FINAL EXAM NR574 QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED)

FINAL EXAM NR574 QUESTIONS WITH CORRECT VERIFIED ANSWERS | 100% PASS (A+ CERTIFIED) 1. What are common trauma-related risk factors for Rhabdomyolysis Correct Answer Trauma, muscle compression, or ischemia 2. What are examples of trauma-related causes of Rhabdomyolysis Correct Answer Compartment syndrome, crush injuries, lightning strike, near-drowning, significant burns, blunt force trauma, high-voltage electrical injuries, prolonged immobilization following a fall 3. What heat-related conditions can lead to Rhabdomyolysis Correct Answer Heatstroke, malignant hyperthermia, and neuroleptic malignant syndrome 4. What infections can directly attack muscle and cause Rhabdomyolysis Correct Answer - Epstein-Barr virus (EBV), cytomegalovirus (CMV), adenovirus, human immunodeficiency virus (HIV), coxsackievirus, influenza A/B, herpes simplex virus (HSV), Varicella-zoster virus (VZV), E. Coli, C. perfringens, Legionella, Rickettsia, Group B beta-hemolytic streptococci, S. pneumoniae, S. pyogenes 5. What metabolic factors can contribute to Rhabdomyolysis Correct Answer Electrolyte imbalances (hypocalcemia, hypophosphatemia, hypokalemia, hypo-and hypernatremia), hypothyroidism, hyperglycemic hyperosmolar nonketotic syndrome 6. Rhabdomylosis risk factors Correct Answer Genetic factors Phosphofructokinase deficiency, myoadenylate deaminase deficiency phosphoglycerate kinase deficiency, mitochondrial respiratory chain enzyme deficiencies, sickle cell trait, etc. Medications that may cause direct myotoxicity HMG-CoA reductase inhibitors, cyclosporin, corticosteroids, zidovudine, colchicine, itraconazole Toxins which may cause indirect myotoxicity CNS depressants, alcohol, heroin, cocaine, ethanol, ketamine, barbiturates, amphetamines, caffeine, neuromuscular blocking agents, ecstasy, carbon monoxide, snake, or spider venom, etc. Exertional activity Marathons, high-intensity interval training, intense repetitive physical activity especially in untrained people, activities causing dehydration or performed in hot or humid conditions Nutritional supplements which contain substances that may induce muscle injuryEphedra, creatine, or large doses of caffeine 7. Clinical presentation of Rhabdo (subjective) Correct Answer Classic clinical findings characteristic of rhabdomyolysis includes dark urine, muscle pain, and muscle weakness. However, myoglobin is rapidly excreted and metabolized to bilirubin (half-life 2-3 hours) so visible changes in the urine may no longer be observable by the time the client seeks care. 8. Physical exam finidings of Rhabdo Correct Answer Physical exam findings in clients with rhabdomyolysis may also include: muscle tenderness soft tissue swelling bruising skin changes consistent with pressure necrosis muscle weakness confusion, delirium, agitation anuria 9. How do you diagnose Rhabdo Correct Answer dark urine, acute neuromuscluar illness without other symptoms PLUS acute elevation in serum creatinine kinase (typically 5x the upper limit of normal) 10. what is the most reliable lab for Rhabdo Correct Answer CK it will be markely elevated 1000 normal level is 45-260 11. Ck levels in rhabdo Correct Answer it begins to rise within 2-12 hours , peaks around 24-72 hrs following the injury. then the levels decline 3-5 days of muscle injury cessation. SERUM CK 5,000 results in AKI 12. what test assesses the extent of injury to the muscles Correct Answer MRI 13. Complications for RHabdo Correct Answer Compartment syndrome is suspected in when CK levels continue to rise or fail to decline following the inciting event. compartment pressures should be measured. 14. TX of Rhabdo Correct Answer Fluids at least 400ml/hr to prevent AKI to maintain a UOP of at least 200ml/hr in patients who CK levels are greater than 15,000 6L of IVF is required 15. what electrolyte imbalance are rhabdo patients at risk for Correct Answer Hypocalcemia - - not clinically signifant unless in a dysrhythmia Hyperkalemia - - Dextrose, sodium bicarb, sodium polystyrene sulfonate , sometimes HD Hyperurecemia & Hyperphosphate usually dont require tx 16. Tx of rhabdo (2) Correct Answer monitor for DIC, renal failure, seizure, ekg changes, hyperkalemia 17. acute Intestinal obstruction risk factors Correct Answer Adhesions from previous abdominal surgery Internal or external hernias Foreign bodies Feces Congenital issues (atresia, stenosis, cyst formation, intestinal duplication, and malrotation) 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 Volvulus Ischemic injury Intussusception Intraperitoneal abscess 18. How will the patient present in acute intestinal obstruction Correct Answer The most common presenting symptoms of acute intestinal obstruction include: 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 History should include essential elements such as previous abdominal or pelvic surgeries, comorbid conditions such as inflammatory bowel disease or malignancy. 19. Key physical exam / clinical findings in acute intestinal obstruction Correct Answer Clients presenting with acute intestinal obstruction can often be critically ill. 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) Significant abdominal tenderness with palpation should increase the NP's suspicion for ischemia, peritonitis, or necrosis. 20. differential diagnosis for abdominal pain: 21. Diagnostic Testing for acute intestinal obstruction Correct Answer if serum lactate is elevated it should raise concern for stragulated obstruction lab findings may be fine at first but as time progresses leukocytosis will appear 22. What imaging would you order for an acute intestinal obstruction Correct Answer CT abdomen it is useful for the location of the obstruction or identification of when surgery is needed 23. in plain XRAY of the abdomen Correct Answer A horizontal pattern of dilated small bowel loops can be seen with small bowel obstruction (SBO) In contrast, plain films will demonstrate a dilated bowel pattern which resembles a "picture frame" around the mid-abdomen 24. The administration of what? is CI Correct Answer imaging studies requiring barium are contraindicated in casdes of high grade or complete obstruction. BARIUM should NEVER be given orally until the diagnosis of obstruction has been excluded bc barium can cause an additional source of blockage 25. Arterio-occlusove mesenteric ischemia Correct Answer caused by arthersclorosis affecting the celiac artery, SMA, ot inferior mesenteric artery. It can progress to acute events if left un treated 26. Risk factors of Arterio-occlusove mesenteric ischemia Correct Answer Non modifiable: 60 male sex family hx of CVD genetic predisposition to arthersclerosis Modifiable? HTN. HLD, DM. smoking, Obesity, Poor diet, CKD, CAD, PAD, CVA/TIA, cocaine use, radiation damage, vasopressors 27. Tx of acute intestinal obstruction Correct Answer Nasogastric tube insertion with intermittent suction can help to decompress the stomach and proximal small bowel, prevent emesis, reduce the risk of aspiration, and improve client comfort. Fluid resuscitation is often indicated, especially in clients with evidence of dehydration. Electrolyte derangements should be corrected as indicated. Complete obstruction is an indication of immediate surgical intervention 28. Complications for postoperative mechanical bowel obstruction Correct Answer within the first six weeks following their operation and should be instructed to self-monitor for this condition. Most cases result in partial obstruction and resolve spontaneously. Clients may require follow-up with general surgery following surgical intervention during their hospitalization. 29. Acute mesenteric Ischemia Correct Answer Acute mesenteric ischemia (AMI) is a syndrome caused by arterial or venous occlusion or inadequate blood flow to mesenteric vessels resulting in ischemia and eventual gangrene of the bowel wall.