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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Course
NR574/ NR 574
Institution
NR574/ NR 574
Midterm Exam: NR574/ NR 574 (2023/2024
New Update) Acute Care Practicum Review |
Week 1-4 | Questions and Verified Answers|
100% Correct- Chamberlain
QUESTION
How often should a CK level be drawn and why?
Answer:
least every 6-12 hours to establish a peak level and then subsequentl...
Midterm Exam : NR574/ NR 574 (2023/2024 New Update) Acute Care Practicum Review | Week 1 -4 | Questions and Verified A nswers | 100% Correct - Chamberlain 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 attri butes 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 uri ne 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 ca rdiac 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 V olvulus 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 high -
grade 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 m ay have otherwise recovered. Retained barium also severely limits the ability to interpret subsequent angiography or cross -sectional imaging.
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