CCRN Gastrointestinal and Renal Care 2 — Questions and Answers
Question 1: A patient with acute pancreatitis develops a positive Cullen sign. What does this finding indicate?
- Periumbilical ecchymosis from retroperitoneal hemorrhage (Correct answer)
- Right upper quadrant rebound tenderness
- Hyperactive bowel sounds
- Jaundice of the sclera
Correct answer: Periumbilical ecchymosis from retroperitoneal hemorrhage
Cullen sign is periumbilical bruising indicating retroperitoneal bleeding seen in severe hemorrhagic pancreatitis.
Question 2: Which serum value is the most specific marker for acute pancreatitis?
- Lipase (Correct answer)
- Amylase
- Alkaline phosphatase
- Bilirubin
Correct answer: Lipase
Lipase is more specific and stays elevated longer than amylase in acute pancreatitis.
Question 3: A patient with cirrhosis has worsening confusion and asterixis. Which intervention is most appropriate?
- Administer lactulose (Correct answer)
- Restrict all protein permanently
- Give a proton pump inhibitor
- Increase sodium intake
Correct answer: Administer lactulose
Lactulose reduces ammonia absorption, treating hepatic encephalopathy that causes confusion and asterixis.
Question 4: Which electrolyte abnormality is most common in a patient with prolonged nasogastric suction?
- Metabolic alkalosis with hypokalemia (Correct answer)
- Metabolic acidosis with hyperkalemia
- Respiratory acidosis
- Hyperchloremia
Correct answer: Metabolic alkalosis with hypokalemia
Loss of gastric acid and potassium from NG suction produces hypokalemic metabolic alkalosis.
Question 5: A patient with an upper GI bleed has melena. What does melena indicate?
- Digested blood from an upper GI source (Correct answer)
- Bright red bleeding from the rectum
- Fresh lower GI bleeding
- Biliary obstruction
Correct answer: Digested blood from an upper GI source
Melena is black, tarry stool from digested blood, signaling an upper GI bleeding source.
Question 6: Which finding is the earliest sign of acute kidney injury in a critically ill patient?
- Rising serum creatinine and decreased urine output (Correct answer)
- Hypotension
- Peripheral edema
- Hyperglycemia
Correct answer: Rising serum creatinine and decreased urine output
A rising creatinine with oliguria is the hallmark early indicator of acute kidney injury.
Question 7: A patient receiving continuous renal replacement therapy (CRRT) suddenly becomes hypotensive. What is the priority action?
- Assess fluid removal rate and circuit (Correct answer)
- Increase the dialysate flow
- Administer a diuretic
- Stop all IV fluids
Correct answer: Assess fluid removal rate and circuit
Excessive ultrafiltration during CRRT can cause hypotension, so assess and adjust the fluid removal rate.
CCRN Gastrointestinal and Renal Care 2
A patient with acute pancreatitis develops a positive Cullen sign.
What does this finding indicate?