CCRN - Review Gastrointestinal and Renal Care Questions and Answers

Question 1

A patient with end-stage liver disease is admitted with worsening confusion, lethargy, and asterixis.
The serum ammonia level is elevated.
The nurse anticipates administering lactulose.
What is the primary therapeutic mechanism of action for this medication?

Accepted Answer

It lowers colonic pH, trapping ammonia in the gut and promoting its excretion.

Answer

It binds directly with ammonia in the bloodstream for renal excretion.

Answer

It stimulates the liver to increase its metabolism of ammonia into urea.

Answer

It acts as a sedative to decrease the neurological effects of ammonia.

Question 2

A patient is receiving continuous veno-venous hemofiltration (CVVH). The nurse notes a high pre-filter pressure alarm and observes that the transmembrane pressure (TMP) is also rising. Which of the following is the MOST likely cause of these alarms?

Accepted Answer

Clotting or clogging of the hemofilter.

Answer

A kink in the return line after the filter.

Answer

Disconnection of the access catheter.

Answer

Hypotension in the patient.

Question 3

A critical care nurse is monitoring a patient at high risk for abdominal compartment syndrome (ACS) following massive fluid resuscitation for trauma. According to the World Society of the Abdominal Compartment Syndrome (WSACS), ACS is defined as a sustained intra-abdominal pressure (IAP) greater than what threshold, accompanied by new organ dysfunction?

Accepted Answer

20 mmHg

Answer

12 mmHg

Answer

16 mmHg

Answer

25 mmHg

Question 4

A patient is admitted to the ICU with acute upper gastrointestinal bleeding from ruptured esophageal varices. In addition to endoscopic intervention, which medication should the nurse anticipate administering as a continuous infusion to reduce splanchnic blood flow and portal pressure?

Accepted Answer

Octreotide

Answer

Norepinephrine

Answer

Pantoprazole

Answer

Vasopressin

Question 5

A patient with severe acute pancreatitis develops sudden, severe flank pain and ecchymosis around the left flank. The nurse recognizes this finding as Grey Turner's sign. This sign is indicative of which life-threatening complication?

Accepted Answer

Retroperitoneal hemorrhage

Answer

Peripancreatic abscess formation

Answer

Ruptured pancreatic pseudocyst

Answer

Splenic vein thrombosis

Question 6

A critical care nurse is evaluating laboratory results to determine the cause of a patient's acute kidney injury (AKI). Which set of findings is most consistent with a prerenal cause, such as hypovolemia?

Accepted Answer

Urine sodium < 20 mEq/L, BUN:Creatinine ratio > 20:1

Answer

Urine sodium > 40 mEq/L, FENa > 2%

Answer

BUN:Creatinine ratio of 10:1, FENa > 2%

Answer

Presence of muddy brown casts in urine, urine sodium > 40 mEq/L