CCRN

Question 1

Kehr’s Sign

Answer 1

Left shoulder pain due to diaphragmatic irritation common in ruptured spleen

Question 2

Grey Turner’s

Answer 2

Ecchymosis of the flank, common in retroperitoneal bleed

Question 3

Cullen’s Sign

Answer 3

Ecchymosis around the umbilicus, common in intraperitoneal bleed

Question 4

Bowel sounds in the chest:

Answer 4

sign oof diaphragm rupture

Question 5

Free air on abdominal xray

Answer 5

GI perf

Question 6

Normal bladder pressure

Answer 6

0-5

Question 7

Where do you place transducer for the bladder pressure

Answer 7

at the level of the symphysis pubis

Question 8

How to maintain abdominal compartment syndrome

Answer 8

-HOB 20 or less or reverse tren.
-ngt to low intm suction

Question 9

What is bowel infarction

Answer 9

reduced blood flow to the mesenteric vessels with prolonged ischemia– will see abdominal distention, abdominal pain and cramping, HYPOACTIVE OOR ABSENT BOWEL SOUNDS

Question 10

3 common types of bowel obstruction

Answer 10

Paralytic Ileus, SBO and LBO

Question 11

SBO

Answer 11

vomiting early, small distention, hypokalemia, high pitches bowel sounds

Question 12

LBO

Answer 12

vomiting late, large distention, low pitched bowel sounds, recent change in bowel habits

Question 13

Bowel Perf

Answer 13

leak of GI contents into the peritoneal cavity causing infection and inflammation

Question 14

Acute liver failure

Answer 14

common cause is Tylenol OD, liver will be enlarged and felt on palpation

Question 15

Late/ chronic liver failure

Answer 15

common cause is alcohol abuse, the liver will become non-palpable

Question 16

Presentation of Liver Failure

Answer 16

-Jaundice: elevated bilirubin
-AMS: high ammonia
-Asterixis: high ammonia
-Ascites: low protein and albumin
-Hepatorenal syndrome
-Sepsis

Question 17

Liver Failure Labs

Answer 17

-Pancytopenia (low WBC, RBC, platelets)
-Inc PT and OPTT
-Dec fibrinogen
- Inc AST, ALT
-Low glucose

Question 18

Neomycin

Answer 18

helps to kill gut bacteria that is responsible for producing ammonia– can cause a Vitamin K deficiency

Question 19

TIPPS Procedure

Answer 19

palliative procedure for liver failure– relieve pressure on esophageal varices or ascites

Question 20

Blakemore Tube

Answer 20

used to tamponade the bleeding of esophageal varices– keep scissors at the side of the bed

Question 21

Meds for Upper GI bleeds

Answer 21

give H2 blockers and PPIs
vasopressin
octreotide
sorbitol
betablockers

Question 22

Acute pancreatitis S/S:

Answer 22

-abd pain in all quadrants
-N/V and rigid abdomen
-dec or absent bowel sounds
-inc WBC, amylase and lipase
-decreased calcium
-inc BS

Question 23

Acute Pancreatitis Complication

Answer 23

-Left pleural effusion
-LLL atelectasis (from the lifting of the diaphragm)
-Bilateral crackles or rales
-ARDS… Death

Question 24

Signs of Hemorrhagic Pancreatitis

Answer 24

ECCHYMOSIS Cullen’s (umbilicus) and Grey Turner’s (flank)