A nurse is completing a focused assessment on a client who has viral hepatitis. Which of the following findings should the nurse expect?

Nursing assessment of a client with viral hepatitis focuses on identifying liver inflammation, impaired bile processing, and systemic effects of hepatocellular injury. Viral hepatitis leads to impaired bilirubin metabolism due to hepatocyte damage, resulting in characteristic changes in urine and stool color. As liver function declines, bilirubin accumulates in the blood and is excreted through the kidneys. Recognizing these expected findings helps guide monitoring and supportive care. Rationale: A. A decrease in alkaline phosphatase level is not expected in viral hepatitis because liver inflammation typically causes elevated liver enzymes, including alkaline phosphatase, AST, and ALT. These enzymes rise due to hepatocellular injury and cholestasis. Therefore, a decreased level would not align with the typical laboratory findings of hepatitis. B. Melena stools are not a typical expected finding in uncomplicated viral hepatitis. While severe liver disease with portal hypertension can eventually lead to gastrointestinal bleeding, melena is not a routine or early manifestation. Instead, hepatitis is more commonly associated with light or clay-colored stools due to reduced bile excretion. C. A decrease in white blood cells is not a characteristic finding of viral hepatitis. In many viral infections, including hepatitis, WBC counts may remain normal or be slightly elevated depending on the stage of illness and immune response. Leukopenia is not a defining or expected feature of hepatic inflammation. D. Dark brown urine is an expected finding in viral hepatitis due to increased conjugated bilirubin excretion by the kidneys. When the liver is unable to properly process and excrete bilirubin through bile, it accumulates in the bloodstream and is filtered into urine. This results in tea-colored or dark urine, often occurring alongside jaundice and pale stools.