope
4. +chronotropic
5. • inotropic
6. • vasotrope
7. Fluid overload - ANSWERAn adrenergic medication is contraindicated in which patient condition?
8. Hypotension
9. Bradycardia
10. Fluid overload
11. Bronchoconstriction Acetaminophen (Tylenol) - ANSWERWhich over-the-counter medication is not the best choice for a patient with dental pain related to irritation and swelling of the gums?
12. Acetaminophen (Tylenol)
13. Naproxen sodium (Aleve)
14. Ibuprofen (Motrin)
15. Aspirin (Bayer)
16. Dyspnea - ANSWERA common side effect of opioid use includes all except for which of the following?
17. Dizziness
18. Drowsiness
19. Constipation
20. Dyspnea

4. Decreased capillary permeability - ANSWERAntihistamine use can result in which of the following?
5. Vasodilation
6. Bronchoconstriction
7. Increased mucus production
8. Decreased capillary permeability
9. General - ANSWERA patient who is receiving anesthesia that results in complete cessation of gross movements and sensation is receiving which kind of anesthesia?
10. General
11. Topical
12. Local
13. Regional
14. • ANSWERWhen educating a patient about oral iron therapy, the nurse realizes the patient needs further instruction when they state:
15. "I'll have my spouse stop by the grocery store for some orange juice for when I take my medication."
16. "I'll have to eliminate caffeine from my diet."
17. "It's best to take my medication on an empty stomach."
18. "Dark stools may occur while taking this medication." VERSION B Cations - ANSWERions with a positive charge Anions - ANSWERions with a negative charge Passive transport - ANSWERthe movement of substances across a cell membrane without the use of energy by the cell Active transport - ANSWERthe movement of materials through a cell membrane using energy Sodium potassium pump - ANSWERa carrier protein that uses ATP to actively transport sodium ions out of a cell and potassium ions into the cell Normal pH of the body - ANSWER7.35-7.

Hypovolemia - ANSWERdecreased blood volume Hypervolemia - ANSWERincreased blood volume Examples of hypovolemia - ANSWERhemorrhage and dehydration Examples of Hypervolemia - ANSWERwater intoxication and edema Extracellular - ANSWERoutside the cell Cirrhosis - ANSWERliver disease characterized by interference of local blood flow and hepatocyte damage Causes of cirrhosis - ANSWERhepatitis and chronic alcohol abuse, altered fluid balance Ascites - ANSWERabnormal accumulation of fluid in the abdomen Hypernatremia - ANSWERhigh sodium Hyperkalemia - ANSWERhigh potassium Hyperchloremia - ANSWERhigh chloride Hypercalcemia - ANSWERhigh calcium Hypermagnesium - ANSWERhigh magnesium levels in blood Hyperphosphatemia - ANSWERhigh phosphate Clinical manifestations of dehydration - ANSWER-decreased LOC -prolonged capillary --refill time -dry mucous membranes -decreased or absent tears -change In vital signs -depressed fontanel -decreases or absent urine output Acids - ANSWERsubstances that donate hydrogen ions Bases - ANSWERsubstances that accept hydrogen ions pH - ANSWERclinical measurement of acid:base ratio Buffer system - ANSWERA mixture of an acid and a base which resists changes in pH

Types of buffer systems - ANSWER-plasma -respiratory -renal Plasma buffer system - ANSWERreacts within seconds in response to hydrogen ion concentration Respiratory buffer system - ANSWERreacts within minutes to excrete CO through change in respiratory rate Renal buffer system - ANSWERreacts within hours to days through the production, absorption, and excretion of acids, bases, and ions Plasma buffer system - ANSWER-bicarbonate -protein -potassium- hydrogen exchange Metabolic acidosis - ANSWERlow pH, low HCO Clinical manifestations of metabolic acidosis - ANSWER- Anorexia

• Nausea
• Vomiting
• Weakness
• Lethargy
• Confusion
• Coma
• Vasodilation
• Decreased heart rate
• Flushed skin Metabolic alkalosis - ANSWERhigh pH, high HCO What can cause metabolic alkalosis? - ANSWERvomiting, anxiety Cerebrovascular circulation - ANSWER1. provides oxygen and nutrients for metabolism and function to the brain

2. maintains perfusion to the brain to prevent cell injury/ death Blood-brain barrier - ANSWERa filtering mechanism of the capillaries that carry blood to the brain and spinal cord tissue, blocking the passage of certain substances. Cerebrospinal fluid - ANSWERFluid in the space between the meninges that acts as a shock absorber that protects the central nervous system.

