GI in Complex Care
The two lab tests most associated with diagnosing pancreatitis are __________ and __________.
Amylase and lipase
What is the hallmark sign of HHS?
A. Severe acidosis
B. Extremely high blood glucose and profound dehydration
C. Ketones in urine
D. Rapid-onset symptoms
B. Extremely high blood glucose and profound dehydration
Two major causes of infective endocarditis are:
poor dental hygiene and IV drug use
A hallmark symptom of dissociative disorders is
missing time and memory loss
In organ donation, conversations should begin when
the family has accepted that there is no more treatment / poor prognosis
What intra-abdominal pressure is considered too high and concerning for abdominal compartment syndrome?
> 20 mmHg
Which ABG findings are common in DKA?
□ Low pH
□ Low bicarb
□ Respiratory alkalosis
□ Ketones
□ Low pH
□ Low bicarb
□ Ketones
Which labs are involved in diagnosing DIC?
□ Platelets
□ PT/INR
□ Fibrinogen
□ D-dimer
□ ALT/AST
Platelets, PT/INR, Fibrinogen, D-dimer
What is the primary treatment goal for somatic symptom disorder?
Return to baseline functioning and help them identify/manage stress triggers
What is the biggest risk with TPN administration?
Infection due to high sugar content and central line access
Which of the following is a functional obstruction?
A. Adhesions
B. Food bolus
C. Opioid-induced ileus
D. Tumors
C. Opioid-induced ileus
In treating DKA, the nurse must bring blood sugar down ________ to avoid cerebral edema.
Slowly
A 76-year-old patient comes to the ED with increased shortness of breath, fatigue, and new lower-extremity swelling. The echocardiogram shows severe mitral stenosis.
Based on the pathophysiology of valve disease, which findings does the nurse expect due to blood backing up before the dysfunctional mitral valve?
Select all that apply:
A. Pulmonary edema
B. Jugular venous distention (JVD)
C. Decreased cardiac output
D. Peripheral edema
E. Crackles in the lungs
F. Increased left ventricular preload
A. Pulmonary edema
Pressure backs up into the pulmonary veins → lungs fill with fluid → pulmonary edema.
C. Decreased cardiac output
Less blood crosses the stenotic mitral valve → less preload to LV → decreased stroke volume and cardiac output.
E. Crackles in the lungs
Fluid accumulation in alveoli from pulmonary venous congestion causes crackles.
Which disorder involves neurological symptoms without a medical cause?
A. Illness anxiety disorder
B. Conversion disorder
C. Factitious disorder
D. Borderline personality disorder
B. Conversion disorder
A patient presents with a painless, waxy-white burn after touching a hot metal pipe. The skin is firm and non-blanching. What type of burn is this?
A. Superficial
B. Superficial partial-thickness
C. Deep partial-thickness
D. Full-thickness
D. Full-thickness
Enteral nutrition is preferred because it maintains GI ________, ________, and ________.
function, motility, immune function
Compare and contrast DKA and HHS
Which is more Type 1 vs Type 2?
Glucose, pH, ketones, serum osmolality, symptoms?
DKA (Type 1):
Glucose > 240
pH < 7.3
Ketones positive
Anion gap widened
Serum osmolality normal
HHS (Type 2):
Glucose > 600
pH > 7.3
Ketones negative
Serum osmolality high
Symptoms
DKA: Kussmaul respirations, fruity breath, tachycardia, hypotension.
HHS: Severe dehydration, altered LOC, very high osmolality, no fruity breath.
Treatment
Both: Fluids + insulin infusion + electrolyte replacement.
DKA specific: When BG <200–250, switch to D5W to prevent cerebral edema.
HHS: Large-volume NS due to profound dehydration.
A 68-year-old patient with a history of IV drug use presents with fatigue, abdominal bloating, and swelling in both legs. An echocardiogram shows severe tricuspid regurgitation.
Based on the pathophysiology of valve dysfunction where blood backs up before the dysfunctional valve, which findings does the nurse expect?
