CEN - Abdominal & Cardiovascular

In a pt who has suffered an AMI, when would cardiac rupture be expected?

50% in the 1st 5 days and 90% withing the 1st 14 day post MI.

A client comes to the ED with a 2 day hx of abdominal cramping and watery diarrhea that has become bloody. Which assessment question should the nurse ask related to the possibility of Ecoli? A. Did anyone else eat the same food, and are they ill? B. Did you eat any improperly cooked eggs in the last 24 hr? C. Have you taken any over-the-counter medications in the last week? D. Do you have a family history of inflammatory bowel disease?

A.

The client comes to the ED complaining of upper abdominal pain that he describes as 7/10. What laboratory findings would specifically indicate the pancreas is involved? A. Elevated amylase and lipase B. Decreased hemoglobin and hematocrit C. Elevated WBC D. Decreased platelets

A. Enzymes released when pancreatic tissue is destroyed in autodigestion of pancreatitis.

A client with a history of EtOH abuse and cirrhosis is vomiting large amounts of bright red blood. The client's responses are poor. VS include BP 80/50, 140 bpm, 36 rr, 99.8 temp. What should the emergency room nurse do first? A. Suction blood from airway B. Insert 2 large bore IV lines C. Insert NG tube D. Give IV vitamin K

A. Establishing a clear airway is the first priority.

A child has swallowed a quarter. What's the nurse's primary concern? A. Corrosion of the stomach's mucosal lining B. Bowel obstruction C. Bowel perforation D. Airway obstruction

D. First the child should be assessed to determine whether the quarter has obstructed his airway. Next, he should be observed for s/s of mucosal lining corrosion and bowel obstruction or perforation.

A mother brings her 2-month old infant to the emergency department. His abdomen is distended, and he has been vomiting forcefully and with increasing frequency over the past 2 weeks. On examination, the ED nurse notes signs of dehydration and a palpable mass to the right of the umbilicus. Peristaltic waves are visible, moving from left to right. The nurse should suspect which condition? A. Colic B. FTT C. Instussesception D. Pyloric stenosis

D. Hypertrophy of the circular pyloric muscle in pyloric stenosis causes these s/s. Surgery is the standard tx.

What physical findings are associated with acute pericarditis?

Pericardial friction rub is the most common. Rub is best heard at the left sternal border or apex in a sitting leaning forward position. Other findings include fever and tachycardia.

Cullen's Sign

Periumbilicatl bruising = intraperitoneal bleeding.

A 30 year old female c/o sharp right lower quadrant pain. Which finding would be indicative of appendicitis rather than of an ectopic pregnancy? A. Negative pregnancy test B. RLQ tenderness C. Low grade fever D. LMP 14 days ago

A. A key distinction between appendicitis and ectopic pregnancy is that appendicitis doesn't have a prostive pregnancy test. Both could have RLQ tenderness and low grade fever, especially if there was a perforation. The timing of LMP could indicate an ectopic pregnancy.

A client has been diagnosed with Crohn's dz. Which assessment finding is most important for the nurse to follow up on immediately? A. Rigid abdomen B. Elevated WBC C. Temperature of 100.4 D. Four diarrheal stools in one day.

A. A rigid or boardlike abdomen is indicative of GI perforation.

As cites may be caused by which condition? A. Cirrhosis B. Ectopic pregnancy C. COPD D. Crohn's disease

A. Ascites is an accumulation of fluid in the peritoneal cavity and may be caused by various factors, such as cirrhosis and peritonitis.

Which of the following is the most distinguishing factor of a pancreatic injury? A. Flank ecchymosis B. Dullness in flank area C. RUQ tenderness D. Rectal bleeding

A. Ecchymosis in the flank area (Turner's sign) suggests retroperitoneal bleeding and is commonly associated with pancreatic injury. Dullness in the flank area (Ballance's sign) is characterized by 2 types of dullness: a fixed dullness to percussion in the L flank and dullness in the R flank that disappears with a change in position. Usually associated with splenic injuries. RUQ tenderness is associated with liver injuries. Rectal bleeding is associated with colon injuries. Pancreatic injury may also demonstrate lieu's, epigastric pain radiating to the back or LUQ, positive Kehr's Sign (pain in the L shoulder secondary to diaphragmatic irritation by blood), and pain, nausea, and vomiting.

