CNUR 204 Exam Questions With
Correctly Solved Solutions
Guaranteed Pass
Extent of burns - ANSWER-•Total body surface area (TBSA) affected by burn (Lund-
Browder chart- more precise and accurate & Rule of nines chart- initital assessment)
•Patchy burns (e.g., irregular/odd shaped) can be estimated using patient's hand as 1%
TBSA, superficial partial thickness burns not measured by TBSA
•Online tools & App are available for TBSA estimation
•First degree burns, equivalent to a sunburn are not included when TBSA burned is
calculated.
•The Lund browder chart is considered more accurate because the patient's age, in
proportion to relative body are size, is taken into account. The rule of nines which is
easy to remember is considered adequate for initial assessment of an adult patient with
burn injury.
•For irregular or odd shaped burns, the size of the patient's hand (including the fingers)
is approximately 1% TBSA.
Subjective data for GI - ANSWER--HPI (history of present illness)-including
OPQRSTUV
-PMHx (past medical history)
-GI related questions
-Appetite; N&V; dysphagia; bowel habits; food intake; food intolerance...
-Family history
-Medications
-Psycho-social history
-Use of alcohol & tobacco
,-Any stressful events, look at chart- -Lab values & recent diagnostics : any significance
related to the current situation
-Other notes (consultation reports...)
Common symptoms of GI - ANSWER-•Abdominal pain- gather lots of info to find the
source of pain, think outside the box
•N&V
•Diarrhea/constipation
•Weight loss
•Indigestion/heartburn
•Other vague symptoms
•A 78 year old female, Mrs. Soretummy presented to ER with acute onset of persistent,
severe epigastric abdominal pain. She states she has been having N&V with abdominal
pain. She also complains of dyspnea. On your examination, you find that the patient is
experiencing fever, tachypnea, and hypotension during the admission process.
•Mrs. Soretummy lives with her son, Greg. Mrs. Soretummy's son, Greg, states the
patient drinks Gin and tonic everyday during the supper time, but not sure if she drinks
during the day while he is gone to work. - ANSWER-She has acute hepatitis, and the
priority assessments are ABCs and vitals, pain assessment, resp or cardio assessment,
GI assessment, and other assessments might be needed, depending on the presenting
symptoms and/or when you suspect complications from the presenting symptoms
Jaundice (icterus) - ANSWER-•Hyperbilirubinemia
-Alteration in normal bilirubin metabolism/flow
•Symptom rather than a disease
•Yellowish discoloration of body tissues- Mucosal membrane may show jaundice
-Appears on the sclera & skin
•Usually appears when serum bilirubin level is higher than 34 mcmol/L (twice the normal
upper limit)
,Jaundice is usually first observed in the sclera and later in the skin, types can overlap-
Pre-hepatic Jaundice
Occurs with an increase in bilirubin; over production of unconjugated bilirubin (i.e.,
hemolysis)- can occur with incorrect blood transfusions, sickle cell anemia
Hepatic Jaundice
Caused by inability to take up bilirubin by the liver due to damaged liver cells (cirrhosis;
hepatitis; hepatocellular carcinoma)- damage to liver
Post-hepatic Jaundice (or cholestatic)
Failure for bile to reach the duodenum due to obstruction of bile flow
Intrahepatic obstructions (i.e., fibrosis or swelling of the liver's canaliculi/bile ducts from
hepatitis, cirrhosis)
Extrahepatic obstructions (i.e., obstruction of common bile duct from gallstones;
pancreatic cancer..)
A & P of Bilirubin - ANSWER-Bilirubin is not water soluble- sticks to albumin to get to
liver (unconjugated)- still not water soluble, needs to conjugate so it is water soluble and
can be excreted in the bile (metabolize fat for digestion), serobilirubin- brown colour to
feces, some urobiliogen can be excreted in the kidneys
Liver, gallbladder, pancreas - ANSWER-Liver produces bile, goes into gall bladder, and
common bile duct, enzyme comes out of pancreatic duct and mixes in duodenum for
digestion
Bile may not be able to go through- post hepatic jaundice
Hepatitis - ANSWER-•Involves widespread Inflammation of liver tissue
•During acute infection:
-Mediated by cytotoxic cytokines & natural killer cells- cause lysis of infected
hepatocytes-liver cell necrosis
-Inflammation interrupt bile flow- cholestasis-liver cell damage
, •With no complications, liver cells can regenerate with complete recovery
•With massive liver cell loss, may progress to chronic hepatitis and cause further
complications (e.g., chronic hepatitis leading to cirrhosis), -The most common cause of
hepatitis is a viral infection
-Hepatitis A, B, C, D, E virus
-Cytomegalovirus
-Epstein-Barr virus
-Herpes virus
-Coxsackie virus
-Rubella virus
-Other possible causes
§Drugs (alcohol)
§Chemicals
§Autoimmune liver disease
§Metabolic disorders
§Genetic abnormalities, •Depending on the stage/types of the liver condition & other
disorders
•No symptoms in individuals with immunosuppressed condition
•30% of patients with HBV are asymptomatic.
•80% of patients with acute HCV will be asymptomatic, HAV has symptoms
Acute Phase vs Chronic Phase of Hepatitis - ANSWER-Acute phase (1-4 months)-GI
symptoms (N&V; anorexia; RUQ discomfort; constipation; diarrhea, altered taste &
smell, wt loss..)
•Malaise; fatigue; headache; low grade fever; arthralgia; skin rashes; pruritus; jaundice;
dark urine and light stool..
