NURS 366 FINAL EXAM QUESTIONS
AND COMPLETE ANSWERS
duodenal peptic ulcers ANSW✅✅burning, cramping, pressure-like pain across mi epigastrium and
abdomen, can have back pain, pain 2-4 hours after meal + midmorning and middle of night, pain
relief with food and antacids
most common peptic ulcer, m > f, high recurrence
management- similar to gastric, ETOH, smoking cessation, meds (H2 or PPI), stop NSAIDs
chronic PUD complications ANSW✅✅hemorrhage/upper GI bleed- tarry stools, nausea, vomiting
blood, tachycardia, hypotension, pallor; EGD to cauterize bleed, meds/IVF to support pt, frequent
vitals, blood products
perforation- sudden, severe upper abdomen pain, not relieved by rest or food, n/v, no bowel tones,
peritonitis, septic shock; emergency surgery to correct, meds/IVF to support, frequent vitals
gastric outlet obstruction- pain/discomfort, worsens as day goes on, constipation, n/v, belching,
anorexia, dehydration; decompress stomach, fluid/electrolyte replacement, NG, bowel rest, meds
(H2, PPI)
inflammatory bowel disease ANSW✅✅crohn's and ulcerative colitis
common onset 15-30 years but can occur at any age
difficult to dx, sx similar to other diseases/conditions
no cure but remissions are possible
ulcerative colitis only involves the colon
crohn's can be colon or small intestine
thought to be autoimmune
urban > rural and highest in white and Ashkenzi Jews, genetic link
crohn's disease ANSW✅✅a chronic relapsing disease that can occur segmentally in the small
bowel and colon
involves the entire thickness of wall, especially the submucosa
common in terminal ileum and colon but can occur anywhere
not common in the rectum
,diarrhea usually without blood
relief during remission
skip lesions- cobblestone appearance
onset teens-mid 30s, >60
abdominal pain, cramping, diarrhea, rectal bleeding, fever, weight loss, malabsorption
dx- H&P exam, CBC, ESR, BMP, stool sample, capsule endo, colonoscopy, barium contrast
complications- cancer, esp small bowel; perianal abscesses and fistulas, perforation, strictures
tx- diet, maybe enteral or PN, drug therapy, physical/emotional rest, counseling/therapy, surgery
ulcerative colitis ANSW✅✅different pattern of inflammation that crohn's, only in mucosal layer
typically starts in rectum and progresses upwards
onset teens to late 30s, >60, severe abdominal pain, diarrhea, fever, rectal bleeding, tenesmus,
pseudopolyps
complications- colorectal cancer, c. diff, perforation, toxic megacolon
tx- diet, maybe enteral or PN, drug therapy, physical/emotional rest, counseling/therapy, surgery
cirrhosis labs ANSW✅✅AST/ALT ratio > 1, more advanced liver failure - return to normal
ALT- specific for liver tissue (4-36)
AST- low specificity for liver, heart, kidneys, skeletal (0-35)
primary biliary cirrhosis- +ANA lab, increased GGT, alk phos, liver biopsy
depressed NK cytolytic activity, decreased DC, reduced B cells
thrombocytopenia, anemia, leukopenia, coagulation disorders, hyperaldosteronism (conn
syndrome), leading to K loss and Na and water retention
dietary deficiency of thiamine, folic acid, and cobalamin
cholecystectomy ANSW✅✅removal of the gallbladder for symptomatic gallstones
mostly done laproscopically
most patients have minimal pain and discharged the day of surgery or day after
resume normal activity and return to work in a week
most common complication- common bile duct injury
referred pain to shoulder bc of CO2 to inflate the abdomen
,sim's position (l side with r knee flexed) helps relieve
deep breathing, movement, ambulation
acute pancreatitis ANSW✅✅alcohol, biliary sludge, trauma, post-ERCP, hypertriglyceridemia,
biliary tract obstruction, hyperparathyroidism, steroids, cancer, mumps, smoking leads to..
