NURSADN6 EXAM #2 STUDY GUIDE
WITH WELL DETAILED ANSWERS
What 4ris 4ra 4r*Bowel 4rPerforation* 4rand 4rwhat 4rare 4rthe 4rsigns/symptoms 4rof 4rit? 4r-
4rANS--Spillage 4rof 4rgastric 4ror 4rduodenal 4rcontents 4rinto 4rperitoneal 4rcavity. 4r
S/S: 4rSudden, 4rsevere 4rupper 4rabdominal 4rpain 4r(may 4rbe 4rreferred 4rto 4rthe
4rshoulder), 4rvomiting, 4rTender 4rrigid, 4rboard-like 4rabdomen, 4rshallow/grunting
4rrespirations 4rand 4rsigns 4rof 4rshock
What 4ris 4rthe 4rintervention 4rfor 4ra 4r*bowel 4rperforation*? 4r- 4rANS--Immediate 4rsurgery
What 4ris 4ran 4r*ileostomy*? 4r- 4rANS--A 4rsurgical 4roperation 4rin 4rwhich 4ra 4rpiece 4rof
4rthe 4rileum 4ris 4rdiverted 4rto 4ran 4rartificial 4ropening 4rin 4rthe 4rabdominal 4rwall.
For 4ra 4rpatient 4rwith 4ran 4r*ileostomy*, 4rwhat 4rmight 4rthe 4rstool 4rlook 4rlike? 4r- 4rANS--
Liquid 4rfecal 4rdrainage; 4rconstant 4rand 4rcannot 4rbe 4rregulated; 4rminimal 4rodor
4rbecause 4rfewer 4rbacteria 4rare 4rpresent
Indications 4rfor 4ran 4r*Ileostomy* 4r- 4rANS--Toxic 4rMegacolon 4rfrom 4rInflammatory
4rBowel 4rDisease
What 4rare 4rsome 4rimportant 4r*ileostomy* 4rcomplications? 4r- 4rANS--High 4rrisk 4rfor
4rbowel 4robstruction 4r(Instruct 4rpt 4rto 4rchew 4rfood 4rthoroughly 4rand 4rdrink 4rlots 4rof
4rwater)
and 4rthe 4rpotential 4rrisk 4rfor 4rvitamin 4rB12 4rdeficiency 4r(Administer 4rsupplements 4ras
4rneeded)
What 4ris 4r*peptic 4rulcer 4rdisease* 4r(PUD)? 4r- 4rANS--A 4rbreak 4ror 4rulceration 4rin 4rthe
4rprotective 4rmucosal 4rlining 4rof 4rthe 4rlower 4resophagus, 4rstomach, 4rpylorus 4ror
4rduodenum 4rassociated 4rwith 4rthe 4rinfection 4rof 4rH. 4rpylori
A 4rpatient 4rpresents 4rto 4rthe 4rclinic 4rwith 4r*dull 4rgnawing 4rpain 4ror 4rburning 4rin 4rthe
4rmid 4repigastrium*, 4rheartburn 4rand
vomiting. 4rWhat 4rdoes 4rthe 4rnurse 4rsuspect 4rthis 4rpatient 4rto 4rbe 4rdiagnosed 4rwith? 4r-
4rANS--Peptic 4rUlcer 4rDisease
One 4rof 4rthe 4rgoals 4rin 4rmanaging 4rPeptic 4rUlcer 4rdisease 4ris 4rto 4rreduce 4rthe
4racidity 4rwithin 4rthe 4rstomach, 4rthis 4rcan 4rbe 4rachieved 4rwith 4rthe 4ruse 4rof 4rPPIs 4ror
4r*Proton 4rPump 4rInhibitors*. 4rTo 4rremember 4rthese 4rmedications, 4rwhat 4ris 4rthe
4r*suffix* 4rassociated 4rwith 4rthem?
,A. 4r-prazole 4r(Ex. 4rPantoprazole)
B. 4r- 4rdine 4r(Ex. 4rFamotidine)
C. 4r-ate 4r(Ex. 4rSucralfate) 4r
D. 4r-cid 4r(Ex. 4rPepcid) 4r- 4rANS--A. 4r-prazole 4r(Ex. 4rPantoprazole)
*Rationale:* 4rFamotidine 4ris 4ran 4rH2 4rBlocker, 4rSucralfate 4ris 4ra 4rsurface 4ragent 4rand
4rPepcid 4ris 4ran 4rantacid. 4rThough 4rthey 4rmay 4rall 4rbe 4rused 4rin 4rthe 4rmanagement
4rof 4rGERD 4rand 4rPUD, 4ronly 4rPanto*prazole* 4ris 4ra 4rPPI.