A client has an intestinal perforation. Which intervention is inappropriate? A. Inserting an NG tube B. Offering clear liquids C. Administering IV Abx D. Preparing the client for surgery

B. Intestinal perforation with require surgery and pt must be NPO.

A client has a hx of liver failure and elevated ammonia levels. The client reports having had two soft, formed BM yesterday. What action should the nurse take? A. Administer the laxative lactulose B. Force oral fluids C. Encourage protein intake D. Administer activated charcoal

A. Lactulose is used to excrete ammonia. It should be held only if the client has constant diarrheal stools, in which case the colon is sterilized with neomycin. Forcing oral fluids or administering activated charcoal is not indicated int tx of elevated ammonia levels with liver failure. Protein intake is also not advised because the liver cannot metabolize the protein.

The pain of mesenteric vascular infarction is commonly associated with which condition? A. Abdominal distention and bloody diarrhea B. Constipationb C. Abdominal distention and abdominal free air D. Vomiting

A. Mesenteric vascular infarction is usually associated with vomiting, bloody diarrhea, abdominal distention and tenderness, and hypotension. Constipation and vomiting are more commonly associated with intestinal obstruction. Abdominal distention and abdominal free air are associated with perforated viscous.

A client with peritonitis will most likely show which s/s? A. Guarding B. LLQ pain C. Increased bowel sounds D. Hyperactive bowel sounds

A. Peritoneal irritation causes guarding, generalized abdominal pain, and hypoaxctive bowel sounds. In addition, this client may experience N/V and low-grade fever, and shallow respirations secondary to the abdominal pain.

Risk factors for Crohn's disease include: A. Smoking B. HTN C. Hispanic ancestry D. Eating hot, spicy foods

A. Smokers are twice as likely to develop the disease than no smokers. Those of Jewish ancestry are 5x at risk. HTN or ingestion of foods has no effect.

A client Complains of right lower quardrant abdominal pain, nausea, and vomiting. Which intervention isn't appropriate? A. Offering clear liquids B. Obtaining a urine specimen C. Obtaining a blood specimen for a CBC D. Assisting the client to a position of comfort

A. Undiagnosed abdominal pain should be NPO in case surgery is required.

A client complains of abdominal pain and distinction, fever, tachycardia, and diaphoresis. An abdominal X-ray shows free air under the diaphragm. The emergency department nurse should suspect which condition? A. Intestinal obstruction B. Acute appendicitis C. Intestinal perforation D. Acute cholelithiasis

C. Intestinal perforation is associated with free air under the diaphragm.

What is the most common source for acute mesenteric ischemia?

Arterial embolism 40-50% Source is usually the heart, most often from a mural thrombus. Most common point of obstruction is the superior mesenteric artery.

Name 5 causes of mesenteric ischemia.

Arterial thrombosis at sites of atherosclerotic plaques, emboli from L atrium in pt with a-fib or rheumatic heart dz who are not anticoagulated, arterial embolism most common to the superior mesenteric artery, insufficient arterial flow, and venous thrombosis.

What are the most common causes of acute pancreatitis? A. Trauma and postoperative syndrome B. EtOH abuse and biliary tract disease C. Hypercalcemia and drug use D. Trauma and EtOH abuse

B. 80%

Which organ is most frequently injured in blunt abdominal trauma? A. Large bowel B. Spleen C. Liver D. Stomach

B. A highly vascular and encapsulated organ, the spleen is compressed against the vertebral column during blunt abdominal trauma. Often see with left lower rib injuries. Liver injuries common in clients with right lower rib fx. The large bowel and stomach are seldom injured in blunt abdominal trauma.

A client comes to the emergency department complaining of stomach pain and has several episodes of coffee-ground emesis. What assessment would be most important for the nurse to ask to help determine the cause of this client's symptoms? A. Hx of most recent food intake B. Hx of NSIAD use C. Hx of taking oral iron supplements D. Hx of hemorrhoids

B. Coffee-ground emesis results from upper GI bleeding that has remained in the stomach. Upper GI bleeding is commonly caused by regular intake of NSAIDS

Decreased or absent bowel sounds may result from which condition? A. Irritants inside the bowel B. Irritants outside the bowel C. Hypovolemia D. Anxiety

B. Decreased or absent bowel sounds may be caused by an irritant, such as blood or intestinal contents, outside the bowel. Irritants inside the bowel usually cause hyperactive bowel sounds.

