Acute Care AGACNP Test 1
Gastroenteritis
Crampy, at any age. Diarrhea, Nausea, and vomiting Food, fever, occasional relief from
diarrhea or vomiting, and hyperactive peristalsis Gastritis The patient's nature Especially
patients who are alcoholics Gastritis location of pain
Epigastrium
S/S appendicitis Vomiting (after pain has started)
Constipation
Fever
appendicitis
Early:epigastrium, periumbilicus Later: RLQ
Cholecystitis, cholelithiasis LOCATION OF PAIN
RUQ
extends to the right scapula's inferior angle. Cholecystitis, cholelithiasis-ASSOCIATED
SYMPTOMS
Vomiting and vomiting Dark urine, light stool
bloating; fatty foods Oral contraceptives and drugs Cholestyramine
Cholecystitis, cholelithiasis
Tenderness when pressed or felt in RUQ Diverticulitis
LLQ, LLQ's palpable mass Pancreatitis: Where the Pain Is epigastric LUQ radiates
backwards Factors that Ameliorate Pancreatitis Lying supine
Leaning forward
Pancreatitis-PHYSICAL FINDINGS
Abdominal distention
Decreased bowel sounds
Rebound spread out Murphy's sign
pancreatitis acute LUQ, epigastric
Radiates to back
Perforated ulcer in the stomach Epigastric tenderness on palpation or percussion
Dissection or rupture of aortic aneurysm
thorax or abdomen May radiate to back and leg
Murmurs
Plan-Do-Study-Act (PDSA) model
ECG with 12 leads ABG
Insufficiency of the vena Patient will have obesity or be pregnant or older
History of prolonged standing, family history of venous insufficiency
Reports leg edema
PE will show skin changes, ulceration, edema, varicose veins
Imaging will show valvular abnormalities
Diagnosis is made by history, physical exam
Valvular abnormalities are the most common cause. Treatment is leg elevation,
compression therapy, ulcer care, ablation
, A 34-year-old woman presents with palpitations. Which of the following might you expect to
hear on examination if she has mitral valve prolapse?
Click mid-systolic Prolapse of the Mitral Valve Patient presents with palpitations, dyspnea,
nonexertional CP, and fatigue
Most cases are asymptomatic
PE will show midsystolic click and late systolic murmur
↑ preload → ↓ murmur
↓ preload → ↑ murmur
Marfan syndrome, Ehlers-Danlos
Echo is used to make a diagnosis. A patient in the intensive care unit develops sinus
bradycardia with tall peaked T waves and absent P waves on ECG. Which electrolyte
abnormality is associated with these changes seen on ECG?
Hyperkalemia
Hyperkalemia
History of kidney failure, DKA, rhabdomyolysis, tumor lysis
Lethargy, weakness, paralysis
Dysrhythmias in the heart, hypotension, and bradycardia will be seen in the PE. ECG will
show peaked T waves, prolonged PR, wide QRS
Treatment is calcium gluconate, insulin, albuterol, bicarbonate
In cardiogenic shock, which of the following hemodynamic parameters decreases? Cardiac
output
How is cardiac index calculated?
Cardiac index = Cardiac output/Body surface area.
Of the following serum studies, which should be obtained frequently in a patient receiving
parenteral nutrition to monitor for complications of intravenous fat emulsion?
Triglycerides
What is the recommended treatment for parenteral nutrition-related hyperglycemia? Add
regular insulin to the parenteral nutrition preparation.
Convenience barrier can be
is a potential barrier to compliance, which can be impacted by access to healthcare,
medication administration methods, telemedicine, and additional factors
Health care disparities between races When compared to Caucasians, obstacles to
compliance are more prevalent among African-American and Hispanic populations.
Cholecystitis
Colicky, steadily increasing RUQ or epigastric pain after eating fatty foods
PE will show Murphy sign, Boas sign (hyperaesthesia, increased or altered sensitivity,
below the right scapula)
Diagnosis
First, the US Gold standard: HIDA
Most commonly caused by obstruction by a gallstone
Treatment is cholecystectomy
Syndrome of cerebral hyperperfusion Increased cerebral perfusion following carotid
endarterectomy can lead to intracerebral edema or hemorrhage. Hypertension is a
precursor of cerebral hyperperfusion injury so blood pressure must be carefully controlled
postoperatively.
The initial symptom of reperfusion injury is severe headache often in association with
severely elevated blood pressure
What risk does a ruptured ectopic pregnancy pose?
