Common Gi Disorders Ch 41 Of Critical Care Nursing: A Holistic Approach

Front 1

Mr. Johnson, a 43-year-old man with history of esphageal varices from prolonged alcohol abuse, is admitted with severe upper GI bleeding. To maintain hemodynamic stability, IV volume replacement is initiated and he is placed on vasopressin (Pitressin) drip. Endoscopy is ordered for eval of varices and scerlotherapy is successfully performed. On hour later, Mr. Johnson complains of chest pressure. The most likely etiology of his chest pressure is:

A. esophageal variceal spasms
B. GERD
C. Myocardial ischemia
D. Pancreatitis

Back 1

C. Myocaridal Ischemia
Myocardial ischemia is most likely etiology of chest pain since coronary and systemic vasospasm is one of major side effects of vasopression

Front 2

Mr. Johnson, the pt in question 1, continues to have CP and his vasopressin drip is discontinued. He subsequently experiences recurrent bleeding of his esophageal varices and a Sengstaken-Blackemore tube is successfully placed. The bleeding is controlled and hemodynamic stability is restored. Later that day, sudden respiratory distress develops in Mr.Johnson. What is the critical care nurse's first responsibility?

A. To call physician and ask for stat CXR.
B. To check stat pulse ox reading
C. To cut and remove Sengstaken-Blakemore tube
D. To raise the HOB and apply O2.

Back 2

C. To cut and remove Sengstaken-Blakemore tube
In this situation, the critcal care nurse's first responsiblity is to cut and remove Sengstaken-Blakemore tube. If the Sengstaken-Blakemore gastric balloon ruptures, the tension on the tubing will dislodge it into upper airway and block respirations. The # one safety rule with this tube is to have scissors available to cut and remove the tube if sudden respiratory distress occurs.

Front 3

Acute pancreatitis is associated with:

A. elevated serum amylase, elevated serum lipase, decreased serum calcium, and decreased serum albumin
B. elevated serum amylase, decreased serum lipase, decreased serum calcium, and decreased serum albumin.
C. decreased serum amylase, elevated serum lipase, decreased serum calcium, and decreased serum albumin.
D. decreased serum amylase, elevated serum lipase, increased serum calcium, increased serum albumin.

Back 3

A. elevated serum amylase, elevated serum lipase, decreased serum calcium, and decreased serum albumin

In acute pancreatitis, both serum amylase and lipase are elevated, Additionally, decreased serum albumin, and, subsequently, decreased serum calcium level are noted.

Front 4

A pt with acute pancreatitis is noted to have facial twitching when the facial nerve is tapped. In addition, the pts arm spasms during BP measurements. This is because:

A. elevated serum amylase and lipase enzymes are very irritating to nerves.
B. Decreased serum lipase levels cause hypoglycemia and seizure activity
C. Decreased serum calcium levels result in muscle tetany
D. Hypoalbuminemia causes muscle weakness and spasms.

Back 4

C. Decreased serum calcium levels result in muscle tetany.
Hypocalcemia from acute pancreatitis causes increased muscle spasm and tetany, and may result in positive Chvostek's and Trousseau's signs. Low albumin levels contribute to decreased serum calcium levels (as a result decreased protein available for calcium to bind to), but hypoalbuminemia does not directly affect these physcial findings. Serum amylase and lipase are not involved in these physical finding.

Front 5

The critical care nurse's first priority in a pt with acute pancreatitis is:
A. insertion of NG tube
B. insertion of foley catheter
C. administration of IV fluids and electrolyte repletion.
D. encouragement of oral fluid intake.

Back 5

C. Administration of IV fluids and electrolyte repletion.
Administration of IV fluids is the top priority for a pts with acute pancreatitis due to potential of these pts to develop hemodynamic instability and renal failure from decreased renal perfusion. Insertion of NG tube and Foley catherter are a part of supportive care needs of this patient, but not a priority over IV fluid administration. Oral intake is discouraged, to decrease pancreatic stimulation for secretion of digestive enzymes.

