Patho
Bariatric surgery is associated with a number of complications. Which of the following is NOT a complication of gastric bypass surgery?
A. bowel obstruction B. malabsorption C. kidney stones D. leakage from the anastomosis site
C. kidney stones
(Question 11)
Which of the following is NOT a sign of a bowel perforation?
A. a "board-like" abdomen B. dilated loops of a gas-filled bowel on a KUB X-ray C. rebound tenderness D. diminished or absent bowel sounds
B. dilated loops of a gas-filled bowel on a KUB X-ray
(Question 4)
The patient presents with acute pancreatitis secondary to chronic, heavy alcohol use. Which of the following treatments is anticipated for this patient?
A. fluid restriction B. NSAIDs for pain C. Nat and CI- replacement D. nasogastric suction
D. nasogastric suction
(Question 15)
Left shoulder; pain is sharp
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
E. Ruptured spleen
(Question 17)
Severe, across the abdomen, in waves, tender to palpation; pain is present in the form of cramping
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
A. Small bowel obstruction
(Question 17)
The patient with pancreatitis has a low-grade fever and abdominal pain. Which of the following assessments indicates a pulmonary complication associated with acute pancreatitis?
A. bilateral wheezes B. right middle lobe crackles C. atelectasis of the left lower lobe D. left lung infiltrate
C. atelectasis of the left lower lobe
(Question 16)
Upon arrival at the emergency department, the patient presented with Kehr's sign. Which clinical sign would the patient with Kehr's sign be expected to demonstrate?
A. left shoulder pain B. bowel sounds in the chest C. free air in the abdomen D. left flank ecchymosis
A. left shoulder pain
(Question 2)
During orientation, the nurse is told by the preceptor that the patient with upper Gl bleeding needs to be closely monitored for ST segment elevation and chest pain. This monitoring is necessary for which of the following treatments for Gl bleeding?
A. administration of octreotide B. infusion of blood products C. administration of vasopressin D. infusion of isotonic fluids
C. administration of vasopressin
(Question 3)
The patient has hepatic failure. Which of the following interventions will the nurse anticipate?
A. furosemide to treat ascites B. neomycin to decrease gut bacteria that produce NH3 C. lactated Ringer's for hypotension D. acetylcysteine (until acetaminophen levels are normal)
to treat an acetaminophen overdose
B. neomycin to decrease gut bacteria that produce NH3
(Question 1)
Epigastric or right upper quadrant; pain is gnawing, burning
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
D. Peptic ulcer
(Question 17)
The patient with alcoholic liver cirrhosis presents with a stuporous mental state, asterixis, hyperventilation, and an abnormal EEG. Based on these signs, how severe is the patient's hepatic encephalopathy?
A. Stage I B. Stage II C. Stage III D. Stage IV
C. Stage III
(Question 13)
The patient has signs and symptoms of hepatic failure. Which of the following statements regarding signs and symptoms of hepatic failure is accurate? A. Hypoventilation may be present as a result of lactic acidosis. B. Jaundice may be present as a result of an elevated BUN. C. Mental status change may develop as a result of elevated NH3. D. Ascites may be present as a result of elevated protein.
C. Mental status change may develop as a result of elevated NH3.
(Question 10)
The patient has a history of having had a Kasai portoenterostomy as an infant. The patient now presents with bacterial cholangitis.
What is most likely the etiology of and the treatment for this patient's medical problem?
A. portal hypertension; a transjugular intrahepatic portosystemic shunt (TIPS) procedure B. fulminant hepatitis; a liver transplant C. gallbladder malignancy; surgery D. biliary atresia; broad-spectrum antibiotics
D. biliary atresia; broad-spectrum antibiotics
(Question 18)
Which of the following is an evidence-based nursing intervention for the provision of enteral nutrition?
A. Confirm tube placement by insufflation and auscultation of air over the abdomen. B. Hold the feeding if there is a gastric residual volume (GRV)
of 250 mL. C. Monitor for feeding tube displacement into the lung during insertion. D. Do not initiate feeding until bowel sounds are auscultated.
C. Monitor for feeding tube displacement into the lung during insertion.
(Question 7)
Epigastric; may radiate to the back, flanks, left shoulder; pain is boring and worsened by lying down.