Gastroenteritis
Crampy, at any age. Diarrhea, Nausea, and vomiting Food, fever, occasional relief from
diarrhea or vomiting, and hyperactive peristalsis Gastritis The patient's nature Especially
patients who are alcoholics Gastritis location of pain
Epigastrium
S/S appendicitis Vomiting (after pain has started)
Constipation
Fever
appendicitis
Early:epigastrium, periumbilicus Later: RLQ
Cholecystitis, cholelithiasis LOCATION OF PAIN
RUQ
extends to the right scapula's inferior angle. Cholecystitis, cholelithiasis-ASSOCIATED
SYMPTOMS
Vomiting and vomiting Dark urine, light stool
bloating; fatty foods Oral contraceptives and drugs Cholestyramine
Cholecystitis, cholelithiasis
Tenderness when pressed or felt in RUQ Diverticulitis
LLQ, LLQ's palpable mass Pancreatitis: Where the Pain Is epigastric LUQ radiates
backwards Factors that Ameliorate Pancreatitis Lying supine
Leaning forward
Pancreatitis-PHYSICAL FINDINGS
Abdominal distention
Decreased bowel sounds
Rebound spread out Murphy's sign
pancreatitis acute LUQ, epigastric
Radiates to back
Perforated ulcer in the stomach Epigastric tenderness on palpation or percussion
Dissection or rupture of aortic aneurysm
thorax or abdomen May radiate to back and leg
Murmurs
Plan-Do-Study-Act (PDSA) model
ECG with 12 leads ABG
Insufficiency of the vena Patient will have obesity or be pregnant or older
History of prolonged standing, family history of venous insufficiency
Reports leg edema
PE will show skin changes, ulceration, edema, varicose veins
Imaging will show valvular abnormalities
Diagnosis is made by history, physical exam
Valvular abnormalities are the most common cause. Treatment is leg elevation,
compression therapy, ulcer care, ablation
, A 34-year-old woman presents with palpitations. Which of the following might you expect to
hear on examination if she has mitral valve prolapse?
Click mid-systolic Prolapse of the Mitral Valve Patient presents with palpitations, dyspnea,
nonexertional CP, and fatigue
Most cases are asymptomatic
PE will show midsystolic click and late systolic murmur
↑ preload → ↓ murmur
↓ preload → ↑ murmur
Marfan syndrome, Ehlers-Danlos
Echo is used to make a diagnosis. A patient in the intensive care unit develops sinus
bradycardia with tall peaked T waves and absent P waves on ECG. Which electrolyte
abnormality is associated with these changes seen on ECG?
Hyperkalemia
Hyperkalemia
History of kidney failure, DKA, rhabdomyolysis, tumor lysis
Lethargy, weakness, paralysis
Dysrhythmias in the heart, hypotension, and bradycardia will be seen in the PE. ECG will
show peaked T waves, prolonged PR, wide QRS
Treatment is calcium gluconate, insulin, albuterol, bicarbonate
In cardiogenic shock, which of the following hemodynamic parameters decreases? Cardiac
output
How is cardiac index calculated?
Cardiac index = Cardiac output/Body surface area.
Of the following serum studies, which should be obtained frequently in a patient receiving
parenteral nutrition to monitor for complications of intravenous fat emulsion?
Triglycerides
What is the recommended treatment for parenteral nutrition-related hyperglycemia? Add
regular insulin to the parenteral nutrition preparation.
Convenience barrier can be
is a potential barrier to compliance, which can be impacted by access to healthcare,
medication administration methods, telemedicine, and additional factors
Health care disparities between races When compared to Caucasians, obstacles to
compliance are more prevalent among African-American and Hispanic populations.
Cholecystitis
Colicky, steadily increasing RUQ or epigastric pain after eating fatty foods
PE will show Murphy sign, Boas sign (hyperaesthesia, increased or altered sensitivity,
below the right scapula)
Diagnosis
First, the US Gold standard: HIDA
Most commonly caused by obstruction by a gallstone
Treatment is cholecystectomy
Syndrome of cerebral hyperperfusion Increased cerebral perfusion following carotid
endarterectomy can lead to intracerebral edema or hemorrhage. Hypertension is a
precursor of cerebral hyperperfusion injury so blood pressure must be carefully controlled
postoperatively.
The initial symptom of reperfusion injury is severe headache often in association with
severely elevated blood pressure
What risk does a ruptured ectopic pregnancy pose?