activation of pancreatic enzymes inside the pancreatic duct leads to..
autodigestion of the pancreatic tissue leads to..
tissue necrosis, severe inflammation of pancreas
enzymes and cell contents leak into general circulation and may cause shock, DIC, ARDs
acute enzyme leak into peritoneal cavity and destruction of tissue with massive inflammation leads
to severe pain, hemorrhage, shock, peritonitis, hypovolemic shock
treatment of pancreatitis ANSW✅✅signs- classified as mild, severe (necrotizing), severe epigastric
or abdominal pain radiating to back after large meal or large intake of ETOH, signs of shock (low SBP,
pallor, sweating, rapid weak pulse from inflammation and hemorrhage, leakage of fluid
retroperitoneally), low grade fever common until infection sets in driving body temp higher,
abdominal distension, decreased bowel sounds due to peritonitis, paralytic ileus from decreased
peristalsis
dx- CT, MRI, detect necrosis, fluid in the peritoneum
labs- increased amylase and lipase, decreased Ca, increased WBC, glucose, bilirubin
tx- NPO, relief of bowel distention (NG), IV fluids, electrolytes replacement, pain control, ERCP if the
pancreatitis is related to a gallstone, percutaneous drainage of a pseudocyst; enteral nutrition to
prevent bacterial transmigration and necrotizing pancreatitis
chronic pancreatitis ANSW✅✅defined as a prolonged inflammation of the pancreas with eventual
destruction of pancreatic tissue
cause- ETOH, biliary obstruction, autoimmune diseases, cystic fibrosis, idiopathic; may follow acute
pancreatitis
most common cause- choledocholithiasis or cancer
s/s- episodes of acute pain with recurring frequency, RUQ pain, not relieved with antacids;
malabsorption, weight loss, mild jaundice, dark urine, steatorrhea
dx- based on pt hx, labs may not be elevated as in acute pancreatitis, increased bilirubin and ALK,
stool sample; ERCP,CT,MRI,MRCP, abdominal US
tx- same as acute, pancreatic enzyme replacement may be needed, smoking cessation, H2 blockers,
antacids, surgical diversion or sphinctertomy
, urinary tract infection ANSW✅✅one of the most common childhood conditions
circumcision status impacts UTI risk
lower UTI- urethra and bladder
upper UTI- ureters, renal pelvis, calyces, and renal parenchyma; more serious, fever, sick, malaise
often impossible to localize the infection
clinical symptoms may or may not occur
bacteriruia- bacteria in the urine, significant is >100,000 CFUs in urine, >1,000 if catheterized
cystitis- inflammation of bladder
urethritis- inflammation of the urethra
pyelonephritis- inflammation of the upper urinary tract and kidneys
types of UTIs ANSW✅✅recurrent- repeated episodes of bacteriuria or symptomatic UTI
persistent- bacteriuria despite antibiotics
febrile UTI- bacteriuria accompanied by fever and other physical signs of UTI (fever often implies
pyelonephritis)
urosepsis- febrile UTI coexisting with systemic signs of bacterial illness, blood cultures have presence
of urinary pathogen
etiology of UTI ANSW✅✅gram-negative enteric organisms are most frequent cause- e coli causes
80%, improper hygiene, self exploration, long baths
other bacterial causes of UTI- staph aureus, proteus in vagina, pseudomonas, klebsiella, haemophilus
fungal and parasitic pathogens are less common causes
short urethra in women
prostatic secretions in men inhibit entry and growth of urinary pathogens
urine is sterile- body temp provides excellent culture medium for bacterial growth
increased urine alkalinity = increased UTI risk
diuresis enhances antibacterial properties of the renal medula- also promotes flushing of bacteria
from bladder
urinary stasis ANSW✅✅urinary stasis (incomplete bladder emptying) is single most important
host factor in occurrence of UTI
may result from vesicoureteral reflux, anatomic abnormalities, dysfunction of the voiding