Front 6

Hypoactive bowel sounds may be associated with:
A. diarrhea
B. an early intestinal obstruction
C. portal HTN
D. an ileus

Back 6

D. an ileus
Hypoactive bowel sounds are associated with an ileus. Diarrhea is associated with hyperactive bowel sounds, and early intestinal obstruction is associated with high-pitched tinkling bowel sounds. Portal HTN does not have a direct influence on bowel sounds.

Front 7

A 65-year-old woman had a total abdominal hysterectomy 2 months ago. She presents to ER with severe, colicky abdominal pain and feculent vomiting for past 12 hrs. What is the most likely diagnosis for this patient?

A. GERD
B. Acute pancreatitis
C. Small bowel obstruction
D. Hepatitis

Back 7

C. Small bowel obstruction
Small bowel obstruction is most likely diagnosis due to pts recent surgical history (and potential for surgical adhesions). Colicky pain is a result of the intestine contracting in an attempt to overcome the obstruction. Failure to bypass the obstruction leads to vomiting of fecal material.

Front 8

Cholestasis may precipitate which of the following problems?

A. Acute small bowel obstruction
B. Acute Hepatitis
C. Acute pancreatitis
D. Both B and C

Back 8

D. Both B and C
Biliary disease is a common cause of extrahepatic-induced noninfectious hepatitis and acute pancreatitis. Cholestasis is not associated with small or large bowel obstruction.

Front 9

Mr. Moore is a 34 yo man admitted to CCU with a history of IV drug abuse. He reports a 4 week history of "flulike symptoms," malaise, and RUQ tenderness. The nurse notes that the pt has scleral and generalized jaundice. A battery of serological diag tests has been ordered. As expected, the pts total bili level is elevated at 2.4 mg/dl. Oter results reveal an elevated ALT of 980 mg/dl, an elevated AST fo 760 mg/dl, and an elevated alkaline phosphatase of 143 mg/dl. Hepatitis serology markers are as follows: HIV is negative, anti-HAV IgM (anti-hepaitits A virus antibody) is negative, HSsAg (hepatitis B surface antigen) is positive; HBeAg (hepatitis B core anitgen) is positive; and anti-HCV (anti-hepaititis C virus antibody) is negaive. As th critical car nurse, what is the correct interpretation of these serology markers?

A. The pt has cute hepatitis A virus (HAV) infection
B. The pt has acute hepatitis B virus (HBV) infection
C. The pt has been exposed to hepatitis B virus (HBV) but does not have active disease.
D. The pt has hepatitis C virus (HCV) infection.

Back 9

B. The pt has acute hepatitis B virus (HBV) infection.
Based on the pts history, physical exam, and lab results, he most likely has acute hepatitis B virus (HBV) infection. Acute hepatitis B infection is marked by a positive hepatitis B surface antigen (HBsAg), positive hepatitis B core antibody (anti-HBc IgM), and positive anti-hepatitis B core antigen (HBeAg). Serial markers for hepatitis A virus (HAV) and hepatitis C virus (HCV) were negative.

Front 10

When admitting a patient with a preexisting endocrine condition, it is important for the nurse to assess the
patient for a history of:

A. weight gain or loss.
B. Cancer
C. Smoking
D. visual problems.

Back 10

A. Weight gain or loss
Because disorders of the pituitary that could result in critical care admission affect fluid and electrolyte balance, the nurse inquires about general hydration status. Paratmenters to be included are weight gain or loss, excessive urination, thirst, edema, and cognitive changes such as slowed mentation, fatigue, or memory impairment.

Front 11

Which of the following is the most likely disease process if the patient's laboratory results indicate an elevated serum ADH and low serum osmolality with an elevated urine osmolality?
A. Central diabetes insipidus
B. SIADH
C. DM
D. Myxedema

Back 11

B. SIADH
SIADH is indicated by an elevated serum ADH and low serum osmolality with an elevated urine osmolality.

Front 12

An increased urine specific gravity is seen in which disease?