How 4rdo 4rPPIs 4rwork? 4r- 4rANS--They 4rblock 4rthe 4rproton 4rpump 4rin 4rour 4rstomach
4rand 4rdecrease 4rthe 4rconcentration 4rof 4rHCl; 4rIrreversible 4rinhibit 4rthe 4rH+/K+
4rATPase 4rin 4rstomach 4rparietal 4rcells.
H 4rpylori 4ris 4rassociated 4r70-90% 4rof 4rPeptic 4rUlcer 4rcases. 4rHow 4rdoes 4rH. 4rpylori
4rcause 4rulcers? 4r- 4rANS--The 4rbacteria 4rbreaks 4rdown 4rthe 4rgastroduodenal
4rmucosal 4rbarrier 4rand 4rstimulates 4rgastric 4racid 4rsecretion 4rburrow 4rthrough 4rbarrier,
4rrelease 4rammonium 4rand 4rliquefy 4rthe 4rbarrier 4rwhich 4rstimulates 4rHCl 4rsecretion
*H. 4rpylori* 4rtreatment 4rcan 4rinclude 4rwhat? 4r- 4rANS--PPI 4r+ 4r2 4rof 4rthe 4rfollowing
4rantibiotics
--Clarithromycin
--Metronidazole
--Amoxicillin
One 4rweek 4rtreatment: 4r90% 4rcure 4rrate
Two 4rweeks 4rof 4rPPI 4r+ 4r1 4rantibiotic 4r(typically 4rclarithromycin): 4r10-20% 4rlower
4rcure 4rrate
MHD 4rnotes:
--Tetracycline 4rcan 4rbe 4r1 4rof 4rthe 4r2 4rantibiotics
--Bismuth 4rsalts, 4rdoxycycline, 4rand 4rmetronidazole 4rfor 4r14 4rdays 4ris 4rcheap 4rand
4reffective
What 4ris 4r*Crohn's 4rdisease*? 4r- 4rANS--A 4rchronic 4rinflammatory 4rbowel 4rdisease
4r(IBD) 4rthat 4raffects 4rthe 4rlining 4rof 4rthe 4rdigestive 4rtract 4r(anywhere 4rfrom 4rmouth
4rto 4ranus) 4rwhich 4rcan 4rlead 4rto 4rabdominal 4rpain, 4rsevere 4rdiarrhea, 4rfatigue,
4rweight 4rloss 4rand 4rmalnutrition
What 4rare 4rthe 4rsigns 4rand 4rsymptoms 4rof 4r*Crohn's 4rDisease*? 4r- 4rANS--First 4rsign
4rwill 4rbe 4rabd 4rpain 4runrelieved 4rby 4rdefecation 4rfollowed 4rby: 4r
-diarrhea, 4r
-weight 4rloss
-constant 4rfluid 4rloss
-low-grade 4rfever
-fatigue
, -tenderness 4rin 4rRLQ
List 4rsome 4r*complications* 4rof 4rCrohn's: 4r- 4rANS---Intestinal 4robstruction
-Perianal 4rdisease
-Electrolyte 4rimbalances
-Malnutrition
-Fistula 4r& 4rabscess 4rformation
A 4rpatient 4ris 4rbeing 4rprovided 4reducation 4rfor 4rnutritional 4rconsumption 4rwith 4ra
4rdiagnosis 4rof 4r*Crohn's 4rdisease*. 4rHow 4rshould 4rthe 4rnurse 4rinstruct 4rthe 4rpatient
4ron 4rhow 4rto 4ralter 4rtheir 4rdiet? 4r- 4rANS--Limit 4rdairy, 4rlow-fat 4rfoods, 4rlimit 4rfiber,
4reat 4rsmall-frequent 4rmeals, 4rincrease 4rfluids, 4rnutritional 4rsupplements 4r(vitamins
4rand 4riron)
What 4ris 4r*Ulcerative 4rColitis*? 4r- 4rANS--Recurrent 4rulcerative 4rand 4rinflammatory
4rbowel 4rdisease 4rof 4rthe 4rmucosal 4rand 4rsubmucosal 4rlayers 4rof 4rthe 4rcolon 4rand
4rrectum 4r(which 4rstarts 4rdistally 4rat 4rthe 4rrectum 4rand 4rprogresses 4rproximally)
4rOnset 4rcould 4rbe 4rgradual 4ror 4rabrupt.
