CCRN Practice -GI Questions and answers with verified
solutions GRADED A+ with 100% correct answers
2024/2025.
A 25-year-old man is admitted to the critical care unit with complaints of generalized abdominal pain
for 8 hours. The pain began yesterday and has been becoming increasingly severe. He is lying still with
his knees flexed. Physical examination reveals diffuse tenderness and boardlike rigidity. His
temperature is 39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and respiratory
rate is 25 breaths/min. He is diagnosed with acute appendicitis with intestinal perforation. Which
description of abdominal pain is most specific to peritoneal irritation?
a. Generalized pain of the abdominal area
b. Pain lasting longer than 6 hours
c. Pain becoming increasingly severe
d. Pain lessened by lying still with knees flexed - ANSWER Correct answer: d
Rationale: The pain of peritoneal irritation is lessened by limiting movement and by flexing the knees
to relieve abdominal tension.
Test-Taking Strategy: Note that option d is the most specific of the answers. Although options a, b, and
c are seen in peritoneal irritation, the most specific to peritoneal irritation is option d.
A 25-year-old man is admitted to the critical care unit with complaints of generalized abdominal pain
for 8 hours. The pain began yesterday and has been becoming increasingly severe. He is lying still with
his knees flexed. Physical examination reveals diffuse tenderness and boardlike rigidity. His
temperature is 39° C, blood pressure is 124/68 mm Hg, heart rate is 120 beats/min, and respiratory
rate is 25 breaths/min. He is diagnosed with acute appendicitis with intestinal perforation. The nurse
should expect to prepare the patient for which of the following?
a. Exploratory laparotomy
b. Nasogastric suction
c. Analgesics, sedation, and antipyretics
d. Upper gastrointestinal series - ANSWER Correct answer: a
Rationale: Immediate exploratory laparotomy is indicated for this patient to prevent further bacterial
contamination and chemical irritation of the peritoneum because he has obvious indications of
peritoneal irritation.
Test-Taking Strategy: One approach is to link the boardlike abdomen to an acute abdomen. Another
name for acute abdomen is surgical abdomen or hot belly. Choose option a.
,A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive
to verbal stimuli at this time. Which finding would the nurse expect in the later stages of hepatic
encephalopathy?
a. Asterixis
b. Confusion
c. Pathologic reflexes (e.g., Babinski)
d. Constructional apraxia - ANSWER Correct answer: c
Rationale: Pathologic reflexes are characteristic of stage IV hepatic encephalopathy. Asterixis occurs by
stage II. Constructional apraxia (the inability to reproduce simple figures [e.g., a star or triangle])
occurs by stage III. Confusion is mild in stage I and
becomes progressively worse until the patient is unconscious in stage IV.
Test-Taking Strategy: Think about which finding sounds the worst. Pathologic reflexes (e.g., Babinski's
reflex and grasp reflex) are indications of severe cerebral failure.
A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive
to verbal stimuli at this time. Which intervention would not specifically decrease serum ammonia
levels in patients with hepatic encephalopathy?
a. Administration of rifaximin
b. Administration of lactulose
c. Provision of adequate caloric intake
d. Avoidance of all hepatotoxic agents - ANSWER Correct answer: d
Rationale: Although avoidance of hepatotoxic agents is important in patients with liver failure, it only
prevents further damage to the liver rather than actually reducing ammonia level. Rifaximin decreases
the bacteria in the gastrointestinal tract that break down nitrogenous materials (protein) to ammonia.
Lactulose increases ammonia excretion and moves nitrogenous materials through the gastrointestinal
tract more quickly, allowing less time for the bacteria to convert the nitrogen to ammonia. The
restriction of protein in the diet and provision of sufficient calories (primarily in the form of
carbohydrates) to prevent
endogenous protein catabolism decreases the ammonia.
Test-Taking Strategy: The key phrase in the questions is "decrease serum ammonia levels." Look at the
first word of each option. Avoidance (in option d) is not likely to actively decrease something,
although it may prevent further increases.
A 52-year-old man is admitted with hepatic failure caused by chronic alcoholism. He is nonresponsive
to verbal stimuli at this time. Which dietary restrictions would be maintained for a patient with
hepatic encephalopathy?
a. Protein and sodium
, b. Fat and potassium
c. Potassium and carbohydrates
d. Sodium and potassium - ANSWER Correct answer: a
Rationale: Protein is restricted because its breakdown causes increased ammonia levels. Sodium is
restricted because patients with hepatic disease have increased circulating levels of aldosterone,
which causes increased sodium reabsorption in the distal tubule and resultant edema. Adequate
caloric intake in the form primarily of carbohydrates with adequate amounts of fats is necessary to
prevent the catabolism of body protein stores. Potassium is not restricted and may need to be
replaced because the increased circulating aldosterone levels cause the excretion of increased
amounts of potassium.
Test-Taking Strategy: Because you know that this patient is likely to be edematous, you should assume
that sodium should be restricted. Options a and d have sodium. Because sodium and potassium are
opposite in relationship to aldosterone, eliminate option d because it is unlikely to restrict both
(though both are restricted in renal failure). Protein is restricted because it contributes to increased
ammonia levels, so choose option a.
A 71-year-old woman reports that she started vomiting large amounts of bright blood 1 hour ago. In
the supine position, her blood pressure is 120/82 mm Hg. When sitting on the edge of the bed, she
complains of dizziness. Which of the following blood pressure measurements would be expected?
a. 140/90 mm Hg
b. 120/82 mm Hg
c. 100/60 mm Hg
d. 60 mm Hg with Doppler ultrasound - ANSWER Correct answer: c
Rationale: Based on the history, you would expect postural or orthostatic hypotension, which is
defined as a drop of 20 mm Hg in pressure when the patient changes position. This sometimes is called
tilt positive. Postural hypotension is an earlier sign of blood volume depletion than frank hypotension.
Test-Taking Strategy: Considering the blood loss, you certainly would not expect the blood pressure to
go up without treatment. The dizziness makes you suspect hypoperfusion to the brain in the upright
position, so the blood pressure is probably less than normal. She is talking to you and so is certainly
cerebrating and perfusing her brain with a blood pressure of greater than 60 mm Hg systolic. Choose
option c.
A 71-year-old woman reports that she started vomiting large amounts of bright blood 1 hour ago. In
the supine position, her blood pressure is 120/82 mm Hg. When sitting on the edge of the bed, she
complains of dizziness. The nurse would expect to administer which of the following?
a. Furosemide (Lasix)
b. Dobutamine (Dobutrex)
c. Fluid bolus of normal saline
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Amazingsirpaul. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