A. Central diabetes insipidus
B. SIADH
C. Diabetes mellitus
D. b and c are correct.

Back 12

D. B and C are correct.
SIADH and diabetes mellitus and dehydration both cause increased specific gravity of urine.

Front 13

Urine osmolality is increased in which of the following conditions?
A. SIADH
B. Addison's disease
C. Renal disease
D. All of the above are correct.

Back 13

D. All of the above
Urine osmolality is increased in SIADH, dehydration, Addison's disease, and renal disease.

Front 14

The thyroid scan and radioactive iodine uptake study are tests used to indicate and provide diagnosis for:

A. hyperthyroidism.
B. hypothyroidism.
C. cancer of the thyroid.
D. All of the above are correct

Back 14

D. All of the above
These nuclear tests indicate areas of increased and decreased function and provide data to diagnose hyperthyroidism, hypothyroidism, nodules, ectopic thyroid tissue, and cancer of the thyroid.

Front 15

A classic sign of hypoparathyroidism is:

A. Trousseau's sign.
B. Chadwick's sign.
C. Chvostek's sign.
D. A and C are both correct.

Back 15

D. A and C are correct
Trousseau's and Chvostek's signs are indicators of hypokalemia caused by hypoparathyroidism.

Front 16

The patient's fasting blood glucose is 110 mg/dL. Nursing implications for the finding include:

A. assessing a 2-hour postprandial blood sugar for further evaluation.
B. assessing the patient for signs and symptoms of hypoglycemia.
C. nothing; it is a normal blood sugar.
D. administering 50 cc of concentrated juice.

Back 16

C. Nothing; it is a normal blood sugar.
The normal value for adults is 65-110 mg/dL

Front 17

Which of the following statements is true about "ketones"?

A. Ketones are normally found in the urine.
B. Whenever blood sugar is low, ketones can be found in the urine.
C. Ketones are present in the blood before they show up in the urine.
D. To test for ketones, a ketone reagent strip is used in a fresh urine sample.

Back 17

D. To test for ketones, the ketone reagent strip is used in a fresh urine sample.
The test is performed by dipping a ketone reagent strip in a fresh urine sample, as ketones appear in urine before they do in serum.

Front 18

In reviewing the patient's labs, the nurse finds an elevation of adrenocorticotropic hormone (ACTH). This increase may be caused by:

A. Addison's crisis.
B. Cushing's syndrome.
C. cirrhosis
D. pituitary hyposecretion.

Back 18

B. Cushing Syndrome
Adrenal hyperfunction may be caused by excess secretion of ACTH by the pituitary gland (Cushing's syndrome), high stress, trauma, and surgery.

Front 19

The critically ill patient reports weight loss, anorexia, nausea and vomiting, diarrhea, thirst, and weakness. Physical findings reveal tachycardia, bronze skin color, and postural hypotension. These findings suggest:

A. Cushing's syndrome.
B. diabetic ketoacidosis.
C. syndrome of inappropriate antidiuretic hormone (SIADH).
D. an adrenal crisis.

Back 19

D. an adrenal crisis
Adrenal insufficiency from autoimmune Addison's disease can lead to an adrenal crisis. The pt becomes lethargic, dehydrated, and unable to mount any stress response to handle acute illness or trauma.

Front 20

The best test to diagnose Cushing's syndrome is:

A. Urine vanillylmandelic acid
B. Cortisol Suppression
C. Cortisol stimulation
D. Urine 17-Ketosteriods and 17-Hydroxycorticosteriods

Back 20

B. Cortisol Suppression
Cortisol suppression is the test of choice to diagnose Cushing's syndrome.

Front 21

A patient with Graves' disease is likely to present with which of the following symptoms?

A. Buffalo Hump
B. Edema
C. Decreased deep tendon reflexes
D. Exophthalmos

Back 21

D. Exophthalmos
Exophthalmos is caused by hyperthyroidism (Grave's disease)