•Hepatomegaly, splenomegaly
Correctly Solved Solutions
Guaranteed Pass
Extent of burns - ANSWER-•Total body surface area (TBSA) affected by burn (Lund-
Browder chart- more precise and accurate & Rule of nines chart- initital assessment)
•Patchy burns (e.g., irregular/odd shaped) can be estimated using patient's hand as 1%
TBSA, superficial partial thickness burns not measured by TBSA
•Online tools & App are available for TBSA estimation
•First degree burns, equivalent to a sunburn are not included when TBSA burned is
calculated.
•The Lund browder chart is considered more accurate because the patient's age, in
proportion to relative body are size, is taken into account. The rule of nines which is
easy to remember is considered adequate for initial assessment of an adult patient with
burn injury.
•For irregular or odd shaped burns, the size of the patient's hand (including the fingers)
is approximately 1% TBSA.
Subjective data for GI - ANSWER--HPI (history of present illness)-including
OPQRSTUV
-PMHx (past medical history)
-GI related questions
-Appetite; N&V; dysphagia; bowel habits; food intake; food intolerance...
-Family history
-Medications
-Psycho-social history
-Use of alcohol & tobacco
,-Any stressful events, look at chart- -Lab values & recent diagnostics : any significance
related to the current situation
-Other notes (consultation reports...)
Common symptoms of GI - ANSWER-•Abdominal pain- gather lots of info to find the
source of pain, think outside the box
•N&V
•Diarrhea/constipation
•Weight loss
•Indigestion/heartburn
•Other vague symptoms
•A 78 year old female, Mrs. Soretummy presented to ER with acute onset of persistent,
severe epigastric abdominal pain. She states she has been having N&V with abdominal
pain. She also complains of dyspnea. On your examination, you find that the patient is
experiencing fever, tachypnea, and hypotension during the admission process.
•Mrs. Soretummy lives with her son, Greg. Mrs. Soretummy's son, Greg, states the
patient drinks Gin and tonic everyday during the supper time, but not sure if she drinks
during the day while he is gone to work. - ANSWER-She has acute hepatitis, and the
priority assessments are ABCs and vitals, pain assessment, resp or cardio assessment,
GI assessment, and other assessments might be needed, depending on the presenting
symptoms and/or when you suspect complications from the presenting symptoms
Jaundice (icterus) - ANSWER-•Hyperbilirubinemia
-Alteration in normal bilirubin metabolism/flow
•Symptom rather than a disease
•Yellowish discoloration of body tissues- Mucosal membrane may show jaundice
-Appears on the sclera & skin
•Usually appears when serum bilirubin level is higher than 34 mcmol/L (twice the normal
upper limit)
,Jaundice is usually first observed in the sclera and later in the skin, types can overlap-
Pre-hepatic Jaundice
Occurs with an increase in bilirubin; over production of unconjugated bilirubin (i.e.,
hemolysis)- can occur with incorrect blood transfusions, sickle cell anemia
Hepatic Jaundice
Caused by inability to take up bilirubin by the liver due to damaged liver cells (cirrhosis;
hepatitis; hepatocellular carcinoma)- damage to liver
Post-hepatic Jaundice (or cholestatic)
Failure for bile to reach the duodenum due to obstruction of bile flow
Intrahepatic obstructions (i.e., fibrosis or swelling of the liver's canaliculi/bile ducts from
hepatitis, cirrhosis)
Extrahepatic obstructions (i.e., obstruction of common bile duct from gallstones;
pancreatic cancer..)
A & P of Bilirubin - ANSWER-Bilirubin is not water soluble- sticks to albumin to get to
liver (unconjugated)- still not water soluble, needs to conjugate so it is water soluble and
can be excreted in the bile (metabolize fat for digestion), serobilirubin- brown colour to
feces, some urobiliogen can be excreted in the kidneys
Liver, gallbladder, pancreas - ANSWER-Liver produces bile, goes into gall bladder, and
common bile duct, enzyme comes out of pancreatic duct and mixes in duodenum for
digestion
Bile may not be able to go through- post hepatic jaundice
Hepatitis - ANSWER-•Involves widespread Inflammation of liver tissue
•During acute infection:
-Mediated by cytotoxic cytokines & natural killer cells- cause lysis of infected
hepatocytes-liver cell necrosis
-Inflammation interrupt bile flow- cholestasis-liver cell damage
, •With no complications, liver cells can regenerate with complete recovery
•With massive liver cell loss, may progress to chronic hepatitis and cause further
complications (e.g., chronic hepatitis leading to cirrhosis), -The most common cause of
hepatitis is a viral infection
-Hepatitis A, B, C, D, E virus
-Cytomegalovirus
-Epstein-Barr virus
-Herpes virus
-Coxsackie virus
-Rubella virus
-Other possible causes
§Drugs (alcohol)
§Chemicals
§Autoimmune liver disease
§Metabolic disorders
§Genetic abnormalities, •Depending on the stage/types of the liver condition & other
disorders
•No symptoms in individuals with immunosuppressed condition
•30% of patients with HBV are asymptomatic.
•80% of patients with acute HCV will be asymptomatic, HAV has symptoms
Acute Phase vs Chronic Phase of Hepatitis - ANSWER-Acute phase (1-4 months)-GI
symptoms (N&V; anorexia; RUQ discomfort; constipation; diarrhea, altered taste &
smell, wt loss..)
•Malaise; fatigue; headache; low grade fever; arthralgia; skin rashes; pruritus; jaundice;
dark urine and light stool..
•Hepatomegaly, splenomegaly
