NR 574/ NR574 FINAL
EXAM: 2025-2026 ACUTE
CARE PRACTICUM I GUIDE|
QUESTIONS & ANSWERS|
GRADE A| 100% CORRECT
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
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
, Acute mesenteric arterial thrombosis causes - ANSWER-aortic dissection/aneurysm,
arteritis, atherosclerotic vascular disease, decreased output from congestive heart
failure [CHF]or myocardial infarction [MI])
Acute mesenteric arterial embolism causes - ANSWER-emboli from fragments of
proximal aortic thrombus cardiac emboli atheromatous plaque dislodged during surgery
or catheterization
Mesenteric venous thrombosis causes - ANSWER-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 ? -
ANSWER-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? - ANSWER-Intestinal Ischemia
embolis etiology involved with AMI includes - ANSWER-afib recent MI soft
atherosclerotic plaque infective endocarditis valvular heart disease recent cardiac or
vascular catheterization.
subjective findings of AMI - ANSWER-severe, acute, unremitting abd pain strikingly out
of proportion to the physical findings
n/v/d, blood per rectum.later findings are peritonitis and cardiovascular collapse.
imaging to Diagnose AMI - ANSWER-Gold standard: CT angio with a 1-mm or thinner
cut should be used to detect mesenteric arterial occlusive disease.
Hepatic steatosis (fatty liver) - ANSWER-Nonalcoholic hepatic steatosis, or nonalcoholic
fatty liver disease (NAFLD), is one of the most common causes of chronic liver disease
in the developed world.It is a spectrum of disease, ranging from hepatic fat
accumulation without inflamma- tion to steatohepatitis, fibrosis, cirrhosis, and end-stage
liver disease.
risk factors of hepatic steatosis - ANSWER-NAFLD is strongly associated with insulin
resistance, overweight/obesity, and metabolic syndromecan occur in thin people with
paucity of adipose depots(lipodystrophy)
nonalcoholic steatohepatitis (NASH) - ANSWER-a more severe form of nonalcoholic
fatty liver disease. it consists of fatty accumulations plus liver-damaging inflammation. in
some cases, this will progress to cirrhosis, irreversible liver scarring or liver cancer
EXAM: 2025-2026 ACUTE
CARE PRACTICUM I GUIDE|
QUESTIONS & ANSWERS|
GRADE A| 100% CORRECT
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
-Acute mesenteric arterial embolism
-Mesenteric venous thrombosis
, Acute mesenteric arterial thrombosis causes - ANSWER-aortic dissection/aneurysm,
arteritis, atherosclerotic vascular disease, decreased output from congestive heart
failure [CHF]or myocardial infarction [MI])
Acute mesenteric arterial embolism causes - ANSWER-emboli from fragments of
proximal aortic thrombus cardiac emboli atheromatous plaque dislodged during surgery
or catheterization
Mesenteric venous thrombosis causes - ANSWER-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 ? -
ANSWER-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? - ANSWER-Intestinal Ischemia
embolis etiology involved with AMI includes - ANSWER-afib recent MI soft
atherosclerotic plaque infective endocarditis valvular heart disease recent cardiac or
vascular catheterization.
subjective findings of AMI - ANSWER-severe, acute, unremitting abd pain strikingly out
of proportion to the physical findings
n/v/d, blood per rectum.later findings are peritonitis and cardiovascular collapse.
imaging to Diagnose AMI - ANSWER-Gold standard: CT angio with a 1-mm or thinner
cut should be used to detect mesenteric arterial occlusive disease.
Hepatic steatosis (fatty liver) - ANSWER-Nonalcoholic hepatic steatosis, or nonalcoholic
fatty liver disease (NAFLD), is one of the most common causes of chronic liver disease
in the developed world.It is a spectrum of disease, ranging from hepatic fat
accumulation without inflamma- tion to steatohepatitis, fibrosis, cirrhosis, and end-stage
liver disease.
risk factors of hepatic steatosis - ANSWER-NAFLD is strongly associated with insulin
resistance, overweight/obesity, and metabolic syndromecan occur in thin people with
paucity of adipose depots(lipodystrophy)
nonalcoholic steatohepatitis (NASH) - ANSWER-a more severe form of nonalcoholic
fatty liver disease. it consists of fatty accumulations plus liver-damaging inflammation. in
some cases, this will progress to cirrhosis, irreversible liver scarring or liver cancer
