NR574 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS GUARANTEE A+
✔✔what diagnostic imaging should be used for bowel obstruction? - ✔✔plain film xray
✔✔what will a plain film xray show if a patient has a bowel obstruction? -
✔✔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? - ✔✔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? -
✔✔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 - ✔✔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) - ✔✔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? - ✔✔malignant tumors, such as
lung cancer, lymphoma, and metastatic tumors.
✔✔Subjective findings with SVCS patients - ✔✔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? - ✔✔bending down, laying
supine, position changes.
✔✔Physical exam findings of SVCS - ✔✔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 - ✔✔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 - ✔✔appendicitis, ectopic pregnancy,
nephrolithiasis,
✔✔ABD PAIN: "RUQ pain" is a red flag for.. - ✔✔cholecystitis, pancreatitis (referred
pain) PNA/empyema hepatitis
✔✔ABD PAIN:: "LUQ pain" is a red flag for.. - ✔✔pancreatitis
✔✔ABD PAIN : "LLQ pain" is red flag for.. - ✔✔Diverticulitis ectopic nephrolithiasis, IBS
✔✔Periumbilical abdominal pain - ✔✔gastroenteritis early appy bowel obstruction
Ruptured aortic aneurysm
✔✔epigastric pain - ✔✔PUD, gastritis GERD pancreatitis MI pericarditis Ruptured AAA
✔✔Abdomen pain differential - ✔✔Appy gallstones, pancreatitis, diverticulitis, ulcer
disease, esophagitis, GI obstruction, IBD, renal stone
✔✔Acute mesenteric ischemia (AMI) - ✔✔occurrence of abrupt cessation of blood flow
to bowel, usually embolic or thrombotic in nature.
✔✔Risk factors for Arterio-Occlusive Mesenteric Ischemia - ✔✔Acute mesenteric
arterial thrombosis
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
✔✔Acute mesenteric arterial thrombosis causes - ✔✔aortic dissection/aneurysm,
arteritis, atherosclerotic vascular disease, decreased output from congestive heart
failure [CHF]or myocardial infarction [MI])
✔✔Acute mesenteric arterial embolism causes - ✔✔emboli from fragments of proximal
aortic thrombus cardiac emboli atheromatous plaque dislodged during surgery or
catheterization
✔✔Mesenteric venous thrombosis causes - ✔✔vasopressors, cocaine, ergotamine,
digitalis, and hypotension
,✔✔Clients with severe acute abdominal pain that seems disproportional to physical
exam findings, or that are resistant to opioid therapy, should be suspected as having ? -
✔✔Acute mesenteric Ischemia
Clinical Tip: Clients often have a normal abdominal examination with mild to no
tenderness to palpation in contrast with a report of severe abdominal pain.
✔✔when splanchnic perfusion fails to meet the metabolic demands of the intestines,
resulting in ischemia tissue injury is what? - ✔✔Intestinal Ischemia
✔✔embolis etiology involved with AMI includes - ✔✔afib recent MI soft atherosclerotic
plaque infective endocarditis valvular heart disease recent cardiac or vascular
catheterization.
✔✔subjective findings of AMI - ✔✔severe, acute, unremitting abd pain strikingly out of
proportion to the physical findings
n/v/d, blood per rectum.later findings are peritonitis and cardiovascular collapse.
✔✔imaging to Diagnose AMI - ✔✔Gold standard: CT angio with a 1-mm or thinner cut
should be used to detect mesenteric arterial occlusive disease.
✔✔Hepatic steatosis (fatty liver) - ✔✔Nonalcoholic hepatic steatosis, or nonalcoholic
fatty liver disease (NAFLD), is one of the most common causes of chronic liver disease
in the developed world.It is a spectrum of disease, ranging from hepatic fat
accumulation without inflamma- tion to steatohepatitis, fibrosis, cirrhosis, and end-stage
liver disease.
✔✔risk factors of hepatic steatosis - ✔✔NAFLD is strongly associated with insulin
resistance, overweight/obesity, and metabolic syndromecan occur in thin people with
paucity of adipose depots(lipodystrophy)
✔✔nonalcoholic steatohepatitis (NASH) - ✔✔a more severe form of nonalcoholic fatty
liver disease. it consists of fatty accumulations plus liver-damaging inflammation. in
some cases, this will progress to cirrhosis, irreversible liver scarring or liver cancer
✔✔Imaging used for NASH - ✔✔Hepatic US and CT scan. Unfortunately, at the present
time, no imaging study can accurately distinguish simple fatty liver from NASH.
✔✔blood levels of acetaminophen correlate with severity of hepatic injury - ✔✔levels
>300 ug/mL 4 hours after ingestion are predicative of the development of severe
damage.
✔✔Treatment of Tylenol OD - ✔✔gastric lavage supportive measures oral
administration of activated charcoal or cholestyramine to prevent residual of the drug.
