CCRN - Review Gastrointestinal and Renal Care Questions and Answers 1

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

Lactulose is a non-absorbable disaccharide that is metabolized by bacteria in the colon. This process produces lactic acid and other organic acids, which lowers the pH of the colon. The acidic environment promotes the conversion of absorbable ammonia (NH3) to non-absorbable ammonium (NH4+), effectively trapping it in the gut to be excreted in the stool.

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 high pre-filter pressure, especially when accompanied by a rising transmembrane pressure (TMP), is a classic sign of increased resistance to blood flow through the hemofilter itself. This is most commonly caused by the accumulation of protein and cellular debris (clogging) or the formation of clots within the filter fibers.

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

The World Society of the Abdominal Compartment Syndrome (WSACS) defines abdominal compartment syndrome (ACS) as a sustained intra-abdominal pressure (IAP) greater than 20 mmHg that is associated with new organ dysfunction or failure. Intra-abdominal hypertension (IAH) is defined as a sustained IAP of 12 mmHg or greater.

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

Octreotide, a synthetic analog of somatostatin, is a primary vasoactive medication used for acute variceal bleeding. It works by causing selective splanchnic vasoconstriction, which reduces blood flow to the portal system and decreases portal pressure without the significant systemic side effects of 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

Grey Turner's sign (flank ecchymosis) and Cullen's sign (periumbilical ecchymosis) are clinical signs of retroperitoneal hemorrhage. In severe acute pancreatitis, inflammatory and enzymatic processes can erode blood vessels, leading to significant bleeding into the retroperitoneal space.

CCRN Review Practice Test

CCRN Review Practice Test

CCRN - Review Gastrointestinal and Renal Care Questions and Answers 1