nr574 final UPDATED ACTUAL Questions
and CORRECT Answers
How often should a CK level be drawn and why? - CORRECT ANSWER - least every 6-
12 hours to establish a peak level and then subsequently a downward trend.
Sylvie is a 26-year-old who presents to the emergency department (ED) after just finishing a full
marathon. She complains of feeling lightheaded, nauseous, and has vomited twice since
completing the race. Her legs feel tired, weak, and sore which she attributes to running 26.2
miles. She reports that she didn't stop to rehydrate as much as she would have liked because she
was intent on finishing with her personal best time. She became very concerned when she went
to use the restroom and noticed that her urine was dark - almost like tea. The AGACNP suspects
rhabdomyolysis. Which test is needed to confirm the diagnosis? - CORRECT ANSWER -
serum creatine kinase
Sylvie's EKG shows markedly elevated T waves and prolongation of the PR and QRS intervals.
The AGACNP should anticipate which of the following results? - CORRECT ANSWER -
hyperkalemia
Risk factors for acute intestinal obstruction? - CORRECT ANSWER - Adhesions from
previous abdominal surgery Internal or external hernias Foreign bodies Feces
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and mal- rotation)
Trauma (hematoma formation)Inflammation (inflammatory bowel disease, diverticulitis,
radiation, and tuberculosis) Neoplasms including carcinomatosis, colon cancer, primary small
bowel cancer, and extraintestinal malignancies such as ovarian cancer
Endometriosis Volvulus Ischemic injury Intussusception Intraperitoneal abscess
Subjective findings of acute intestinal obstruction - CORRECT ANSWER - colicky
abdominal pain (cramping periumbilical pain initially; later becomes constant and
diffuse)abdominal pain often more severe with distal obstruction vomiting (more significant with
proximal obstruction) abdominal bloatingobstipation
What key information should be discussed during H/P, if you are concerned for bowel
obstruction? - CORRECT ANSWER - History should include essential elements such as
,previous abdominal or pelvic surgeries, comorbid conditions such as inflammatory bowel disease
or malignancy.
Objective findings in a patient with intestinal obstruction? - CORRECT ANSWER - Key
physical exam findings may include:
Fever (systemic inflammation or strangulation)
High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete obstruction)
Abdominal distention (more significant with distal obstruction due to the greater volume of
intraluminal fluid accumulation)Mild abdominal tenderness but no peritoneal findingsTender
abdominal or groin masses (can represent incarcerated hernia) Signs of shock (tachycardia,
hypotension, oliguria)
Significant abdominal tenderness with palpation should increase the NP's suspicion for? -
CORRECT ANSWER - ischemia, peritonitis, or necrosis.
why is a serum lactate useful in dx a bowel obstruction? - CORRECT ANSWER - Serum
lactate (increased serum lactate should raise concern for strangulated obstruction)
what diagnostic imaging should be used for bowel obstruction? - CORRECT ANSWER -
plain film xray
what will a plain film xray show if a patient has a bowel obstruction? - CORRECT
ANSWER - Obstruction will reveal dilated loops of bowel and visible air-fluid levels
which should prompt further studies.A horizontal pattern of dilated small bowel loops can be
seen with small bowel obstruction (SBO)
Should barium contrast be given to a patient with a bowel obstruction? - CORRECT
ANSWER - NO! Imaging studies requiring administration of barium are contraindicated in
cases of high- grade or complete obstruction.
What does barium contrast do within the body with a bowel obstruction? - CORRECT
ANSWER - Barium should NEVER be given orally to a client until the diagnosis of
obstruction has been excluded completely as retained barium can cause concretions which create
,an additional source of blockage which can require surgical intervention in clients who may have
otherwise recovered. Retained barium also severely limits the ability to interpret subsequent
angiography or cross-sectional imaging.
Treatment of bowel obstruction - CORRECT ANSWER - Gen surg consult, NG tube
(intermittent suction) for decompression, fluid rescusitation, electrolyte management as
indicated,
complete obstruction= immediate surgical intervention
Superior Vena Cava Syndrome (SVCS) - CORRECT ANSWER - SVCS is the clinical
manifestation of SVC obstruction with severe reduction in venous return from the head, neck,
and upper extremities.
What is responsible for the majority of SVCS cases? - CORRECT ANSWER - malignant
tumors, such as lung cancer, lymphoma, and metastatic tumors.