Out 4rof 4rthe 4rfollowing 4rpopulations, 4rwho 4ris 4rmore 4rhigh 4rrisk 4rfor 4ra 4rdiagnosis 4rof
4r*Ulcerative 4rColitis*? 4r(Select 4rall 4rthat 4rapply)
4r- 4rCaucasians
- 4rAsian
- 4rHispanic
- 4rAfrican 4rAmerican
- 4rMen 4r
- 4rWomen
- 4rJewish 4r- 4rANS--- 4rCaucasians
- 4rWomen
- 4rJewish
What 4rare 4rthe 4rsigns 4rand 4rsymptoms 4rof 4r*Ulcerative 4rColitis*? 4r- 4rANS--Diarrhea
4r(6+ 4rliquid 4rstools/day), 4rpassage 4rof 4rmucus, 4rpus 4ror 4rblood,
LLQ 4rabdominal 4rpain, 4rintermittent
tenesmus 4r(straining 4rwith 4rBM), 4rrectal
bleeding 4r(mild 4ror 4rsevere), 4rPallor, 4ranemia 4rand 4rfatigue, 4rhypocalcemia
*Extra 4rInformation:* 4rHemoglobin/Hematocrit 4r(H&H) 4r- 4rANS--Red 4rblood 4rcell
4rmeasurements 4rto 4revaluate 4ranemia
In 4r*Ulcerative 4rColitis*, 4rH&H 4rlevels 4rmay 4rbe 4r*high 4ror 4rlow*? 4r- 4rANS--High
What 4rare 4rthe 4r*three* 4rmajor 4rcomplications 4rof 4r*Ulcerative 4rColitis*? 4r- 4rANS--
Toxic 4rmegacolon, 4rperforation 4rand 4rbleeding
WITH WELL DETAILED ANSWERS
What 4ris 4ra 4r*Bowel 4rPerforation* 4rand 4rwhat 4rare 4rthe 4rsigns/symptoms 4rof 4rit? 4r-
4rANS--Spillage 4rof 4rgastric 4ror 4rduodenal 4rcontents 4rinto 4rperitoneal 4rcavity. 4r
S/S: 4rSudden, 4rsevere 4rupper 4rabdominal 4rpain 4r(may 4rbe 4rreferred 4rto 4rthe
4rshoulder), 4rvomiting, 4rTender 4rrigid, 4rboard-like 4rabdomen, 4rshallow/grunting
4rrespirations 4rand 4rsigns 4rof 4rshock
What 4ris 4rthe 4rintervention 4rfor 4ra 4r*bowel 4rperforation*? 4r- 4rANS--Immediate 4rsurgery
What 4ris 4ran 4r*ileostomy*? 4r- 4rANS--A 4rsurgical 4roperation 4rin 4rwhich 4ra 4rpiece 4rof
4rthe 4rileum 4ris 4rdiverted 4rto 4ran 4rartificial 4ropening 4rin 4rthe 4rabdominal 4rwall.
