NSB236 Exam Questions and Verified
Rationalized Answers | Already Graded
A+
Situation
Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which
has now required surgical intervention. Mr Butterworth is being admitted to
your ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-
barreled ileostomy brought out, a peritoneal washout performed, times two
Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side
80mls of haemoserous fluid) and mid-line abdominal closure performed.
Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2
litres of Hartman's solution. A quad (4) lumen central venous line, a Salem
sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC)
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,were inserted. On admission at 16:15 hours he has Hartman's solution
running at 125mls/hour, and an urinary output - ✔✔Key points:
Decreased urinary out indicator of decreased organ perfusion as evidenced
by decreased blood pressure.
Hypotension - related to the inflammatory process associated with sepsis
and vasodilatory effects of the inflammatory mediators.
Tachycardia - compensatory response to decreased blood pressure and
the bodies attempt to improve cardiac output (stroke volume x heart rate)
secondary to the decreased blood pressure and organ perfusion.
Tachypnea - an incresed respiratory effort to improve oxygenation
secondary to compromise organ perfusion and decreased Oxygenation
(supplemented via Hudson mask)
Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which
has now required surgical intervention. Mr Butterworth is being admitted to
your ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-
barreled ileostomy brought out, a peritoneal washout performed, times two
Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, 80mls of haemoserous fluid) and mid-line abdominal closure performed.
Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2
litres of Hartman's solution. A quad (4) lumen central venous line, a Salem
sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC)
were inserted. On admission at 16:15 hours he has Hartman's solution
running at 125mls/hour, and an urinary output of 70-90ml - ✔✔Elevated
white cell count: indication of increased white cell activity in response to a
systemic infection, in order to fight the invading bacteria.
Increased creatinine - indication of decreased renal function secondary to
decreased blood pressure and renal perfusion, that has occurred
secondary to the vasodilatory effects of sepsis and evidenced by
decreased urinary output.
Increased Alanine Aminotransferase (ALT) - liver enzyme: increased levels
secondary to decreased organ perfusion as a result of hypotension and
decreased end-organ perfusion, as a result of the vasodilatory effects of
sepsis. In low blood pressure states, blood is shunted to support critical
organs such as the heart, respiratory system and brain.
Mr Williams is day 2 postoperatively (appendectomy) on assessment this
morning, he is reporting abdominal discomfort with a pain score of 5/10, is
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
Rationalized Answers | Already Graded
A+
Situation
Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which
has now required surgical intervention. Mr Butterworth is being admitted to
your ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-
barreled ileostomy brought out, a peritoneal washout performed, times two
Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side
80mls of haemoserous fluid) and mid-line abdominal closure performed.
Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2
litres of Hartman's solution. A quad (4) lumen central venous line, a Salem
sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC)
1
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
,were inserted. On admission at 16:15 hours he has Hartman's solution
running at 125mls/hour, and an urinary output - ✔✔Key points:
Decreased urinary out indicator of decreased organ perfusion as evidenced
by decreased blood pressure.
Hypotension - related to the inflammatory process associated with sepsis
and vasodilatory effects of the inflammatory mediators.
Tachycardia - compensatory response to decreased blood pressure and
the bodies attempt to improve cardiac output (stroke volume x heart rate)
secondary to the decreased blood pressure and organ perfusion.
Tachypnea - an incresed respiratory effort to improve oxygenation
secondary to compromise organ perfusion and decreased Oxygenation
(supplemented via Hudson mask)
Mr. Johnson Butterworth is a 72-year-old man who was initially admitted 3
days ago for the conservative managed of a small bowel obstruction, which
has now required surgical intervention. Mr Butterworth is being admitted to
your ward post-operatively and has undergone a left hemicolectomy with
approximately 15cm of necrotic small bowel resected and a double-
barreled ileostomy brought out, a peritoneal washout performed, times two
Redivacs in situ to drain the pericolic gutter (Right side 100mls, Left side
2
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
, 80mls of haemoserous fluid) and mid-line abdominal closure performed.
Intra-operatively, Mr. Butternut received 4 units of blood and an additional 2
litres of Hartman's solution. A quad (4) lumen central venous line, a Salem
sump nasogastric tube (NGT) and an indwelling urinary catheter (IDC)
were inserted. On admission at 16:15 hours he has Hartman's solution
running at 125mls/hour, and an urinary output of 70-90ml - ✔✔Elevated
white cell count: indication of increased white cell activity in response to a
systemic infection, in order to fight the invading bacteria.
Increased creatinine - indication of decreased renal function secondary to
decreased blood pressure and renal perfusion, that has occurred
secondary to the vasodilatory effects of sepsis and evidenced by
decreased urinary output.
Increased Alanine Aminotransferase (ALT) - liver enzyme: increased levels
secondary to decreased organ perfusion as a result of hypotension and
decreased end-organ perfusion, as a result of the vasodilatory effects of
sepsis. In low blood pressure states, blood is shunted to support critical
organs such as the heart, respiratory system and brain.
Mr Williams is day 2 postoperatively (appendectomy) on assessment this
morning, he is reporting abdominal discomfort with a pain score of 5/10, is
3
©NINJANERD 2025/2026. YEAR PUBLISHED 2025.