mechanism, extrinsic or ureteral or bladder compression that may be caused by constipation
AND COMPLETE ANSWERS
duodenal peptic ulcers ANSW✅✅burning, cramping, pressure-like pain across mi epigastrium and
abdomen, can have back pain, pain 2-4 hours after meal + midmorning and middle of night, pain
relief with food and antacids
most common peptic ulcer, m > f, high recurrence
management- similar to gastric, ETOH, smoking cessation, meds (H2 or PPI), stop NSAIDs
chronic PUD complications ANSW✅✅hemorrhage/upper GI bleed- tarry stools, nausea, vomiting
blood, tachycardia, hypotension, pallor; EGD to cauterize bleed, meds/IVF to support pt, frequent
vitals, blood products
perforation- sudden, severe upper abdomen pain, not relieved by rest or food, n/v, no bowel tones,
peritonitis, septic shock; emergency surgery to correct, meds/IVF to support, frequent vitals
gastric outlet obstruction- pain/discomfort, worsens as day goes on, constipation, n/v, belching,
anorexia, dehydration; decompress stomach, fluid/electrolyte replacement, NG, bowel rest, meds
(H2, PPI)
inflammatory bowel disease ANSW✅✅crohn's and ulcerative colitis
common onset 15-30 years but can occur at any age
difficult to dx, sx similar to other diseases/conditions
no cure but remissions are possible
ulcerative colitis only involves the colon
crohn's can be colon or small intestine
thought to be autoimmune
urban > rural and highest in white and Ashkenzi Jews, genetic link
crohn's disease ANSW✅✅a chronic relapsing disease that can occur segmentally in the small
bowel and colon
involves the entire thickness of wall, especially the submucosa
common in terminal ileum and colon but can occur anywhere
not common in the rectum
,diarrhea usually without blood
relief during remission
skip lesions- cobblestone appearance
onset teens-mid 30s, >60
abdominal pain, cramping, diarrhea, rectal bleeding, fever, weight loss, malabsorption
dx- H&P exam, CBC, ESR, BMP, stool sample, capsule endo, colonoscopy, barium contrast
complications- cancer, esp small bowel; perianal abscesses and fistulas, perforation, strictures
tx- diet, maybe enteral or PN, drug therapy, physical/emotional rest, counseling/therapy, surgery
ulcerative colitis ANSW✅✅different pattern of inflammation that crohn's, only in mucosal layer
typically starts in rectum and progresses upwards
onset teens to late 30s, >60, severe abdominal pain, diarrhea, fever, rectal bleeding, tenesmus,
pseudopolyps
complications- colorectal cancer, c. diff, perforation, toxic megacolon
tx- diet, maybe enteral or PN, drug therapy, physical/emotional rest, counseling/therapy, surgery
cirrhosis labs ANSW✅✅AST/ALT ratio > 1, more advanced liver failure - return to normal
ALT- specific for liver tissue (4-36)
AST- low specificity for liver, heart, kidneys, skeletal (0-35)
primary biliary cirrhosis- +ANA lab, increased GGT, alk phos, liver biopsy
depressed NK cytolytic activity, decreased DC, reduced B cells
thrombocytopenia, anemia, leukopenia, coagulation disorders, hyperaldosteronism (conn
syndrome), leading to K loss and Na and water retention
dietary deficiency of thiamine, folic acid, and cobalamin
cholecystectomy ANSW✅✅removal of the gallbladder for symptomatic gallstones
mostly done laproscopically
most patients have minimal pain and discharged the day of surgery or day after
resume normal activity and return to work in a week
most common complication- common bile duct injury
referred pain to shoulder bc of CO2 to inflate the abdomen
,sim's position (l side with r knee flexed) helps relieve
deep breathing, movement, ambulation
acute pancreatitis ANSW✅✅alcohol, biliary sludge, trauma, post-ERCP, hypertriglyceridemia,
biliary tract obstruction, hyperparathyroidism, steroids, cancer, mumps, smoking leads to..
