NR574/t NRt 574t Midtermt Exam:t Acutet
Caret Practicumt Reviewt (Latestt 2025/t
2026t Update)t |t Questionst &t Answers|t
Gradet A|t 100%t Correctt (Verifiedt
Solutions)-t Chamberlain
QUESTION
t Subjectivet findingst oft acutet intestinalt obstruction
Answer:
t Mostt common:
colickyt abdominalt paint (crampingt periumbilicalt paint initially;t latert becomest constantt
andt diffuse)
abdominalt paint oftent moret severet witht distalt obstructiont vomitingt (moret significantt
witht proximalt obstruction)t abdominalt bloating
obstipation
QUESTION
t Whatt keyt informationt shouldt bet discussedt duringt H/P,t ift yout aret concernedt fort bowelt
obstruction?
Answer:
t Historyt shouldt includet essentialt elementst sucht ast previ-t oust abdominalt ort pelvict
surgeries,t comorbidt conditionst sucht ast inflammatoryt bowelt diseaset ort malignancy.
QUESTION
t Objectivet findingst int at patientt witht intestionalt obstruction?
Answer:
t Keyt physicalt examt findingst mayt include:
Fevert (systemict inflammationt ort strangulation)
,High-pitched,t tinkling,t bowelt soundst (mayt bet hypoactivet ort absentt witht completet
obstruction)
Abdominalt distentiont (moret significantt witht distalt obstructiont duet tot thet greatert volumet
oft intraluminalt fluidt accumulation)
Mildt abdominalt tendernesst butt not peritonealt findings
Tendert abdominalt ort groint massest (cant representt incarceratedt hernia)t Signst oft shockt
(tachycardia,t hypotension,t oliguria)
QUESTION
t Significantt abdominalt tendernesst witht palpationt shouldt increaset thet NP'st suspiciont for?
Answer:
t ischemia,t peritonitis,t ort necrosis.
QUESTION
t whyt ist at serumt lactatet usefult int dxt at bowelt obstruction?
Answer:
t Serumt lactate
(increasedt serumt lactatet shouldt raiset concernt fort strangulatedt obstruction)
QUESTION
t whatt diagnostict imagingt shouldt bt usedt fort bowelt obstruction?
Answer:
t plaint filmt xray
QUESTION
t whatt willt at plaint filmt xrayt showt ift at patientt hast at bowelt obstruction?
Answer:
t Ob-t structiont willt revealt dilatedt loopst oft bowelt andt visiblet air-fluidt levelst whicht
shouldt promptt furthert studies.
,At horizontalt patternt oft dilatedt smallt bowelt loopst cant bet seent witht smallt bowelt
obstructiont (SBO)t ast shownt int thet followingt photo.
QUESTION
t Shouldt bariumt contrastt bet givent tot at patientt witht at bowelt obstruction
Answer:
t NO!t Imagingt studiest requiringt administrationt oft bariumt aret contraindicatedt int casest oft
high-gradet ort completet obstruction.
QUESTION
t Whatt doest bariumt contrastt dot withint thet bodyt witht at bowelt obstruction?-
Answer:
t Bariumt shouldt NEVERt bet givent orallyt tot at clientt untilt thet diagnosist oft obstructiont
hast beent excludedt completelyt ast retainedt bariumt cant causet concretionst whicht createt ant
additionalt sourcet oft blockaget whicht cant requiret surgicalt interventiont int clientst whot
mayt havet otherwiset recovered.t Retainedt bariumt alsot severelyt limitst thet abilityt tot
interprett subsequentt angiographyt ort cross-sectionalt imaging.
QUESTION
t Howt oftent shouldt at CKt levelt bet drawnt andt why?
Answer:
t leastt everyt 6-12t hourst tot establisht at peakt levelt andt thent subsequentlyt at downwardt
trend.