, ✔✔activated charcoal and cholestyramine should be done how soon after ingestion or
else they wont do anything? - ✔✔>30minutes from ingestion timegastric lavage should
be done before other orals.
✔✔N-acetylcysteine reduces markedly the severity of? - ✔✔hepatic necrosis
✔✔N-acetylcysteine should be given when? - ✔✔4-8 hours after ingestion if the blood
levels of tylenol are >200ug/mL at 4 hours
or
>100 ug/mL at 8 hours.
✔✔IV N-acetylcysteine dose - ✔✔loading dose: 140 mg/kg over 1 hour followed by 70
mg/kg every 4 hours for 15-20 doses.
✔✔When is liver transplantation indicated in pt with tylenol OD? - ✔✔hepatic failure
signs (jaundice, coagulopathy, confusion) occur after N-acetylcysteine dose, live
transplant may be the only option.
✔✔what does serum lactate tell us about the need for liver transplant? - ✔✔is serum
lactate is >3.5 - likely will require liver transplant to survive.
✔✔A 28-year-old woman is seen in a sexually transmitted disease clinic and is
diagnosed with Chlamydia trachomatis. An HIV antibody test is ordered. Which one of
the following statements
is TRUE regarding laboratory-based HIV antibody tests that are approved for use by the
United States Food and Drug Administration? - ✔✔Recent inocculation with the
influenza vaccine is a known cause of a false-positive result
✔✔A 31-year-old woman has exposure to HIV after a condom broke while having
vaginal sex with her partner who has HIV. She has follow-up HIV testing related to this
exposure. Which one of the following best describes the window period? - ✔✔The CDC
recommends using 45 days as the window period for all laboratory-based IgM/IgG HIV-
1/2 antibody immunoassays
✔✔A 22-year-old man presents for follow-up after a recent diagnosis of HIV. He has an
initial CD4 count of 390 cells/mm3 and his HIV RNA level is46,120 copies/mL; a
baseline genotype resistance assay shows no evidence of antiretroviral resistance. He
is motivated to start antiretroviral therapy and states that he can take medications
without issue. According to the Adult and Adolescent Antiretroviral (ARV) Guidelines,
which one of the following best describes the recommendations for starting antiretroviral
therapy in treatment-naïve persons with HIV? - ✔✔Antiretroviral therapy is
recommended for all persons with HIV
SOLUTIONS GUARANTEE A+
✔✔what diagnostic imaging should be used for bowel obstruction? - ✔✔plain film xray
✔✔what will a plain film xray show if a patient has a bowel obstruction? -
✔✔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? - ✔✔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? -
✔✔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 - ✔✔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) - ✔✔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? - ✔✔malignant tumors, such as
lung cancer, lymphoma, and metastatic tumors.
✔✔Subjective findings with SVCS patients - ✔✔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? - ✔✔bending down, laying
supine, position changes.
✔✔Physical exam findings of SVCS - ✔✔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 - ✔✔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 - ✔✔appendicitis, ectopic pregnancy,
nephrolithiasis,
✔✔ABD PAIN: "RUQ pain" is a red flag for.. - ✔✔cholecystitis, pancreatitis (referred
pain) PNA/empyema hepatitis
✔✔ABD PAIN:: "LUQ pain" is a red flag for.. - ✔✔pancreatitis
✔✔ABD PAIN : "LLQ pain" is red flag for.. - ✔✔Diverticulitis ectopic nephrolithiasis, IBS
✔✔Periumbilical abdominal pain - ✔✔gastroenteritis early appy bowel obstruction
Ruptured aortic aneurysm
✔✔epigastric pain - ✔✔PUD, gastritis GERD pancreatitis MI pericarditis Ruptured AAA
✔✔Abdomen pain differential - ✔✔Appy gallstones, pancreatitis, diverticulitis, ulcer
disease, esophagitis, GI obstruction, IBD, renal stone
✔✔Acute mesenteric ischemia (AMI) - ✔✔occurrence of abrupt cessation of blood flow
to bowel, usually embolic or thrombotic in nature.
✔✔Risk factors for Arterio-Occlusive Mesenteric Ischemia - ✔✔Acute mesenteric
arterial thrombosis
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
✔✔Acute mesenteric arterial thrombosis causes - ✔✔aortic dissection/aneurysm,
arteritis, atherosclerotic vascular disease, decreased output from congestive heart
failure [CHF]or myocardial infarction [MI])
✔✔Acute mesenteric arterial embolism causes - ✔✔emboli from fragments of proximal
aortic thrombus cardiac emboli atheromatous plaque dislodged during surgery or
catheterization
✔✔Mesenteric venous thrombosis causes - ✔✔vasopressors, cocaine, ergotamine,
digitalis, and hypotension
,✔✔Clients with severe acute abdominal pain that seems disproportional to physical
exam findings, or that are resistant to opioid therapy, should be suspected as having ? -
✔✔Acute mesenteric Ischemia
Clinical Tip: Clients often have a normal abdominal examination with mild to no
tenderness to palpation in contrast with a report of severe abdominal pain.
