1|Page
Final Exam: NR 574/ NR574 (Latest 2025/ 2026 Update) Acute Care
Practicum I Test Bank| 450 Questions with Verified Answers| 100%
Correct | Grade A – Chamberlain .
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
,2|Page
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.
How often should a CK level be drawn and why?
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
,3|Page
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?
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?
hyperkalemia
Risk factors for acute intestinal obstruction?
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
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?
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?
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?
ischemia, peritonitis, or necrosis.
why is a serum lactate useful in dx a bowel obstruction?
Serum lactate (increased serum lactate should raise concern for strangulated obstruction)
, 4|Page
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.
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
Final Exam: NR 574/ NR574 (Latest 2025/ 2026 Update) Acute Care
Practicum I Test Bank| 450 Questions with Verified Answers| 100%
Correct | Grade A – Chamberlain .
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
,2|Page
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.
How often should a CK level be drawn and why?
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
,3|Page
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?
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?
hyperkalemia
Risk factors for acute intestinal obstruction?
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
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?
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?
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?
ischemia, peritonitis, or necrosis.
why is a serum lactate useful in dx a bowel obstruction?
Serum lactate (increased serum lactate should raise concern for strangulated obstruction)
, 4|Page
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.
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