QUESTION
t Sylviet ist at 26-year-oldt whot presentst tot thet emergencyt departmentt (ED)t aftert justt
finishingt at fullt marathon.t Shet complainst oft feelingt lightheaded,t nauseous,t andt hast
vomitedt twicet sincet completingt thet race.t Hert legst feelt tired,t weak,t andt soret whicht shet
attributest tot runningt 26.2t miles.t Shet reportst thatt shet didn'tt stopt tot rehydratet ast mucht
ast shet wouldt havet likedt becauset shet wast intentt ont finishingt witht hert personalt bestt
, time.t Shet becamet veryt concernedt whent shet wentt tot uset thet restroomt andt noticedt thatt
hert urinet wast darkt -t almostt liket tea.t Thet AGACNPt suspectst rhabdomyolysis.t Whicht
testt ist neededt tot confirmt thet diagnosis?
a.t urinet dipstick
b.t urinet myoglobin
c.t serumt creatinet kinase
d.t serumt myoglobin
Answer:
t c.t serumt creatinet kinase
Rationale:t Rhabdomyolysist cant bet diagnosedt whent thet followingt aret present:t Darkt
urinet ort ant acutet neuromusculart illnesst withoutt othert symptomst PLUSt Ant acutet
elevationt int serumt creatinet kinaset (typicallyt att leastt fivet timest thet uppert limitt oft
normal).
QUESTION
t Sylvie'st EKGt showst markedlyt elevatedt Tt wavest andt prolongationt oft thet PRt andt QRSt
intervals.t Thet AGACNPt shouldt anticipatet whicht oft thet followingt results?
a.t hyperkalemiat b.t hypercalcemiat c.t hypouricemia
d.t hypophosphatemia
Answer:
t a.t hyperkalemiat (Correctt answer)
Rationale:t Hyperkalemia,t hypocalcemia,t hyperphosphatemia,t andt hyperuricemiat aret
commont electrolytet disorderst seent witht rhabdomyolysis.t EKGt changest re-t flectivet oft
hyperkalemiat includet elevatedt T-wavest andt prolongedt PRt andt QRS.t Hyperkalemiat cant
resultt int cardiact arrhythmiast ort cardiact arrestt andt mustt bet treatedt immediately.t
Treatmentt oft hyperkalemiat consistst oft IVt glucose,t sodiumt bicarbonate,t andt insulin,t
sodiumt polystyrenet sulfonate;t andt int severet ort refractoryt cases,t hemodialysist ist
sometimest required.
QUESTION
t Riskt factorst fort acutet intestinalt obstruction?
Answer:
t Adhesionst fromt previoust ab-t dominalt surgery
Internalt ort externalt hernias
Caret Practicumt Reviewt (Latestt 2025/t
2026t Update)t |t Questionst &t Answers|t
Gradet A|t 100%t Correctt (Verifiedt
Solutions)-t Chamberlain
QUESTION
t Subjectivet findingst oft acutet intestinalt obstruction
Answer:
t Mostt common:
colickyt abdominalt paint (crampingt periumbilicalt paint initially;t latert becomest constantt
andt diffuse)
abdominalt paint oftent moret severet witht distalt obstructiont vomitingt (moret significantt
witht proximalt obstruction)t abdominalt bloating
obstipation
QUESTION
t Whatt keyt informationt shouldt bet discussedt duringt H/P,t ift yout aret concernedt fort bowelt
obstruction?
Answer:
t Historyt shouldt includet essentialt elementst sucht ast previ-t oust abdominalt ort pelvict
surgeries,t comorbidt conditionst sucht ast inflammatoryt bowelt diseaset ort malignancy.
QUESTION
t Objectivet findingst int at patientt witht intestionalt obstruction?
Answer:
t Keyt physicalt examt findingst mayt include:
Fevert (systemict inflammationt ort strangulation)
,High-pitched,t tinkling,t bowelt soundst (mayt bet hypoactivet ort absentt witht completet
obstruction)
Abdominalt distentiont (moret significantt witht distalt obstructiont duet tot thet greatert volumet
oft intraluminalt fluidt accumulation)
Mildt abdominalt tendernesst butt not peritonealt findings
Tendert abdominalt ort groint massest (cant representt incarceratedt hernia)t Signst oft shockt
(tachycardia,t hypotension,t oliguria)
QUESTION
t Significantt abdominalt tendernesst witht palpationt shouldt increaset thet NP'st suspiciont for?
Answer:
t ischemia,t peritonitis,t ort necrosis.
QUESTION
t whyt ist at serumt lactatet usefult int dxt at bowelt obstruction?
Answer:
t Serumt lactate
(increasedt serumt lactatet shouldt raiset concernt fort strangulatedt obstruction)
QUESTION
t whatt diagnostict imagingt shouldt bt usedt fort bowelt obstruction?