activation of pancreatic enzymes inside the pancreatic duct leads to..
autodigestion of the pancreatic tissue leads to..
tissue necrosis, severe inflammation of pancreas
enzymes and cell contents leak into general circulation and may cause shock, DIC, ARDs
acute enzyme leak into peritoneal cavity and destruction of tissue with massive inflammation leads
to severe pain, hemorrhage, shock, peritonitis, hypovolemic shock
treatment of pancreatitis ANSW✅✅signs- classified as mild, severe (necrotizing), severe epigastric
or abdominal pain radiating to back after large meal or large intake of ETOH, signs of shock (low SBP,
pallor, sweating, rapid weak pulse from inflammation and hemorrhage, leakage of fluid
retroperitoneally), low grade fever common until infection sets in driving body temp higher,
abdominal distension, decreased bowel sounds due to peritonitis, paralytic ileus from decreased
peristalsis
dx- CT, MRI, detect necrosis, fluid in the peritoneum
labs- increased amylase and lipase, decreased Ca, increased WBC, glucose, bilirubin
tx- NPO, relief of bowel distention (NG), IV fluids, electrolytes replacement, pain control, ERCP if the
pancreatitis is related to a gallstone, percutaneous drainage of a pseudocyst; enteral nutrition to
prevent bacterial transmigration and necrotizing pancreatitis
chronic pancreatitis ANSW✅✅defined as a prolonged inflammation of the pancreas with eventual
destruction of pancreatic tissue
cause- ETOH, biliary obstruction, autoimmune diseases, cystic fibrosis, idiopathic; may follow acute
pancreatitis
most common cause- choledocholithiasis or cancer
s/s- episodes of acute pain with recurring frequency, RUQ pain, not relieved with antacids;
malabsorption, weight loss, mild jaundice, dark urine, steatorrhea
dx- based on pt hx, labs may not be elevated as in acute pancreatitis, increased bilirubin and ALK,
stool sample; ERCP,CT,MRI,MRCP, abdominal US
tx- same as acute, pancreatic enzyme replacement may be needed, smoking cessation, H2 blockers,
antacids, surgical diversion or sphinctertomy
, urinary tract infection ANSW✅✅one of the most common childhood conditions
circumcision status impacts UTI risk
lower UTI- urethra and bladder
upper UTI- ureters, renal pelvis, calyces, and renal parenchyma; more serious, fever, sick, malaise
often impossible to localize the infection
clinical symptoms may or may not occur
bacteriruia- bacteria in the urine, significant is >100,000 CFUs in urine, >1,000 if catheterized
cystitis- inflammation of bladder
urethritis- inflammation of the urethra
pyelonephritis- inflammation of the upper urinary tract and kidneys
types of UTIs ANSW✅✅recurrent- repeated episodes of bacteriuria or symptomatic UTI
persistent- bacteriuria despite antibiotics
febrile UTI- bacteriuria accompanied by fever and other physical signs of UTI (fever often implies
pyelonephritis)
urosepsis- febrile UTI coexisting with systemic signs of bacterial illness, blood cultures have presence
of urinary pathogen
etiology of UTI ANSW✅✅gram-negative enteric organisms are most frequent cause- e coli causes
80%, improper hygiene, self exploration, long baths
other bacterial causes of UTI- staph aureus, proteus in vagina, pseudomonas, klebsiella, haemophilus
fungal and parasitic pathogens are less common causes
short urethra in women
prostatic secretions in men inhibit entry and growth of urinary pathogens
urine is sterile- body temp provides excellent culture medium for bacterial growth
increased urine alkalinity = increased UTI risk
diuresis enhances antibacterial properties of the renal medula- also promotes flushing of bacteria
from bladder
urinary stasis ANSW✅✅urinary stasis (incomplete bladder emptying) is single most important
host factor in occurrence of UTI
may result from vesicoureteral reflux, anatomic abnormalities, dysfunction of the voiding
mechanism, extrinsic or ureteral or bladder compression that may be caused by constipation