Cerebral Palsy - ANSWERparalysis caused by damage to the area of the brain responsible for movement Clinical manifestations of cerebral palsy - ANSWER-limited fine motor skills -lack of coordination and balance -impaired cognitive function -speech disorder -seizure disorder Multiple Sclerosis - ANSWERA chronic disease of the central nervous system marked by damage to the myelin sheath Hydrocephalus - ANSWERaccumulation of fluid in the spaces of the brain How is hydrocephalus caused? - ANSWER-Born with damage to ventricles -intraventricular hemorrhage -neural tube defect -brain tumor -meningitis -traumatic injury -CSF flow obstruction -impaired CSF absorption Negative feedback loop - ANSWERA feedback loop that causes a system to change in the opposite direction from which it is moving Positive feedback loop - ANSWERfeedback loop that causes a system to change further in the same direction Hyponatremia - ANSWERlow sodium in the blood SIADH - ANSWERsyndrome of inappropriate antidiuretic hormone SIADH pathophysiology - ANSWER-excess production and release of ADH -most often caused by tumor secreting ectopic ADH ADH - ANSWERpromotes retention of water by kidneys Clinical manifestations of SIADH - ANSWER•Decreased urine output (concentrated) •Severity of symptoms depends on serum sodium levels -Anorexia, nausea, vomiting, headache -Irritability, disorientation, cramps, weakness -Psychosis, gait disturbances, seizures, coma Treatment of SIADH - ANSWER-remove cause

-water restriction -isotonic or hypertonic IV replacement -pharmacologic treatment Diabetes Insipidus - ANSWER-insufficient ADH -inability to concentrate or retain water -causes by insufficient ADH production or secretion -caused by inadequate kidney response to ADH -caused by water intoxication DI clinical manifestations - ANSWER-polyuria -excessive thirst -dehydration

• shock -death if untreated How is DI diagnosed - ANSWER-lab tests -urine specific gravity How is DI treated - ANSWER-hydration -desmopressin Hyperthyroidism - ANSWERexcessive activity of the thyroid gland Hyperthyroidism pathophysiology - ANSWERcondition of excess thyroid hormone due to: excess stimulation of thyroid gland, disease of thyroid gland, excess production of TSH Most common cause of hyperthyroidism - ANSWERGraves disease: graves disease: most common form in U.S.: autoimmune disorder of unknown etiology IgG binds to TSH receptors on thyrocytes Graves disease clinical manifestations - ANSWER-Goiter -Weight loss -Agitation -Restlessness -Sweating -Heat intolerance -Diarrhea -Tachycardia -Palpitations -Tremors -Fine hair, oily skin -Irregular menstrual cycle
• Weakness

-Exophthalmos What levels are high in graves disease - ANSWERT3 and T Treatment for graves disease - ANSWER-medications that block thyroid hormone production -destructiton of all or part of gland with radioactive iodine Hypothyroidism - ANSWERA disorder caused by a thyroid gland that is slower and less productive than normal Hypothyroidism pathophysiology - ANSWER•Congenital or acquired deficiency of thyroid hormone (TH) from: -Lack of thyroid gland development -Deficient synthesis of TH -Destruction of thyroid gland -Impaired secretion of TSH or TRH •Many potential causes such as autoimmunity, genetic defects, injury to gland, iodine deficiency Hypothyroidism clinical manifestations - ANSWER•Fatigue, weakness, lethargy, weight gain •Cold intolerance •Constipation •Dry skin, course hair •Impaired reproduction •Impaired memory •Goiter, myxedema Where is urine produced - ANSWERkidneys Renal system - ANSWER-Regulates body fluid volume/composition -Eliminates metabolic wastes -Synthesizes, releases, or activates hormones -Regulates blood pressure Nephron - ANSWERfunctional unit of the kidney Which kidney sits higher - ANSWERleft kidney Glomerular filtration rate (GFR) - ANSWERthe amount of filtrate in nephrons/ minute What affects GFR - ANSWER-changes in net filtration pressure -blood volume** -pressure in bowman capsule

Tubuloglomerular feedback - ANSWERmechanism by which glomerulus receives feedback on the status of the downstream tubular fluid and adjusts filtration to regulate the composition of the fluid, stabilize its own performance, and compensate for fluctuation in systemic blood pressure Polycystic Kidney Disease (PKD) - ANSWERmultiple fluid-filled sacs (cysts) within and on the kidney -reduced perfusion -tubule obstruction PKD categories - ANSWER-Genetic, autosomal dominant -Genetic, autosomal recessive -Acquired PKD clinical manifestations - ANSWER•Enlarged kidneys •Hypertension •Flank pain •Altered fluid and electrolyte balance •Renal calculi