Answer:
t plaint filmt xray
QUESTION
t whatt willt at plaint filmt xrayt showt ift at patientt hast at bowelt obstruction?
Answer:
t Ob-t structiont willt revealt dilatedt loopst oft bowelt andt visiblet air-fluidt levelst whicht
shouldt promptt furthert studies.
,At horizontalt patternt oft dilatedt smallt bowelt loopst cant bet seent witht smallt bowelt
obstructiont (SBO)t ast shownt int thet followingt photo.
QUESTION
t Shouldt bariumt contrastt bet givent tot at patientt witht at bowelt obstruction
Answer:
t NO!t Imagingt studiest requiringt administrationt oft bariumt aret contraindicatedt int casest oft
high-gradet ort completet obstruction.
QUESTION
t Whatt doest bariumt contrastt dot withint thet bodyt witht at bowelt obstruction?-
Answer:
t Bariumt shouldt NEVERt bet givent orallyt tot at clientt untilt thet diagnosist oft obstructiont
hast beent excludedt completelyt ast retainedt bariumt cant causet concretionst whicht createt ant
additionalt sourcet oft blockaget whicht cant requiret surgicalt interventiont int clientst whot
mayt havet otherwiset recovered.t Retainedt bariumt alsot severelyt limitst thet abilityt tot
interprett subsequentt angiographyt ort cross-sectionalt imaging.
QUESTION
t Howt oftent shouldt at CKt levelt bet drawnt andt why?
Answer:
t leastt everyt 6-12t hourst tot establisht at peakt levelt andt thent subsequentlyt at downwardt
trend.
QUESTION
t Sylviet ist at 26-year-oldt whot presentst tot thet emergencyt departmentt (ED)t aftert justt
finishingt at fullt marathon.t Shet complainst oft feelingt lightheaded,t nauseous,t andt hast
vomitedt twicet sincet completingt thet race.t Hert legst feelt tired,t weak,t andt soret whicht shet
attributest tot runningt 26.2t miles.t Shet reportst thatt shet didn'tt stopt tot rehydratet ast mucht
ast shet wouldt havet likedt becauset shet wast intentt ont finishingt witht hert personalt bestt
, time.t Shet becamet veryt concernedt whent shet wentt tot uset thet restroomt andt noticedt thatt
hert urinet wast darkt -t almostt liket tea.t Thet AGACNPt suspectst rhabdomyolysis.t Whicht
testt ist neededt tot confirmt thet diagnosis?
a.t urinet dipstick
b.t urinet myoglobin
c.t serumt creatinet kinase
d.t serumt myoglobin
Answer:
t c.t serumt creatinet kinase
Rationale:t Rhabdomyolysist cant bet diagnosedt whent thet followingt aret present:t Darkt
urinet ort ant acutet neuromusculart illnesst withoutt othert symptomst PLUSt Ant acutet
elevationt int serumt creatinet kinaset (typicallyt att leastt fivet timest thet uppert limitt oft
normal).
QUESTION
t Sylvie'st EKGt showst markedlyt elevatedt Tt wavest andt prolongationt oft thet PRt andt QRSt
intervals.t Thet AGACNPt shouldt anticipatet whicht oft thet followingt results?
a.t hyperkalemiat b.t hypercalcemiat c.t hypouricemia
d.t hypophosphatemia
Answer:
t a.t hyperkalemiat (Correctt answer)
Rationale:t Hyperkalemia,t hypocalcemia,t hyperphosphatemia,t andt hyperuricemiat aret
commont electrolytet disorderst seent witht rhabdomyolysis.t EKGt changest re-t flectivet oft
hyperkalemiat includet elevatedt T-wavest andt prolongedt PRt andt QRS.t Hyperkalemiat cant
resultt int cardiact arrhythmiast ort cardiact arrestt andt mustt bet treatedt immediately.t
Treatmentt oft hyperkalemiat consistst oft IVt glucose,t sodiumt bicarbonate,t andt insulin,t
sodiumt polystyrenet sulfonate;t andt int severet ort refractoryt cases,t hemodialysist ist
sometimest required.
QUESTION
t Riskt factorst fort acutet intestinalt obstruction?
Answer:
t Adhesionst fromt previoust ab-t dominalt surgery
Internalt ort externalt hernias