Acute abdominal pain in the geriatric client may be related to which of the following? A. Inflammatory bowel disease B. Diverticulitis C. Bowel obstruction with intussesception D. Ulcerative colitis

B. Diverticulitis is one of the most common causes of acute abdomnianl pain in the geriatric population. About 50% of all Americans from 60-80 yrs have diverticulitis, as do most Americans over age 80. Inflammatory bowel disease is more commonly caused by adhesions from previous surgeries, fecal impaction, or tumors - not intussesception - in this population. Ulcerative colitis is more prevalent in clients aged 30-50.

What is the FAST examination used for in clients with primarily blunt abdominal trauma? A. As a fecal assay screening test B. To determine the presence of hemoperitoneum C. To determine the presence of free air from perforation D. To determine whether bladder injury has occurred

B. FAST is a focused assessment sonography for trauma ultrasonography. It is a bedside, rapid, accurate Dx tool to detect the presence of hemoperitoneum. Four areas are examined: the hepatorenal fossa, the splendor ENA fossa, the pericardial sac, and the pelvis.

For a client with gastroesophageal reflux disease, discharge instructions should include which of the following? A. "Lie down and rest after each meal" B. "Avoid fried and fatty food." C. "Drink 16 oz of water with each meal." D. "Wine with your dinner is ok"

B. Foods that irritate the esophagus should be avoided. Includes fried and fatty foods, EtOH, and chocolate. Should be instructed not to lie down for 3 hr after meals.

A client has the following s/s: dyspnea, dependent edema, hepatomegaly, crackles, and distended jugular veins. The nurse should suspect which condition? A. Pulmonary embolism B. Heart failure C. Cardiac tamponade D. Tension pneumothorax

B. Heart failure

Most hiatal hernias are asymptomatic. Though rare, complications include the following except: A. Gastric volvulus or strangulation B. Aortic aneurysm C. Esophagitis D. Gastric reflux

B. Hiatal hernias result from muscle weakening and loss of elasticity.

For which of the following clients is it most important to receive IV hydration? A. 30 yr old who has vomited several times today B. 6 mo old who had 2 wet diapers today C. 80 yr old with skin tenting noted on the forearm D. 15 yr old with 450 mL output in 8 hrs

B. Infant is at highest risk for decompensation from dehydration and has fewer diapers than usual.

Which medication should be avoided in the client with biliary colic? A. Ampicillin/sulbactam (Unasyn) B. Morphine C. Demerol (Meperidine) D. Ketorolac tromethamine (Toradol)

B. Morphine should be avoided because it can cause spasm of the sphincter of Oddi at the common bile duct, worsening the pain. Demerol and Toradol may be used for short-term pain control. Secondary infection of the gallbladder can occur as a result of cystic duct obstruction and bile stasis. The most request organizes ar Ecoli, enterococcus, klebsiell, and enterobacter. A third generation Cepheus-Orin and metronidazole or Unasyn will cover most common organisms.

Which of the following is characteristic of a small-bowel obstruction? A. Hyperactive bowel sounds B. Copious vomiting C. Gradual onset D. Metabolic acidosis

B. Obstruction of the small intestine is characterized by frequent and copious vomiting, a rapid (not gradual) onset, and colicky, intermitten, cramp like abdominal pain. Bowel sounds are present but not hyperactive in the large intestine. Small-bowel obstructions place the client at risk for metabolic alkalosis because of fluid and electrolyte deficiencies due to loss of gastric acid.

A common finding during the evaluation of a client with cholecystits is: A. Increased RLQ pain B. Pain during liver palpation C. Periumbilical bruising D. Shock like pain with neck flexion

B. Pain during liver palpation when the client inhales and the inflamed gallbladder slides over the examiners fingers (called Murphy's sign) is a positive finding or cholecystitis.

A client is complaining of dark stools. The nurse should assess for which of the following? A. Ingestion of beets B. Ingestion of bismuth-containing compounds C. Ingestion of red meat D. Ingestion of green vegetables

B. Peptic-bismol and other bismuth-containing items make dark stools. Also iron and charcoal.

Which drug shouldn't be given by way of an endotracheal tube? A. Atropine B. Sodium bicarbonate C. Epinephrine D. Lidocaine

B. Sodium bicarbonate shouldn't be given by way of an ET tube because of it's alkalinity and because the large amounts required shouldn't be administered by this route. Atropine, epinephrine, and lidocaine are absorbed rapidly by the lungs and may be given safely by way of an ET tube.

