NR574 FINAL EXAM: ACUTE CARE PRACTICUM
2025 2026 I GUIDE| QUESTIONS & ANSWERS|
GRADE A| 100% CORRECT
How often should a CK level be drawn and why? - 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? - 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 congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and
lethargy.
what can cause symptoms of SVCS to become worse? - ANSWER....bending down, laying supine,
position changes.
Physical exam findings of SVCS - 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 - 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 - ANSWER....appendicitis, ectopic pregnancy,
nephrolithiasis,
ABD PAIN: "RUQ pain" is a red flag for.. - ANSWER....cholecystitis, pancreatitis (referred pain)
PNA/empyema hepatitis
ABD PAIN:: "LUQ pain" is a red flag for.. - ANSWER....pancreatitis
ABD PAIN : "LLQ pain" is red flag for.. - ANSWER....Diverticulitis ectopic nephrolithiasis, IBS
Periumbilical abdominal pain - ANSWER....gastroenteritis early appy bowel obstruction
Ruptured aortic aneurysm
epigastric pain - ANSWER....PUD, gastritis GERD pancreatitis MI pericarditis Ruptured AAA
Abdomen pain differential - ANSWER....Appy gallstones, pancreatitis, diverticulitis, ulcer disease,
esophagitis, GI obstruction, IBD, renal stone
Acute mesenteric ischemia (AMI) - ANSWER....occurrence of abrupt cessation of blood flow to
bowel, usually embolic or thrombotic in nature.
Risk factors for Arterio-Occlusive Mesenteric Ischemia - ANSWER....Acute mesenteric arterial
thrombosis
2025 2026 I GUIDE| QUESTIONS & ANSWERS|
GRADE A| 100% CORRECT
How often should a CK level be drawn and why? - 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? - 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 congestion, epistaxis, hemoptysis, dysphagia, pain, dizziness, syncope, and
lethargy.
what can cause symptoms of SVCS to become worse? - ANSWER....bending down, laying supine,
position changes.
Physical exam findings of SVCS - 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 - 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 - ANSWER....appendicitis, ectopic pregnancy,
nephrolithiasis,
ABD PAIN: "RUQ pain" is a red flag for.. - ANSWER....cholecystitis, pancreatitis (referred pain)
PNA/empyema hepatitis
ABD PAIN:: "LUQ pain" is a red flag for.. - ANSWER....pancreatitis
ABD PAIN : "LLQ pain" is red flag for.. - ANSWER....Diverticulitis ectopic nephrolithiasis, IBS
Periumbilical abdominal pain - ANSWER....gastroenteritis early appy bowel obstruction
Ruptured aortic aneurysm
epigastric pain - ANSWER....PUD, gastritis GERD pancreatitis MI pericarditis Ruptured AAA
Abdomen pain differential - ANSWER....Appy gallstones, pancreatitis, diverticulitis, ulcer disease,
esophagitis, GI obstruction, IBD, renal stone
Acute mesenteric ischemia (AMI) - ANSWER....occurrence of abrupt cessation of blood flow to
bowel, usually embolic or thrombotic in nature.
Risk factors for Arterio-Occlusive Mesenteric Ischemia - ANSWER....Acute mesenteric arterial
thrombosis
