Gastrointestinal and Genitourinary Emergencies Flashcards

A patient presents with sudden onset severe epigastric pain, a rigid 'board-like' abdomen, and absent bowel sounds. Which condition is most likely?

Answer: Perforated peptic ulcer

Perforated peptic ulcer causes sudden, severe pain with board-like abdominal rigidity due to chemical peritonitis from gastric contents spilling into the peritoneum.

A patient with active upper GI bleeding presents with hematemesis, BP 82/50 mmHg, and HR 128 bpm. Which assessment finding represents the highest priority concern?

Answer: Hematemesis with hemodynamic instability

Hematemesis with hemodynamic instability indicates massive active hemorrhage requiring immediate resuscitation and emergency endoscopy.

A cirrhotic patient presents with confusion, asterixis, and jaundice. The nurse anticipates which primary diagnosis?

Answer: Hepatic encephalopathy

Hepatic encephalopathy presents with altered mental status and asterixis (flapping tremor) in cirrhotic patients due to ammonia accumulation from impaired liver detoxification.

Which medication is the priority pharmacological intervention for a patient with suspected esophageal variceal bleeding?

Answer: IV octreotide

Octreotide reduces portal hypertension and splanchnic blood flow by inhibiting vasoactive intestinal peptides, making it the drug of choice for acute variceal bleeding.

A patient presents with acute right lower quadrant pain, fever of 38.6°C, nausea, and rebound tenderness at McBurney's point. The nurse anticipates which diagnosis?

Answer: Acute appendicitis

Acute appendicitis classically presents with RLQ pain at McBurney's point, fever, nausea, and rebound tenderness due to peritoneal inflammation.

Which finding is characteristic of a positive Murphy's sign?

Answer: Pain and inspiratory arrest during deep RUQ palpation

Murphy's sign is positive when the patient experiences sharp pain and stops inspiring during deep right upper quadrant palpation, indicating acute cholecystitis.

A patient with inflammatory bowel disease presents with severe abdominal pain, absent bowel sounds, abdominal distension, and fever of 39.4°C. Which life-threatening complication is most concerning?

Answer: Toxic megacolon

Toxic megacolon is a life-threatening complication characterized by colonic dilation greater than 6 cm with systemic toxicity, requiring emergency surgical evaluation.

A patient presents with sudden onset severe right flank pain radiating to the groin, hematuria, and costovertebral angle tenderness. Which imaging study is the gold standard for diagnosis?

Answer: Non-contrast CT scan of abdomen and pelvis

Non-contrast CT scan is the gold standard for nephrolithiasis as it detects all stone types including radiolucent uric acid stones and provides precise anatomical detail without contrast risk.

A patient with acute liver failure develops worsening confusion, decorticate posturing, and papilledema. The most immediately life-threatening complication is:

Answer: Cerebral edema with increased intracranial pressure

Cerebral edema with increased ICP is the leading cause of death in acute liver failure, requiring immediate neurological monitoring and ICP-lowering interventions.

Which nursing intervention is the highest priority for a patient with confirmed small bowel obstruction presenting with abdominal distension and bilious vomiting?

Answer: Insert a nasogastric tube and connect to low intermittent suction

Nasogastric tube insertion with low intermittent suction decompresses the obstructed GI tract, relieves distension, reduces vomiting, and prevents aspiration.

A patient develops profuse watery diarrhea, abdominal cramping, and low-grade fever 10 days after completing a course of clindamycin. Which pathogen is most likely responsible?

Answer: Clostridioides difficile

C. difficile infection classically follows antibiotic use, which disrupts normal intestinal flora and allows C. difficile to proliferate and produce cytotoxins causing colitis.

A patient presents with scrotal swelling, crepitus on palpation, foul odor, fever of 40°C, and severe pain. The nurse recognizes this as Fournier's gangrene. What is the priority intervention?

Answer: Prepare the patient for emergent surgical debridement

Fournier's gangrene is a rapidly progressive polymicrobial necrotizing fasciitis requiring emergency surgical debridement as definitive treatment, with broad-spectrum IV antibiotics as adjunct therapy.

Which sign, elicited on abdominal examination, is most specific for peritonitis?

Answer: Rebound tenderness (Blumberg's sign)

Rebound tenderness (Blumberg's sign) — pain that is worse with sudden release of deep pressure than with pressure itself — indicates peritoneal irritation consistent with peritonitis.

A patient with 72 hours of persistent vomiting has ABG results showing pH 7.52, HCO3 32 mEq/L, and labs showing K+ 2.8 mEq/L, Cl- 88 mEq/L. Which IV fluid replacement is most appropriate?

Answer: 0.9% Normal saline with potassium chloride (KCl)

Normal saline with KCl replaces the chloride lost through gastric contents (correcting hypochloremic metabolic alkalosis) and replenishes the hypokalemia caused by prolonged vomiting.