NR574 ACUTE CARE PRACTICUM ACTUAL
TEST PAPER 2026 COMPLETE QUESTIONS AND
ANSWERS GRADED A+
◉ 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?
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? Answer: hyperkalemia
◉ Risk factors for acute intestinal obstruction? 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 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? 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?
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? Answer: ischemia, peritonitis, or necrosis.
◉ why is a serum lactate useful in dx a bowel obstruction? Answer:
Serum lactate (increased serum lactate should raise concern for
strangulated obstruction)
◉ what diagnostic imaging should be used for bowel obstruction?
Answer: plain film xray
◉ what will a plain film xray show if a patient has a bowel
obstruction? 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? 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? 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 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) 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? Answer:
malignant tumors, such as lung cancer, lymphoma, and metastatic
tumors.
◉ Subjective findings with SVCS patients Answer: Commonly: neck
and facial swelling (especially around the eyes) dyspnea, and cough
other symptoms:hoarseness, tongue swelling, headaches, nasal
TEST PAPER 2026 COMPLETE QUESTIONS AND
ANSWERS GRADED A+
◉ 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?
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? Answer: hyperkalemia
◉ Risk factors for acute intestinal obstruction? 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 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? 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?
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? Answer: ischemia, peritonitis, or necrosis.
◉ why is a serum lactate useful in dx a bowel obstruction? Answer:
Serum lactate (increased serum lactate should raise concern for
strangulated obstruction)
◉ what diagnostic imaging should be used for bowel obstruction?
Answer: plain film xray
◉ what will a plain film xray show if a patient has a bowel
obstruction? 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? 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? 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 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) 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? Answer:
malignant tumors, such as lung cancer, lymphoma, and metastatic
tumors.
◉ Subjective findings with SVCS patients Answer: Commonly: neck
and facial swelling (especially around the eyes) dyspnea, and cough
other symptoms:hoarseness, tongue swelling, headaches, nasal
