GI
What is the most critical concern during the acute phase of care of a patient with an intestinal obstruction?
a. Aspiration
b. Hyperkalemia
c. Hypovolemia
d. Metabolic acidosis
What is c. Hypovolemia?
What is the best lab test to evaluate a patient's glomerular filtration rate?
a. Blood urea nitrogen (BUN)
b. Serum creatinine
c. Urine creatinine clearance
d. Serum amylase
What is c. Urine creatinine clearance?
You are caring for a 51-year-old male in DKA. To help assess the effectiveness of treatment, which of the following components are needed to determine an anion gap based on serum laboratory results?
a. sodium glucose, BUN
b. sodium, potassium, chloride, bicarbonate
c. potassium, chloride, glucose
d. urine and serum creatinine levels
What is B. Sodium, potassium, chloride, bicarbonate?
You are caring for a patient diagnosed with nephrogenic diabetes insipidus. Which of the following correctly identifies the cause of this disorder?
a. insufficient insulin production
b. ingestion of excessive amount of water resulting in suppression of vasopressin release
c. the kidneys are not responding appropriately to vasopressin (ADH)
d. deficiency of vasopressin production secondary to damage to the posterior pituitary
What is c. the kidneys are not responding appropriately to vasopressin (ADH)?
A 56-year-old suffered a cardiac arrest and received 45 minutes of chest compressions. On day 2 of his ICU stay, his urine drainage bag is suddenly full. The urine is clear without color. He continues with UOP of 700-1000mL per hour for 2 hours. Which of the following assessment findings would you expect?
a. Serum sodium level of 126
b. Serum osmolality of 320
c. Urine specific gravity of 1.025
d. Serum potassium of 3.5
What is b. Serum osmolality of 320?
A patient is admitted with acute necrotizing pancreatitis. What should the nurse anticipate as the priority in nutrition management for this patient?
a. Begin regular diet once serum amylase and lipase return to normal
b. Begin feedings via jejunal route to minimize pancreatic stimulation
c. Administer TPN until patient is free of abdominal pain
d. Maintain NPO status for minimum of seven days
What is B. Begin feedings via a jejunal route to minimize pancreatic stimulation?
A 17-year-old patient who sustained multiple traumas and subsequent multiorgan dysfunction syndrome, has a BUN of 60, a serum creatinine of 6.1, fluid overload, and blood pressure of 98/50. Which of the following is the most appropriate treatment for this patient?
a. Loop diuretics
b. Hemodialysis
c. Peritoneal dialysis
d. Continuous renal replacement therapy (CRRT)
What is D. Continuous renal replacement therapy?
A patient presents with decreased LOC and tachypnea. ABG results pH 7.05, PaCO2 24, PaO2 90, HCO3 16. Ketones are present in serum and urine, serum osmolality is 320, serum sodium 132, and anion gap is 22. Based on these results, you suspect the following diagnosis:
a. HHS
b. DKA
c. DI
d. Adrenal crisis
What is b. DKA?
Which of the following findings would be expected for a patient with HHS?
a. A pH of 7.15
b. A urine specific gravity of 1.030
c. A K level of 6.1
d. A serum osmolality of 270
What is b. A urine specific gravity of 1.030?
A patient with acute pancreatitis should be monitored for which of the following physical assessment findings indicating an electrolyte imbalance?
a. Chvostek sign
b. Kehr's sign
c. Kernig's sign
d. Cullen's sign
What is A. Chvostek sign?
Which cells of the pancreas produce glucagon?
a. Alpha cells
b. Beta cells
c. Delta cells
d. Kappa cells
What is A. alpha cells?
After a CT scan with contrast media, which of the following nursing interventions is most important?
a. Ensuring adequate fluid intake
b. Maintaining fluid restriction
c. Providing extra doses of sodium
d. Administering antibiotics
What is a. Ensuring adequate fluid intake?