For 4ra 4rpatient 4rwith 4ran 4r*ileostomy*, 4rwhat 4rmight 4rthe 4rstool 4rlook 4rlike? 4r- 4rANS--
Liquid 4rfecal 4rdrainage; 4rconstant 4rand 4rcannot 4rbe 4rregulated; 4rminimal 4rodor
4rbecause 4rfewer 4rbacteria 4rare 4rpresent
Indications 4rfor 4ran 4r*Ileostomy* 4r- 4rANS--Toxic 4rMegacolon 4rfrom 4rInflammatory
4rBowel 4rDisease
What 4rare 4rsome 4rimportant 4r*ileostomy* 4rcomplications? 4r- 4rANS--High 4rrisk 4rfor
4rbowel 4robstruction 4r(Instruct 4rpt 4rto 4rchew 4rfood 4rthoroughly 4rand 4rdrink 4rlots 4rof
4rwater)
and 4rthe 4rpotential 4rrisk 4rfor 4rvitamin 4rB12 4rdeficiency 4r(Administer 4rsupplements 4ras
4rneeded)
What 4ris 4r*peptic 4rulcer 4rdisease* 4r(PUD)? 4r- 4rANS--A 4rbreak 4ror 4rulceration 4rin 4rthe
4rprotective 4rmucosal 4rlining 4rof 4rthe 4rlower 4resophagus, 4rstomach, 4rpylorus 4ror
4rduodenum 4rassociated 4rwith 4rthe 4rinfection 4rof 4rH. 4rpylori
A 4rpatient 4rpresents 4rto 4rthe 4rclinic 4rwith 4r*dull 4rgnawing 4rpain 4ror 4rburning 4rin 4rthe
4rmid 4repigastrium*, 4rheartburn 4rand
vomiting. 4rWhat 4rdoes 4rthe 4rnurse 4rsuspect 4rthis 4rpatient 4rto 4rbe 4rdiagnosed 4rwith? 4r-
4rANS--Peptic 4rUlcer 4rDisease
One 4rof 4rthe 4rgoals 4rin 4rmanaging 4rPeptic 4rUlcer 4rdisease 4ris 4rto 4rreduce 4rthe
4racidity 4rwithin 4rthe 4rstomach, 4rthis 4rcan 4rbe 4rachieved 4rwith 4rthe 4ruse 4rof 4rPPIs 4ror
4r*Proton 4rPump 4rInhibitors*. 4rTo 4rremember 4rthese 4rmedications, 4rwhat 4ris 4rthe
4r*suffix* 4rassociated 4rwith 4rthem?
,A. 4r-prazole 4r(Ex. 4rPantoprazole)
B. 4r- 4rdine 4r(Ex. 4rFamotidine)
C. 4r-ate 4r(Ex. 4rSucralfate) 4r
D. 4r-cid 4r(Ex. 4rPepcid) 4r- 4rANS--A. 4r-prazole 4r(Ex. 4rPantoprazole)
*Rationale:* 4rFamotidine 4ris 4ran 4rH2 4rBlocker, 4rSucralfate 4ris 4ra 4rsurface 4ragent 4rand
4rPepcid 4ris 4ran 4rantacid. 4rThough 4rthey 4rmay 4rall 4rbe 4rused 4rin 4rthe 4rmanagement
4rof 4rGERD 4rand 4rPUD, 4ronly 4rPanto*prazole* 4ris 4ra 4rPPI.
How 4rdo 4rPPIs 4rwork? 4r- 4rANS--They 4rblock 4rthe 4rproton 4rpump 4rin 4rour 4rstomach
4rand 4rdecrease 4rthe 4rconcentration 4rof 4rHCl; 4rIrreversible 4rinhibit 4rthe 4rH+/K+
4rATPase 4rin 4rstomach 4rparietal 4rcells.
H 4rpylori 4ris 4rassociated 4r70-90% 4rof 4rPeptic 4rUlcer 4rcases. 4rHow 4rdoes 4rH. 4rpylori
4rcause 4rulcers? 4r- 4rANS--The 4rbacteria 4rbreaks 4rdown 4rthe 4rgastroduodenal
4rmucosal 4rbarrier 4rand 4rstimulates 4rgastric 4racid 4rsecretion 4rburrow 4rthrough 4rbarrier,
4rrelease 4rammonium 4rand 4rliquefy 4rthe 4rbarrier 4rwhich 4rstimulates 4rHCl 4rsecretion
*H. 4rpylori* 4rtreatment 4rcan 4rinclude 4rwhat? 4r- 4rANS--PPI 4r+ 4r2 4rof 4rthe 4rfollowing
4rantibiotics
--Clarithromycin
--Metronidazole
--Amoxicillin
One 4rweek 4rtreatment: 4r90% 4rcure 4rrate