Which statement about a penetrating abdominal trauma is true? A. The outside appearance of the wound reflects the extent of internal injury B. The outside appearance of the wound does not reflect the extent of internal injury C. Death occurs more commonly after penetrating trauma than after blunt trauma. D. Objects impaled in the abdomen should be removed soon after the client arrives in the ED.

B. The appearances o entrance and exit wounds doesn't reflect the extent of internal injury; for example, a bullet may fragment and change direction once inside the body. Death occurs more commonly after blunt abdominal trauma. Impaled objects should not be removed but stabilized with a dressing to prevent further injury to the client.

Which of the following isn't indicative of a stomach injury? A. Blood in the NS aspirate B. Bowel sounds in the chest C. Epigastric pain and tenderness D. Decreased or absent bowel sounds

B. The client with a stomach injury may have blood in the NG aspirate as well as epigastric pain and tenderness. Bowel sounds may be decreased or absent. Signs of peritonitis may be present if acidic gastric contents have been released. Bowel sounds in the chest are indicative of diaphragmatic rupture, not stomach injury.

A client with upper GI bleeding may require medications to reduce the acidity of gastric secretions, which can irritate the bleeding site. Which drug doesn't reduce gastric secretion acidity? A. Cimetidine (Tagamet) B. Vasopressin C. Famotidine (Pepsi's) D. Ranitidine (Zantac)

B. Vasopressin decreases blood flow to the site. The other drugs are histamine antagonists and reduce gastric acidity.

Peritoneal lavage is a diagnostic tool used in detecting abdominal injuries. Which of the following is a contraindication for peritoneal lavage? A. An unconscious client B. A history of abdominal surgery C. A distended bladder D. An allergy to radiopaque dye

C. A distended bladder is an absolute CI for peritoneal lavage. An indwelling catheter must be inserted prior to procedure.

What instructions should the nurse give to a client diagnosed with Hep A? A. Wear a condom during sex B. Avoid EtOH as long as jaundice is present. C. Avoid acetaminophen for at least a year. D. Consume a low-residue diet.

C. Acetaminophen should be avoided for at least a year. EtOH should be avoided regardless of whether jaundice is present.

A client has corrosive injury to the esophagus from ingesting a liquid alkali substance. What should be included in the treatment? A. Induce vomiting B. Insert a NG tube C. Manage the airway D. Administer steriods

C. Airway management is important in a client with corrosive injury to the esophagus because aspiration of th alkali substance may have occurred. Esophageal perforation may be present. Vomiting should not be induced because this will further expose tissue to the alkali. Insertion of an NG tube should be avoided except with endoscopy or fluoroscopy. The administration of steroids probably isn't beneficial to this client. If the client is seen within 1 hr of ingestion, water may be given.

The client presents to the emergency department with vomiting and diarrhea and is diagnosed with gastroenteritis. Which of the following is most important prior to allowing the client to be discharged home? A. Administration of antidiarrheal medication B. Ability to repeat back the BRAT diet C. Ability to tolerate oral fluids D. Decreased or absent bowel sounds

C. Before a client goes home, the client must be able to take and keep oral fluids so no dehydration's occurs at home.

Which statement about GI bleeding ins't true? A. The color of passed blood is a product of GI transit time B. Melena is a chemical interaction of gastric acid with blood over several hours. C. Bright red rectal bleeding rules out upper GI bleeding D. As little as 50 mL of blood can cause clinical melena

C. Brisk upper GI bleeding with a quick passage of blood through the GI tract can result in bright red rectal bleeding. The other options are accurate.

Assessment of the abdomen should be performed in what sequence? A. Percussion, palpation, auscultation, inspection B. Inspection, percussion auscultation, palpation C. Inspection, auscultation, percussion palpation D. Auscultation, percussion, palpation, inspection

C. Inspection, followed by auscultation should be the first part of an abdominal assessment. Percussion and palpation may alter bowel sounds, so they should be done after auscultation. Palpation s should be the last step because it may cause client discomfort and guarding.

A 4-year old child is brought to the emergency department after being hit in the abdomen with a baseball bat. Which of the following isn't a normal finding for this child? A. High-pitched tympanic sound over the stomach B. Cylindrical contour of the abdomen C. Failure of the abdomen to move with respiration's D. Crying during examination

C. Children younger than 9 are abdominal breathers, chest movements are normally synchronized with abdominal movements. High-pitched sound indicate air in the stomach, common for mouth breathers. Young children have a spinal lordosis that gives the abdomen a cylindrical, prominent contour.