• UTI Chronic renal failure - ANSWERgradual and progressive loss of kidney function Minimum urine output - ANSWER30 mL/hr Acute tubular necrosis - ANSWERdamage to the renal tubules due to presence of toxins in the urine or to ischemia What makes stool brown - ANSWERstercobilin (bile pigment) Urolithiasis - ANSWERkidney stones Pathophysiology of urolithiasis - ANSWER•Stones form when urinary concentrations of substances increase. IT CAN COME FROM DIFF TYPES OF COMPOSITION. COMMON- INCREASE IN CALCIUM. Renal calculi - ANSWERkidney stones Urolithiasis clinical manifestations - ANSWERPain: colic - distention of collecting system or ureter, characterized as acute, intermittent, radiating, excruciating. Non-colic - distention of renal calices or pelvis, characterized a dull, deep with varying intensity (mild to severe).

Urolithiasis treatment - ANSWERsupportive treatment for symptom management: pharmacologic - pain control; calculi removal - increased fluid intake, reduction of calculi size, surgical calculi removal; prevention - diet with foods low in calcium oxalate What happened during urinary incontinence - ANSWERthey lose their muscle tone Most common genetic disorder that affects the kidney - ANSWERPKD First s/s of PKD - ANSWERhypertension GERD (gastroesophageal reflux disease) - ANSWERbackflow of gastric contents into the esophagus due to a malfunction of the sphincter muscle at the inferior portion of the esophagus Barretts esophagus - ANSWERa condition that occurs when the cells in the epithelial tissue of the esophagus are damaged by chronic acid exposure What labs increase in PKD - ANSWER-creatnine

• BUN What lab decreases in PKD - ANSWERGFR Peptic Ulcer Disease (PUD) - ANSWERsores that affect the mucous membranes of the digestive system Major cause of PUD - ANSWERH. pylori S/S of PUD - ANSWER-epigastric burning pain usually relieved by food intake or antacids -gastric pain occurs on empty stomach or soon after a meal -duodenal pain 2-3 hours after meal and relieved by ingesting more food Complications of PUD - ANSWER-GI bleed/ hemorrhage -obstruction -perforation Cholelithiasis - ANSWERgallstones in the gallbladder Types of cholelithiasis - ANSWERCholesterol (most common) and pigmented (cirrhosis) Factors affecting formation of cholelithiasis - ANSWER-abnormal bile composition -bile stasis -gallbladder inflammation

Cholecystitis - ANSWERinflammation of the wall of the gallbladder -related to continued presence of gallstones Acute cholecystitis - ANSWERthe sudden onset of gallbladder inflammation Chronic cholecystitis - ANSWERcholecystitis that results from the intermittent obstruction of the cystic duct by gallstones Acute pancreatitis - ANSWER-autodigestion and inflammation of pancreas from enzymes -abrupt onset epigastric pain Chronic pancreatitis - ANSWER-chronic inflammatory lesions in pancreas, insidious onset -steady, boring epigastric pain radiating to back/ nausea Hepatocellular failure - ANSWERDecreases albumin synthesis and clotting factor synthesis. Prolonged PT - PTT in severe disease - tx with fresh frozen plasma. Portal Hypertension - ANSWERGI congestion, development of esophageal or gastric varices, hemorrhoids, splenomegaly, ascites Ascites - ANSWERabnormal accumulation of fluid in the abdomen -occurs with portal hypertension and hypoalbuminemia Clinical manifestations of hepatocellular failure - ANSWER-jaundice -impaired protein metabolism -muscle wasting -ascites -impaired absorption of fat soluble vitamins: A,D,E,K -altered lipoprotein processing -abnormal storage of glycogen and release of glucose Jaundice - ANSWERtoo much bilirubin for liver to clear in blood or body tissues which causes yellowing End product of RBC hemolysis - ANSWERbilirubin How is bilirubin transported to the liver - ANSWERby albumin Portal hypertension - ANSWERsluggish blood flow resulting in increased pressure in portal circulation -congested venous drainage of the GI tract

Portal Hypertension clinical manifestations - ANSWER-Anorexia -Varices (esophageal, gastric, hemorrhoidal) can rupture; cause uncontrolled bleeding -Ascites Liver function tests - ANSWERtests for the presence of enzymes and bilirubin in blood ALT (alanine aminotransferase) - ANSWERliver specific AST (aspartate aminotransferase) - ANSWERliver and other organs What two enzymes rise when liver cells are damaged? - ANSWERALT** AST