✔✔when splanchnic perfusion fails to meet the metabolic demands of the intestines,
resulting in ischemia tissue injury is what? - ✔✔Intestinal Ischemia
✔✔embolis etiology involved with AMI includes - ✔✔afib recent MI soft atherosclerotic
plaque infective endocarditis valvular heart disease recent cardiac or vascular
catheterization.
✔✔subjective findings of AMI - ✔✔severe, acute, unremitting abd pain strikingly out of
proportion to the physical findings
n/v/d, blood per rectum.later findings are peritonitis and cardiovascular collapse.
✔✔imaging to Diagnose AMI - ✔✔Gold standard: CT angio with a 1-mm or thinner cut
should be used to detect mesenteric arterial occlusive disease.
✔✔Hepatic steatosis (fatty liver) - ✔✔Nonalcoholic hepatic steatosis, or nonalcoholic
fatty liver disease (NAFLD), is one of the most common causes of chronic liver disease
in the developed world.It is a spectrum of disease, ranging from hepatic fat
accumulation without inflamma- tion to steatohepatitis, fibrosis, cirrhosis, and end-stage
liver disease.
✔✔risk factors of hepatic steatosis - ✔✔NAFLD is strongly associated with insulin
resistance, overweight/obesity, and metabolic syndromecan occur in thin people with
paucity of adipose depots(lipodystrophy)
✔✔nonalcoholic steatohepatitis (NASH) - ✔✔a more severe form of nonalcoholic fatty
liver disease. it consists of fatty accumulations plus liver-damaging inflammation. in
some cases, this will progress to cirrhosis, irreversible liver scarring or liver cancer
✔✔Imaging used for NASH - ✔✔Hepatic US and CT scan. Unfortunately, at the present
time, no imaging study can accurately distinguish simple fatty liver from NASH.
✔✔blood levels of acetaminophen correlate with severity of hepatic injury - ✔✔levels
>300 ug/mL 4 hours after ingestion are predicative of the development of severe
damage.
✔✔Treatment of Tylenol OD - ✔✔gastric lavage supportive measures oral
administration of activated charcoal or cholestyramine to prevent residual of the drug.
, ✔✔activated charcoal and cholestyramine should be done how soon after ingestion or
else they wont do anything? - ✔✔>30minutes from ingestion timegastric lavage should
be done before other orals.
✔✔N-acetylcysteine reduces markedly the severity of? - ✔✔hepatic necrosis
✔✔N-acetylcysteine should be given when? - ✔✔4-8 hours after ingestion if the blood
levels of tylenol are >200ug/mL at 4 hours
or
>100 ug/mL at 8 hours.
✔✔IV N-acetylcysteine dose - ✔✔loading dose: 140 mg/kg over 1 hour followed by 70
mg/kg every 4 hours for 15-20 doses.
✔✔When is liver transplantation indicated in pt with tylenol OD? - ✔✔hepatic failure
signs (jaundice, coagulopathy, confusion) occur after N-acetylcysteine dose, live
transplant may be the only option.
✔✔what does serum lactate tell us about the need for liver transplant? - ✔✔is serum
lactate is >3.5 - likely will require liver transplant to survive.
✔✔A 28-year-old woman is seen in a sexually transmitted disease clinic and is
diagnosed with Chlamydia trachomatis. An HIV antibody test is ordered. Which one of
the following statements
is TRUE regarding laboratory-based HIV antibody tests that are approved for use by the
United States Food and Drug Administration? - ✔✔Recent inocculation with the
influenza vaccine is a known cause of a false-positive result
✔✔A 31-year-old woman has exposure to HIV after a condom broke while having
vaginal sex with her partner who has HIV. She has follow-up HIV testing related to this
exposure. Which one of the following best describes the window period? - ✔✔The CDC
recommends using 45 days as the window period for all laboratory-based IgM/IgG HIV-
1/2 antibody immunoassays
✔✔A 22-year-old man presents for follow-up after a recent diagnosis of HIV. He has an
initial CD4 count of 390 cells/mm3 and his HIV RNA level is46,120 copies/mL; a
baseline genotype resistance assay shows no evidence of antiretroviral resistance. He
is motivated to start antiretroviral therapy and states that he can take medications
without issue. According to the Adult and Adolescent Antiretroviral (ARV) Guidelines,
which one of the following best describes the recommendations for starting antiretroviral
therapy in treatment-naïve persons with HIV? - ✔✔Antiretroviral therapy is
recommended for all persons with HIV