The nurse is providing discharge instructions to a client with gastroenteritis. Which of the following is an example of initial intake the nurse should encourage? A. Milkshake B. Banana C. Gatorade D. Oatmeal

C. Gatorade Oral hydration with clear liquids such as cola, ginger ale, juice, tea, broth, electrolyte replacement.

A Client is diagnosed with Hep B. What question would help determine how the disease was contracted? A. "Did you eat any raw shellfish?" B. "How much alcohol do you drink?" C. "Do you use IV drugs?" D. "Have you donated blood recently?"

C. Hepatitis B is mainly contracted by blood and and sexual contact not oral fecal route.

A client with upper GI bleeding and a history of liver disease arrives at the emergency department. The ED nurse may need to administer which drug by way of NG tube? A. Vasopressin B. Heparin C. Magnesiumcitrate D. Propylthiouracil (PTU)

C. Magnesium citrate helps rid the bowel of blood and fecal matter; digested blood releases ammonia and other toxins into the bloodstream, increasing the risk of hepatic encephalopathy. Vasopressin is administered IV to control bleeding. Heparin is CI. PTU is given via NG tube but is used to treat thyroid storm.

Which assessment finding is most important for the nurse to act on for a client Dx with acute pancreatitis? A. Sharp, knifelike pain B. Bluish discoloration around the umbilicus C. Orthostatic hypotension D. One episode of emesis

C. Majorly complication of pancreatitis is hypovolemia. This lowers blood pressure so orthostatic hypotension is associated. Sharp knifelike pain is expected and will be treated, but circulation takes priority. Bluish discoloration around the umbilicus (Cullen's sign) is a result of the exudate from autodigestion of the pancreas and does not require immediate attention.

Which of the following findings would make the nurse suspect intussesception in a child? A. Dark, tarry stool B. Delayed growth and development C. Sharp, intermittent abdominal pain D. Daily episodes of bright red rectal bleeding

C. Obstruction in the small intestine is characterized classically by sharp, intermittent abdominal pain. Dark, tarry stools are a classic sign of upper GI bleeding. Delayed growth and development is primarily due to inadequate nutritional intake or absorption problems, not an obstruction. Episodes of bright red rectal bleeding indicate a lower GI bleed caused. Y hemorrhoids not an obstruction.

A client arrives at the ED complaining of burning, gnawing epigastric pain that occurs 1-2 hours after meals. Symptoms have been present for 2 weeks. The ED nurse recognizes these symptoms as indicative of which condition? A. Pancreatitis B. Irritable bowel syndrome C. Peptic ulcer disease D. Cholecystitis

C. Peptic ulcer disease

Murphy's Sign

Pain during liver palpation when the client inhales and the inflamed gallbladder slides over the examiner's fingers.

Peritoneal lavage is appropriate for which of the following? A. Rapidly increasing abdominal distention B. An impaled object in the abdomen C. A blood EtOH level of 0.2450 mg/dL and a tender abdomen D. Hypotension unresponsive to fluid bolus

C. Peritoneal lavage is commonly used when a client can't participate in the abdominal examination (because of injuries or intoxication) or when the examination doesn't r/o the possibility of abdominal injury. A client with rapidly increasing abdominal distention or with an impaled object in the abdomen has abdominal injuries, and peritoneal lavage would serve no Dx purpose. A client with hypotension that's unresponsive to fluid blouses needs immediate tx; peritoneal lavage would waste time.

The diagnostic test of choice for the client with cholecystitis is: A. abdominal x-ray B. Upper GI barium swallow C. RUQ abdominal ultrasound D. Oral cholecystogram

C. RUQ abdominal ultrasound

The client with inflammatory bowel disease comes to the ED with an exacerbation of his disease. What finding is most important for the nurse to follow up related to potential peritonitis? A. WBC of 11,000 B. Oral temp 100.4 C. Positive rebound tenderness D. Abdominal cramping

C. Rebound tenderness is not associated with IBD and would indicate the client is developing peritonitis. Clients with peritonitis will exhibit sharp pain with voluntary and involuntary abdominal muscl rigidity, not abdominal cramping or irritation, which is more likely to be present with gastroenteritis. An elevated WBC could and elevated temp are most likely d/t and infectious process.

