Midterm Exam: NR574/ NR 574 (2023/2024
New Update) Acute Care Practicum Review |
Week 1-4 | Questions and Verified Answers|
100% Correct- Chamberlain
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QUESTION
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.
QUESTION
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?
a. urine dipstick
b. urine myoglobin
c. serum creatine kinase
d. serum myoglobin
Answer:
c. serum creatine kinase
Rationale: Rhabdomyolysis can be diagnosed when the following are present: Dark urine or an
acute neuromuscular illness without other symptoms PLUS An acute elevation in serum creatine
kinase (typically at least five times the upper limit of normal).
QUESTION
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?
a. hyperkalemia b. hypercalcemia c. hypouricemia
d. hypophosphatemia
Answer:
a. hyperkalemia (Correct answer)
Rationale: Hyperkalemia, hypocalcemia, hyperphosphatemia, and hyperuricemia are common
electrolyte disorders seen with rhabdomyolysis. EKG changes re- flective of hyperkalemia
include elevated T-waves and prolonged PR and QRS. Hyperkalemia can result in cardiac
arrhythmias or cardiac arrest and must be treated immediately. Treatment of hyperkalemia
consists of IV glucose, sodium bicarbonate, and insulin, sodium polystyrene sulfonate; and in
severe or refractory cases, hemodialysis is sometimes required.
QUESTION
Risk factors for acute intestinal obstruction?
Answer:
Adhesions from previous ab- dominal 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
QUESTION
Subjective findings of acute intestinal obstruction
Answer:
Most common:
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 bloating
obstipation
QUESTION
What key information should be discussed during H/P, if you are concerned for bowel
obstruction?
Answer:
History should include essential elements such as previ- ous abdominal or pelvic surgeries,
comorbid conditions such as inflammatory bowel disease or malignancy.
QUESTION
Objective findings in a patient with intestional 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 findings
Tender abdominal or groin masses (can represent incarcerated hernia) Signs of shock
(tachycardia, hypotension, oliguria)
QUESTION
Significant abdominal tenderness with palpation should increase the NP's suspicion for?
Answer:
ischemia, peritonitis, or necrosis.
QUESTION
why is a serum lactate useful in dx a bowel obstruction?
Answer:
Serum lactate
(increased serum lactate should raise concern for strangulated obstruction)
QUESTION
what diagnostic imaging should b used for bowel obstruction?
Answer:
plain film xray
QUESTION
what will a plain film xray show if a patient has a bowel obstruction?
Answer:
Ob- struction 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) as shown in the following photo.
QUESTION
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 highgrade
or complete
obstruction.
QUESTION
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. [Show Less]