# A nurse is assessing a 45-year-old patient who presents with fever, malaise, and dark urine. Laboratory results show elevated ALT and AST levels. Which assessment finding would be most indicative of acute hepatitis A infection? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540567 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 45-year-old patient who presents with fever, malaise, and dark urine. Laboratory results show elevated ALT and AST levels. Which assessment finding would be most indicative of acute hepatitis A infection? ## 보기 1. Presence of spider angiomata and palmar erythema 2. Recent consumption of contaminated food or water **✔ 정답** 3. History of intravenous drug use or unprotected sexual contact 4. Gradual onset of symptoms over several months with progressive fatigue **정답: 2** ## 해설 Hepatitis A is transmitted through the fecal-oral route, commonly through contaminated food or water. The incubation period is typically 2-4 weeks, making recent exposure to contaminated sources the most indicative assessment finding for acute hepatitis A infection. Option 1: Spider angiomata and palmar erythema are signs of chronic liver disease (e.g., cirrhosis), not specific to acute hepatitis A. Option 3: Intravenous drug use or unprotected sexual contact are risk factors for hepatitis B or C, not hepatitis A. Option 4: Gradual onset over months suggests chronic hepatitis (e.g., hepatitis B or C), not acute hepatitis A which typically has a sudden onset. ## 심화 해설 Understanding Hepatitis A Transmission Hepatitis A virus (HAV) is primarily transmitted via the fecal-oral route. This means the virus is shed in the stool of an infected person and enters a new host through the mouth, most commonly via ingestion of contaminated food or water. The provided study on hospitalized HAV cases in Bulgaria reinforces that HAV infection remains a significant public health issue linked to sanitation and hygiene, with outbreaks often tied to common-source food or water contamination. For a patient presenting with acute symptoms like fever, malaise, dark urine, and elevated liver enzymes (ALT and AST), a history of recent consumption of potentially contaminated food or water is the most direct epidemiological clue pointing toward an acute HAV infection. Why Other Options Are Less Indicative The other assessment findings are more characteristic of chronic liver disease or other types of viral hepatitis, not an acute HAV infection. - **Option 1:** Spider angiomata and palmar erythema are cutaneous signs of chronic liver dysfunction and hyperestrogenism, typically seen in cirrhosis. Acute HAV infection, while causing acute liver inflammation, does not usually produce these stigmata of chronic liver disease. - **Option 3:** A history of intravenous drug use or unprotected sexual contact is a major risk factor for blood-borne hepatitis viruses, specifically Hepatitis B and Hepatitis C. While HAV can be transmitted through certain sexual practices that involve oral-anal contact, this is not its primary or most classic mode of transmission. - **Option 4:** A gradual onset of symptoms over several months with progressive fatigue is suggestive of a chronic, indolent process, most commonly associated with Hepatitis C. HAV causes an acute illness with a relatively abrupt onset and does not progress to a chronic carrier state. Clinical Reasoning and Test-Taking Strategy When the NCLEX-RN presents a cluster of symptoms suggestive of acute hepatitis (fever, malaise, dark urine, elevated ALT/AST), the question is testing your ability to differentiate between the types of viral hepatitis based on their transmission routes. The key is to link the specific risk factor to the most likely pathogen. The fecal-oral route is the hallmark of Hepatitis A, making the ingestion of contaminated food or water the most indicative assessment finding for this diagnosis [1]. References (research sources) - [1]Single-Center Retrospective Study of Hospitalized Hepatitis A Cases in Southern Bulgaria, 2015-2023.Research articleHristamyan M, Zlatanova S, Rangelova V, Tsachev I. (2026) · DOI: 10.3390/healthcare14101428 ## 임상 시나리오 Hepatitis A Risk AssessmentIdentifying the fecal-oral transmission route For a patient with acute fever, malaise, dark urine, and elevated ALT/AST, the most specific risk factor for Hepatitis A is recent ingestion of contaminated food or water. Differentiate from Hepatitis B/C by focusing on transmission: HAV is fecal-oral, while HBV/HCV are blood-borne (e.g., IV drug use, unprotected sex). CautionCutaneous signs like spider angiomata and palmar erythema indicate chronic liver disease (cirrhosis), not an acute HAV infection. A gradual symptom onset over months also points to a chronic process. ## 핵심 개념 - **Fecal-Oral Route** — A transmission pathway where pathogens from fecal particles enter a new host through the mouth, commonly via contaminated food or water. - **ALT (Alanine Aminotransferase)** — A liver enzyme released into the bloodstream when liver cells are damaged; elevated levels indicate acute liver injury. - **AST (Aspartate Aminotransferase)** — An enzyme found in the liver and other tissues; elevated levels, along with ALT, suggest hepatocellular damage. - **Spider Angiomata** — A vascular skin lesion with a central red arteriole and radiating branches, associated with chronic liver disease and hyperestrogenism. - **Cirrhosis** — Late-stage scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as chronic hepatitis. ## 같은 주제 문제 - [A nurse is assessing a 35-year-old patient who presents to the emergency department with a…](https://mymerci.kr/pages/nclex_q.php?qn_id=540559) - [A nurse is assessing a 60-year-old patient with suspected hepatitis B who presents with ja…](https://mymerci.kr/pages/nclex_q.php?qn_id=540560) - [A nurse is caring for a client with acute hepatitis B. 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