The client with pancreatitis has s/s of hypovolemia. What would the nurse anticipate administering? A. D5W and 1/2 NS at 125 mL/hr B. NS at 80 mL/hr C. LR at 150 mL/hr D. Clear oral liquids

C. Replacement fluids should be isotonic. NS could also be given but the replacement rate is 125-150 mL/hr. Maintenance rate is 60-80 mL/hr.

Which clinical presentation would be most indicative of a small-bowel obstruction? A. Dark, tarry stool B. Bowel sounds occurring at a rate of 5-10/min C. Foul-smelling, dark, copious emesis D. Metallic taste in the mouth

C. Small bowel obstructions are higher and tend to lead to reverse peristalsis and emesis of feculent material.

What are three major complications of pancreatitis? A. Hyperbole is, latent hypocalcemia, and latent hypoxia B. Hyperbole is, latent hypercalcemia, and laten hypoxia C. Hypovolemia, latent hypocalcemia, and latent hypoxia D. Hypovolemia, latent hypercalcemia, and latent hypoxia

C. The three major complications of pancreatitis include hypovolemia, latent hypocalcemia, and laten hypoxia

The difference between ulcerative colitis and Crohn's disease is that ulcerative colitis: A. Reveals patchy areas of full-thickness inflammation anywhere along the GI tract from mouth to anus B. Recurs despite surgical intervention C. Is an inflammatory disorder affecting the mucosal lining of the colon and rectum D. Is more common in females

C. Ulcerative colitis begins as an inflammatory intestinal disorder affecting the mucosal lining of the colon and the rectum. The chronic inflammatory process can cause diffuse mucosal bleeding. A total Cole Tony offers com[plet cure and remission of peripheral s/s. Crohn's disease involves the mucosa a well as the surrounding musculature. More commonly found in females, the goals of tx and management include improving s/s and controlling the disease process.

Contraindications to Beta Blockers?

CHF, variant angina, AV block, COPD, asthma (relative), bradycardia, hypotension and insulin dependent diabetes mellitus.

Describe the features and tx of Mobitz II 2nd degree AV block.

Constant P-R interval. One or more fail to conduct. Treat with atropine and transcutaneous pacing.

How is atrial fibrillation treated?

Control rate with digitalis or verapamil then convert with procainamide, quinidine, or verapamil. Synchronized cardioversion at 100-200 J in an unstable pt requiring cardioversion. In a stable pt with a-fib of unclear duration anticoagulation for 2-3 weeks should be considered prior to chemical or electrical cardioversion.

The client with liver failure will have which of the following laboratory values? A. Increased platelets, increased magnesium B. Increased lipase, increased amylase PT C. Decreased ALT, decreased AST PT D. Decreased albumin, increased PT

D. Albumin decreases because the liver can't synthesize blood proteins. PT increases because the diseased liver can't make clotting factors in sufficient amounts. These clients are prone to bleeding.

A client arrives in the emergency department complaining of nausea, diaphoresis, SOB, and squeezing substernal pain that radiates to the left shoulder and teeth. The nurse should perform which intervention? A. Complete registration , order ECG, establish IV, record vitals B. Alert the catheter laboratory team, administer oxygen, apply a cardiac monitor, and notify the physician. C. Take the client to the exam room, establish IV, give SL nitro, and alert the cath lab team. D. Administer O2, apply cardiac monitor, record VS, and give SL nitro

D. Check the pain is caused by myocardial ischemia. O2 increases to heart. Cardiac monitor reveals life-threatening arrhythmias. Check vitals before giving nitro.

A client in the emergency department has severe nausea and has been vomiting every 30-45 minutes for the past 8 hours. This client is at risk for developing which condition? A. Metabolic acidosis and hypercalcemia B. Metabolic acidosis and hypokalemia C. Metabolic alkalosis and hyperkalemia D. Metabolic alkalosis and hypokalemia

D. Excessive vomiting which reduces hydrochloride acid in the stomach, causes metabolic alkalosis. It also leads to hypokalemia. Clients with the above s/s would not be prone to acidosis or hyperkalemia.