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
C. Pancreatitis
(Question 17)
Which of the following statements regarding bowel obstructions is accurate?
A. A small bowel obstruction (SBO) presents with continuous, dull pain. B. A large bowel obstruction (LBO) presents with early projectile vomiting. C. A large bowel obstruction (LBO) presents with hypokalemia. D. A small bowel obstruction (SBO) presents with high-pitched bowel sounds
D. A small bowel obstruction (SBO) presents with high-pitched bowel sounds
(Question 14)
The patient presents with signs of nausea, vomiting, abdominal pain that increases with knees flexed, and an abdomen that is rigid to palpation with rebound tenderness. What is the most likely cause of this patient's clinical signs?
A. appendicitis B. bowel obstruction C. esophageal varices D. peritonitis
D. peritonitis
(Question 5)
Which of the following is a contraindication for treating a patient who has chronic alcoholism and bleeding esophageal varices?
A. administration of lactulose B. banding or sclerosis of varices C. insertion of an esophageal balloon (Sengstaken-Blakemore tube) D. maintenance of the head of the bed in the supine position
D. maintenance of the head of the bed in the supine position
(Question 6)
The patient presented with abdominal trauma and hypovolemic shock that required fluid resuscitation and surgery. The patient has been hemodynamically stable, but, on day 3 post-op, the patient's blood pressure steadily decreased and tachycardia, tachypnea, and oliguria developed. Which of the following interventions is indicated at this time?
A. Measure the patient's bladder pressure. B. Transfuse 2 units of PRBCs. C. Place the patient in Trendelenburg position. D. Initiate norepinephrine (Levophed).
A. Measure the patient's bladder pressure.
(Question 19)
Epigastric or periumbilical and later localizes to the right upper quadrant; pain is dull to sharp
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
F. Appendicitis
(Question 17)
The pathophysiology of acute pancreatitis leads to specific signs and symptoms. The nurse anticipates that which of the following signs may develop as a result of the pathophysiology of acute pancreatitis?
A. Hypoxemia may develop as a result of the release of phospholipase A. B. Hypoglycemia may occur as a result of beta cell injury. C. Trousseau's sign may develop as a result of hypercalcemia. D. Diffuse inflammation will develop, which will require antibiotic therapy.
A. Hypoxemia may develop as a result of the release of phospholipase A.
(Question 12)
The patient sustained trauma while driving a car on the interstate.
The patient is alert and oriented; however, the patient's blood pressure is 88/48 and the heart rate is 114 beats/minute. The physician suspects intraperitoneal bleeding and is preparing for a diagnostic peritoneal lavage. Which of the following is a clinical sign that would indicate that the patient has intraperitoneal bleeding?
A. Kernig's sign B. asterixis C. Grey Turner's sign D. Cullen's sign
D. Cullen's sign
(Question 9)
The patient with a history of alcohol abuse presents with confusion and lethargy. The patient is jaundiced, there is hyperreflexia as evidenced by asterixis, and the patient's liver is non-palpable. Based on this patient's history and clinical exam, which of the following most likely represents this patient's medical issue(s)?
A. biliary atresia B. hepatic encephalopathy, chronic liver failure C. hepatitis C D. hepatic encephalopathy, acute liver failure
B. hepatic encephalopathy, chronic liver failure
(Question 20)
The patient is day 3 status post repair of a ruptured abdominal aortic aneurysm for which he required fluid resuscitation. The patient has now developed hypotension, tachycardia, and tachypnea. After speaking with the physician, the nurse measured the patient's bladder pressure with the transducer leveled at the symphysis pubis and obtained a reading of 18 mmHg. Which of the following interventions are indicated at this time?
A. Re-level the transducer, and re-measure the pressure. B. Prep the patient for decompression surgery. C. Transfuse 2 units of PRBCs. D. Place the bed in reverse Trendelenburg position.
D. Place the bed in reverse Trendelenburg position.
(Question 8)
Generalized, but may become localized later; pain is dull initially but intensifies and worsens with movement.
A. Small bowel obstruction B. Peritonitis ("acute abdomen") C. Pancreatitis D. Peptic ulcer E. Ruptured spleen F. Appendicitis
B. Peritonitis ("acute abdomen")
(Question 17)