Family Nurse Practitioner Exam

A patient is positive for anti-HCV. What is the next step to further evaluate this patient?

1. Refer the patient to a gastroenterologist

2. Order a hepatitis C PCR test

3. Order a hepatitis B comprehensive panel

4. The patient is immune to hepatitis C and no further testing is indicated

The correct answer is: Order a hepatitis C PCR test

When a patient tests positive for anti-HCV antibodies, it indicates that they have been exposed to the hepatitis C virus (HCV). However, this initial antibody test does not differentiate between past infections that may have resolved spontaneously and current infections that require treatment and monitoring. The next appropriate step is to order a hepatitis C PCR (polymerase chain reaction) test. This test will detect the presence of the viral RNA in the blood, allowing the clinician to confirm if the infection is active. If the PCR test is positive, it confirms a current active hepatitis C infection, and further evaluation and management can proceed, potentially including genotyping and assessing the extent of liver disease. While referring the patient to a gastroenterologist could be relevant later in the management of chronic hepatitis C, it is premature without confirming an active infection. Ordering a hepatitis B comprehensive panel or suggesting that the patient is immune to hepatitis C would not be warranted in this situation, as neither addresses the need to confirm current infection status after a positive anti-HCV test.