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CCRN Practice Questions -GI(63 questions and answers)
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CCRN Practice Questions -GI(63 questions and answers)
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CCRN PracticeQuestions -GI(63
questions and
answers)
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
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