Subjective findings with SVCS patients - CORRECT ANSWER - Commonly: neck and
facial swelling (especially around the eyes) dyspnea, and cough other symptoms:hoarseness,
tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness,
syncope, and lethargy.
what can cause symptoms of SVCS to become worse? - CORRECT ANSWER - bending
down, laying supine, position changes.
Physical exam findings of SVCS - CORRECT ANSWER - dilated neck veins increase
number of collateral veins covering the anterior chest wall cyanosis edema of the face, arms and
chest. typically will be worse when the patient is laying supine
treatment of SVCS - CORRECT ANSWER - symptomatic relief:diuretics w/ low sodium
diet head elevation supplemental 02Radiation therapy is the primary treatment for SVCS.
obstruction needs to be taken care of to relief symptoms.
, Abdomen Pain in the RLQ Pain differentials - CORRECT ANSWER - appendicitis,
ectopic pregnancy, nephrolithiasis,
ABD PAIN: "RUQ pain" is a red flag for.. - CORRECT ANSWER - cholecystitis,
pancreatitis (referred pain) PNA/empyema hepatitis
ABD PAIN:: "LUQ pain" is a red flag for.. - CORRECT ANSWER - pancreatitis
ABD PAIN : "LLQ pain" is red flag for.. - CORRECT ANSWER - Diverticulitis ectopic
nephrolithiasis, IBS
Periumbilical abdominal pain - CORRECT ANSWER - gastroenteritis early appy bowel
obstruction Ruptured aortic aneurysm
epigastric pain - CORRECT ANSWER - PUD, gastritis GERD pancreatitis MI pericarditis
Ruptured AAA
Abdomen pain differential - CORRECT ANSWER - Appy gallstones, pancreatitis,
diverticulitis, ulcer disease, esophagitis, GI obstruction, IBD, renal stone
Acute mesenteric ischemia (AMI) - CORRECT ANSWER - occurrence of abrupt
cessation of blood flow to bowel, usually embolic or thrombotic in nature.
Risk factors for Arterio-Occlusive Mesenteric Ischemia - CORRECT ANSWER - Acute
mesenteric arterial thrombosis
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
Acute mesenteric arterial thrombosis causes - CORRECT ANSWER - aortic
dissection/aneurysm, arteritis, atherosclerotic vascular disease, decreased output from congestive
heart failure [CHF]or myocardial infarction [MI])
and CORRECT Answers
How often should a CK level be drawn and why? - CORRECT ANSWER - least every 6-
12 hours to establish a peak level and then subsequently a downward trend.
Sylvie is a 26-year-old who presents to the emergency department (ED) after just finishing a full
marathon. She complains of feeling lightheaded, nauseous, and has vomited twice since
completing the race. Her legs feel tired, weak, and sore which she attributes to running 26.2
miles. She reports that she didn't stop to rehydrate as much as she would have liked because she
was intent on finishing with her personal best time. She became very concerned when she went
to use the restroom and noticed that her urine was dark - almost like tea. The AGACNP suspects
rhabdomyolysis. Which test is needed to confirm the diagnosis? - CORRECT ANSWER -
serum creatine kinase
Sylvie's EKG shows markedly elevated T waves and prolongation of the PR and QRS intervals.
The AGACNP should anticipate which of the following results? - CORRECT ANSWER -
hyperkalemia
Risk factors for acute intestinal obstruction? - CORRECT ANSWER - Adhesions from
previous abdominal surgery Internal or external hernias Foreign bodies Feces
Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and mal- rotation)
Trauma (hematoma formation)Inflammation (inflammatory bowel disease, diverticulitis,
radiation, and tuberculosis) Neoplasms including carcinomatosis, colon cancer, primary small
bowel cancer, and extraintestinal malignancies such as ovarian cancer
Endometriosis Volvulus Ischemic injury Intussusception Intraperitoneal abscess
Subjective findings of acute intestinal obstruction - CORRECT ANSWER - colicky
abdominal pain (cramping periumbilical pain initially; later becomes constant and
diffuse)abdominal pain often more severe with distal obstruction vomiting (more significant with
proximal obstruction) abdominal bloatingobstipation
What key information should be discussed during H/P, if you are concerned for bowel
obstruction? - CORRECT ANSWER - History should include essential elements such as
,previous abdominal or pelvic surgeries, comorbid conditions such as inflammatory bowel disease
or malignancy.