Two 4rweeks 4rof 4rPPI 4r+ 4r1 4rantibiotic 4r(typically 4rclarithromycin): 4r10-20% 4rlower
4rcure 4rrate
MHD 4rnotes:
--Tetracycline 4rcan 4rbe 4r1 4rof 4rthe 4r2 4rantibiotics
--Bismuth 4rsalts, 4rdoxycycline, 4rand 4rmetronidazole 4rfor 4r14 4rdays 4ris 4rcheap 4rand
4reffective
What 4ris 4r*Crohn's 4rdisease*? 4r- 4rANS--A 4rchronic 4rinflammatory 4rbowel 4rdisease
4r(IBD) 4rthat 4raffects 4rthe 4rlining 4rof 4rthe 4rdigestive 4rtract 4r(anywhere 4rfrom 4rmouth
4rto 4ranus) 4rwhich 4rcan 4rlead 4rto 4rabdominal 4rpain, 4rsevere 4rdiarrhea, 4rfatigue,
4rweight 4rloss 4rand 4rmalnutrition
What 4rare 4rthe 4rsigns 4rand 4rsymptoms 4rof 4r*Crohn's 4rDisease*? 4r- 4rANS--First 4rsign
4rwill 4rbe 4rabd 4rpain 4runrelieved 4rby 4rdefecation 4rfollowed 4rby: 4r
-diarrhea, 4r
-weight 4rloss
-constant 4rfluid 4rloss
-low-grade 4rfever
-fatigue
, -tenderness 4rin 4rRLQ
List 4rsome 4r*complications* 4rof 4rCrohn's: 4r- 4rANS---Intestinal 4robstruction
-Perianal 4rdisease
-Electrolyte 4rimbalances
-Malnutrition
-Fistula 4r& 4rabscess 4rformation
A 4rpatient 4ris 4rbeing 4rprovided 4reducation 4rfor 4rnutritional 4rconsumption 4rwith 4ra
4rdiagnosis 4rof 4r*Crohn's 4rdisease*. 4rHow 4rshould 4rthe 4rnurse 4rinstruct 4rthe 4rpatient
4ron 4rhow 4rto 4ralter 4rtheir 4rdiet? 4r- 4rANS--Limit 4rdairy, 4rlow-fat 4rfoods, 4rlimit 4rfiber,
4reat 4rsmall-frequent 4rmeals, 4rincrease 4rfluids, 4rnutritional 4rsupplements 4r(vitamins
4rand 4riron)
What 4ris 4r*Ulcerative 4rColitis*? 4r- 4rANS--Recurrent 4rulcerative 4rand 4rinflammatory
4rbowel 4rdisease 4rof 4rthe 4rmucosal 4rand 4rsubmucosal 4rlayers 4rof 4rthe 4rcolon 4rand
4rrectum 4r(which 4rstarts 4rdistally 4rat 4rthe 4rrectum 4rand 4rprogresses 4rproximally)
4rOnset 4rcould 4rbe 4rgradual 4ror 4rabrupt.
Out 4rof 4rthe 4rfollowing 4rpopulations, 4rwho 4ris 4rmore 4rhigh 4rrisk 4rfor 4ra 4rdiagnosis 4rof
4r*Ulcerative 4rColitis*? 4r(Select 4rall 4rthat 4rapply)
4r- 4rCaucasians
- 4rAsian
- 4rHispanic
- 4rAfrican 4rAmerican
- 4rMen 4r
- 4rWomen
- 4rJewish 4r- 4rANS--- 4rCaucasians
- 4rWomen
- 4rJewish
What 4rare 4rthe 4rsigns 4rand 4rsymptoms 4rof 4r*Ulcerative 4rColitis*? 4r- 4rANS--Diarrhea
4r(6+ 4rliquid 4rstools/day), 4rpassage 4rof 4rmucus, 4rpus 4ror 4rblood,
LLQ 4rabdominal 4rpain, 4rintermittent
tenesmus 4r(straining 4rwith 4rBM), 4rrectal
bleeding 4r(mild 4ror 4rsevere), 4rPallor, 4ranemia 4rand 4rfatigue, 4rhypocalcemia
*Extra 4rInformation:* 4rHemoglobin/Hematocrit 4r(H&H) 4r- 4rANS--Red 4rblood 4rcell
4rmeasurements 4rto 4revaluate 4ranemia
In 4r*Ulcerative 4rColitis*, 4rH&H 4rlevels 4rmay 4rbe 4r*high 4ror 4rlow*? 4r- 4rANS--High
What 4rare 4rthe 4r*three* 4rmajor 4rcomplications 4rof 4r*Ulcerative 4rColitis*? 4r- 4rANS--
Toxic 4rmegacolon, 4rperforation 4rand 4rbleeding