What treatment does the nurse anticipate for a client with upper-bowel obstruction? A. Soap suds enema B. Warm, moist compresses C. Oral fluids D. NG tube

D. NG tube to decompress the GI tract.

What is important to teach a client with chronic gastritis? A. Consume milk with meals B. Remain upright 1 hr after eating C. Avoid food with gluten D. Do not smoke

D. Smoking is CI in all forms of gastritis.

Which of the following isn't a physical indication of a potential liver injury? A. Trauma to the RUQ or RL chest wall B. Right sided rib fractures C. Referred pain to the R shoulder D. Kehr's sign

D. The liver is located in the RUQ. It is the second most commonly injured solid organ in blunt trauma. Kehr's sign is left shoulder pain caused by diaphragmatic irritation, usually as a result of splenic bleeding. Both rib fractures and referred pain to the R shoulder may be physical indicators of liver injury.

The nurse would expect to hear which sound during percussion of the stomach? A. Resonance B. Dullness C. Hyperresonance D. Tympany

D. Tympany is normally Howard over air-filled viscera such as the stomach. Hyperresonance and resonance are more commonly heard over lung tissue. Dullness is heard over solid organs.

A pt presents 2 wk post AMI with CP, fever, and pleuropericarditis. a pleural effusion is seen on CXR. Diagnosis?

Dressler's (postmyocardial infarction) syndrome which is caused by an immunologic reaction to myocardial antigens.

Adverse drug effects of lidocaine?

Drowsiness, nausea, vertigo, confusion, ataxia, tinnitus, muscle twitching, respiratory depression, and psychosis.

Causes of SVT?

Ectopic SVT may be due to digitalis toxicity (25% of digitalis induced arrhythmias), pericarditis, MI, COPD, preexcitation syndromes, mitral valve prolapse, rheumatic heart disease, pneumonia, and EtOH abuse.

Lhermitte's Sign

Pain resembling a sudden electric shock through the body produced by flexing the neck is caused by cervical spine trauma, multiple sclerosis, cervical cord tumor, or cervical spondylosis

For a client with upper GI bleeding, gastric lavage is used to achieve the following with which exception? A. Removing blood from the stomach B. Reducing acid-peptide activity in the stomach C. Reducing gastric mucosal blood flow D. Sclerosis bleeding varices

Gastric lavage with room temperature saline solution or water removes blood from the stomach (absorption of this blood may increase the client's ammonia levels) Lavage also reduces acid-peptide activity in the stomach, reduces gastric mucosal blood flow, and prepares the client for diagnostic procedures such as endoscopy. Gastric lavage isn't effective in scerosing bleeding varices.

What are the causes of atrial fibrillation?

HTN, rheumatic heart dz, pneumonia, thryrotoxicosis, and ischemic heart dz are common causes. Pericarditis, EtOH intoxication, PE, CHF, and COPD are other causes.

What side effect is expected with too rapid an infusion of procainamide?

Hypotension. Other s/e include: myocardial depression, QRS/QT prolongation, V-fib, and torsade de pointes.

Psoas Sign

Increased RLQ pain by hyper extension of the R hip and elevation of the R leg for appendicitis.

How is atrial flutter treated?

Iniate A-V nodal blockade with beta-adrenergic or calcium channel blockers or with digoxin. If necessary, in a stable patient, attempt chemical cardioversion with a class IA agent such as procainamide or quinidine after digitalization. If such tx fails, or if pt is unstable and requires immediate electocardioversion, use 25-50J.

What is the most common s/s of aortic dissection?

Interscapular back pain

Can pts be retreated with streptokinase or APSAC?

No, because antibodies persist for 6 mo.

When is dobutamine used in CHF?

Potent inotrope with some vasodilation activity. Used when heart failure is not accompanied by severe hypotension.

Describe the key features of Mobitz I (Wenkebach) 2nd degree AV block.

Progressive prolongation of the PR interval until impulse is not conducted. If symptomatic, atropine and transcutaneous/tranvenous pacing.

What is the most common s/s of acute pericarditis?

Sharp or stabbing retrosternal or precordial chest pain. Pain increases when supine and decreases when sitting-up and leaning forward. Pain may be increased with movement and deep breaths. Other s/s include fever, dyspnea described as pain with inspiration and dysphagia.

When is dopamine selected in CHF?

Vasoconstrictor and positive inotrope, used if shock is present.

A pt presents 1 day after discharge for an acute myocardial infarction with a new harsh systolic murmur along the Left sternal border and pulmonary edema. Diagnosis?

Ventricular septal rupture. Dx is confirmed with Swan-Ganz catheterization or echo. Tx includes nitroprusside for afterload reduction and possible intra-aortic balloon pump followed by surgical repair.