Objective findings in a patient with intestinal obstruction? - CORRECT ANSWER - Key
physical exam findings may include:
Fever (systemic inflammation or strangulation)
High-pitched, tinkling, bowel sounds (may be hypoactive or absent with complete obstruction)
Abdominal distention (more significant with distal obstruction due to the greater volume of
intraluminal fluid accumulation)Mild abdominal tenderness but no peritoneal findingsTender
abdominal or groin masses (can represent incarcerated hernia) Signs of shock (tachycardia,
hypotension, oliguria)
Significant abdominal tenderness with palpation should increase the NP's suspicion for? -
CORRECT ANSWER - ischemia, peritonitis, or necrosis.
why is a serum lactate useful in dx a bowel obstruction? - CORRECT ANSWER - Serum
lactate (increased serum lactate should raise concern for strangulated obstruction)
what diagnostic imaging should be used for bowel obstruction? - CORRECT ANSWER -
plain film xray
what will a plain film xray show if a patient has a bowel obstruction? - CORRECT
ANSWER - Obstruction will reveal dilated loops of bowel and visible air-fluid levels
which should prompt further studies.A horizontal pattern of dilated small bowel loops can be
seen with small bowel obstruction (SBO)
Should barium contrast be given to a patient with a bowel obstruction? - CORRECT
ANSWER - NO! Imaging studies requiring administration of barium are contraindicated in
cases of high- grade or complete obstruction.
What does barium contrast do within the body with a bowel obstruction? - CORRECT
ANSWER - Barium should NEVER be given orally to a client until the diagnosis of
obstruction has been excluded completely as retained barium can cause concretions which create
,an additional source of blockage which can require surgical intervention in clients who may have
otherwise recovered. Retained barium also severely limits the ability to interpret subsequent
angiography or cross-sectional imaging.
Treatment of bowel obstruction - CORRECT ANSWER - Gen surg consult, NG tube
(intermittent suction) for decompression, fluid rescusitation, electrolyte management as
indicated,
complete obstruction= immediate surgical intervention
Superior Vena Cava Syndrome (SVCS) - CORRECT ANSWER - SVCS is the clinical
manifestation of SVC obstruction with severe reduction in venous return from the head, neck,
and upper extremities.
What is responsible for the majority of SVCS cases? - CORRECT ANSWER - malignant
tumors, such as lung cancer, lymphoma, and metastatic tumors.
Subjective findings with SVCS patients - CORRECT ANSWER - Commonly: neck and
facial swelling (especially around the eyes) dyspnea, and cough other symptoms:hoarseness,
tongue swelling, headaches, nasal congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness,
syncope, and lethargy.
what can cause symptoms of SVCS to become worse? - CORRECT ANSWER - bending
down, laying supine, position changes.
Physical exam findings of SVCS - CORRECT ANSWER - dilated neck veins increase
number of collateral veins covering the anterior chest wall cyanosis edema of the face, arms and
chest. typically will be worse when the patient is laying supine
treatment of SVCS - CORRECT ANSWER - symptomatic relief:diuretics w/ low sodium
diet head elevation supplemental 02Radiation therapy is the primary treatment for SVCS.
obstruction needs to be taken care of to relief symptoms.
, Abdomen Pain in the RLQ Pain differentials - CORRECT ANSWER - appendicitis,
ectopic pregnancy, nephrolithiasis,
ABD PAIN: "RUQ pain" is a red flag for.. - CORRECT ANSWER - cholecystitis,
pancreatitis (referred pain) PNA/empyema hepatitis
ABD PAIN:: "LUQ pain" is a red flag for.. - CORRECT ANSWER - pancreatitis
ABD PAIN : "LLQ pain" is red flag for.. - CORRECT ANSWER - Diverticulitis ectopic
nephrolithiasis, IBS
Periumbilical abdominal pain - CORRECT ANSWER - gastroenteritis early appy bowel
obstruction Ruptured aortic aneurysm
epigastric pain - CORRECT ANSWER - PUD, gastritis GERD pancreatitis MI pericarditis
Ruptured AAA
Abdomen pain differential - CORRECT ANSWER - Appy gallstones, pancreatitis,
diverticulitis, ulcer disease, esophagitis, GI obstruction, IBD, renal stone
Acute mesenteric ischemia (AMI) - CORRECT ANSWER - occurrence of abrupt
cessation of blood flow to bowel, usually embolic or thrombotic in nature.
Risk factors for Arterio-Occlusive Mesenteric Ischemia - CORRECT ANSWER - Acute
mesenteric arterial thrombosis
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
Acute mesenteric arterial thrombosis causes - CORRECT ANSWER - aortic
dissection/aneurysm, arteritis, atherosclerotic vascular disease, decreased output from congestive
heart failure [CHF]or myocardial infarction [MI])