A 57-year-old male is admitted with HHS. Which of the following should you expect as an initial treatment?
a. IV of 40 potassium in 200mL NS over 4 hours
b. Single IV bolus of 10 units of insulin
c. Fluid replacement with dextrose 5% in half normal saline
d. Fluid replacement with an isotonic solution
What is d. Fluid replacement with an isotonic solution?
The following are complications related to the pathophysiological changes in acute pancreatitis EXCEPT:
a. Hyperglycemia related to beta cell injury
b. Hypercalcemia due to pancreatic auto-digestion
c. ARDS related to a type II alveolar cell injury
d. Left-sided atelectasis related to a left-sided diaphragm shift
What is b. Hypercalcemia due to pancreatic auto-digestion?
A patient is admitted after an assault. The nurse notices that the patient has a bluish discoloration to her left flank when turning her. This patient most likely has what?
What is a retroperitoneal bleed?
Which of the following lab profiles would be expected in a patient with end stage hepatic failure?
a. Elevated ammionia, elevated albumin, and decreased protein
b. Decreased bilirubin, elevated ammonia, and elevated PTT, PT, & INR
c. Decreased ammonia, decreased bilirubin, increased protein
d. Elevated bilirubin, decreased albumin, and elevated PTT, PT, & INR
A patient with AKI has the following ABG 7.32, PaCO2 35, and HCO3 18. This acid-base abnormality is the result of the kidneys' inability to:
a. Excrete the acid byproducts of metabolism
b. Excrete carbon dioxide
c. Excrete bicarbonate ions
d. Excrete calcium ions
What is a. Excrete the acid byproducts of metabolism?
A female patient with history of heart failure and thyroid disease was admitted for heart failure. Three days after admission, she developed decreased LOC, bradycardia, hypothermia secondary to a thyroid emergency. Based on this situation, the nurse should anticipate administering which medication?
What is levothyroxine?
Which set of potential complication are most associated with acute pancreatitis?
a.ARDS, DIC, hypovolemic shock
b.Stroke, pulmonary embolism, and acute MI
c.Tension pneumothorax, cardiac tamponade, and chylothorax
d.Acute liver failure, DIC, and acute renal failure
What is a. ARDS, DIC, hypovolemic shock?
The nurse is caring for a patient immediately post liver transplant. Initially, the post-operative blood glucose was 221, requiring a continuous insulin infusion. The nurse understands monitoring the blood glucose frequently is indicated for assessment of:
a. Surgical site infection
b. Urinary tract infection
c. Hepatorenal syndrome
d. Acute liver failure
What is d. Acute liver failure?
EMS arrives with a patient that was found down. When assessing your patient's abdomen you notice ecchymosis in the lower abdomen and flank region. This is know as ______ and is indicative of ______.
What is Grey-Turners sign and retroperitoneal bleed?
Which of the following laboratory findings would be expected in the diuretic phase of Acute Tubular Necrosis (ATN)?
a. Decreased urine osmolality
b. Decreased BUN:Creatinine ratio
c. Hypophosphatemia
d. Decreased urine sodium
What is a. Decreased urine osmolality?
A patient was treated for septic shock secondary to necrotizing fasciitis. He initially responded well to therapy with fluids and norepinephrine, but is now hypotensive despite appropriate antibiotics, fluid resuscitation, and high-dose vasopressors. The physician suspects adrenal insufficiency, although the patient has no known history of the problem. Which medication is priority for this patient?
What is dexamethasone?
The patient just had a post small bowel resection. The nurse states that if tachycardia, tachypnea, or left shoulder pain is assessed the provider needs to be called immediately due to which complication?
a. Pulmonary embolism
b. Anastomotic leak
c. Myocardial infarction
d. Atelectasis
What is b. Anastomotic leak?
Which set of lab values is commonly seen in acute pancreatitis?
a. hyperglycemia, hypercalcemia, hyperkalemia
b. Hyperglycemia, hypocalcemia, hypokalemia
c. Hypoglycemia, hypocalcemia, hypokalemia
d. Hypoglycemia, hypercalcemia, hyperkalemia
What is b. Hyperglycemia, hypocalcemia, hypokalemia?