Select all that apply:
A. Jugular venous distention (JVD)
B. Ascites
C. Crackles in the lungs
D. Hepatomegaly (enlarged liver)
E. Pink frothy sputum
F. Peripheral edema
G. Pulmonary edema
A. JVD — Correct.
Backup from the right ventricle → right atrium → systemic venous system → neck veins distend.
B. Ascites — Correct.
Systemic venous congestion ↑ hydrostatic pressure → fluid shifts into abdominal cavity.
D. Hepatomegaly — Correct.
Blood backs up into hepatic veins → liver becomes enlarged and tender.
F. Peripheral edema — Correct.
Backed-up venous pressure causes fluid to pool in dependent tissues (legs/feet).
Name the three clusters and the adjectives that go with. Name examples of each disorder for each cluster.
A: odd, eccentric
ex. Paranoid personality disorder, Schizoid personality disorder, Schizotypal personality disorder
B: dramatic, emotional, erratic
ex. Antisocial personality disorder, BPD, Histrionic personality disorder, Narcissistic personality disorder
C: anxious, fearful
ex. Avoidant personality disorder, Dependent personality disorder, Obsessive-compulsive personality disorder
Which patients require ICU-level burn management?
☐ A patient with 40% TBSA partial-thickness burns
☐ A patient with inhalation injury
☐ A patient with 2% superficial burns on the arm
☐ A patient with electrical burns
☐ A patient with full-thickness burns to the hands and face
A patient with 40% TBSA partial-thickness
A patient with inhalation injury
A patient with electrical burns
A patient with full-thickness to hands + face
Which of the following are complications of pancreatitis? Select all that apply.
□ Hypovolemia
□ Hyperglycemia
□ Sepsis
□ Electrolyte imbalance
□ Increased ICP
□ Hypovolemia
□ Hyperglycemia
□ Sepsis
□ Electrolyte imbalance
A 58-year-old patient with a history of type 2 diabetes is brought to the ED by EMS after his wife found him confused and increasingly lethargic. She reports he has had a respiratory infection for the past week and has been “too tired to take his diabetes medications.” On assessment, the nurse notes:
BP 92/54
HR 126
RR 22, shallow (no Kussmaul respirations)
Dry mucous membranes, poor skin turgor
Capillary refill >3 sec
The patient is disoriented ×3
Blood glucose: 846 mg/dL
Serum osmolality: high
Urine ketones: negative
ABG: pH 7.41
Potassium: 3.1
Serum sodium: 150
Question:
Which findings support the nurse’s conclusion that the patient is likely experiencing Hyperglycemic Hyperosmolar State (HHS) rather than Diabetic Ketoacidosis (DKA)?
Select all that apply.
✔ A. Extremely elevated blood glucose (>600 mg/dL)
✔ B. Absence of ketones in the urine
✔ C. Normal blood pH
✔ E. Presence of severe dehydration and altered mental status
A patient with sepsis begins showing signs of diffuse bleeding, petechiae, hypotension, and oozing from IV sites. Labs show:
↓ platelets
↑ PT/INR
↑ D-dimer
↓ fibrinogen
The provider suspects disseminated intravascular coagulation (DIC).
Which treatment priority should the nurse anticipate?
A. Begin heparin to halt the ongoing clotting process
B. Administer a large IV fluid bolus to correct hypotension
C. Start high-dose steroids to reduce systemic inflammation
D. Give platelet transfusion immediately to correct thrombocytopenia
A. Begin heparin to halt the ongoing clotting process
Borderline Personality Disorder: Clinical Presentation
State of crisis
Frequent mood swings
Affect is extreme intensity
Behavior changes
Chronic depression
Close to being psychotic, don't have firm grasp on reality
Always in crisis
A patient with mitral regurgitation is most likely to have blood backing up into the:
A. Aorta
B. Right atrium
C. Lungs
D. Right ventricle
C (left-sided → lungs)