CEN Gastrointestinal and Genitourinary Emergencies — Questions and Answers
Question 1: A patient presents with sudden onset severe epigastric pain, a rigid 'board-like' abdomen, and absent bowel sounds. Which condition is most likely?
- Acute appendicitis
- Perforated peptic ulcer (Correct answer)
- Acute pancreatitis
- Small bowel obstruction
Correct 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.
Question 2: 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?
- Coffee-ground emesis
- Melena without hemodynamic changes
- Bright red blood per rectum only
- Hematemesis with hemodynamic instability (Correct answer)
Correct answer: Hematemesis with hemodynamic instability
Hematemesis with hemodynamic instability indicates massive active hemorrhage requiring immediate resuscitation and emergency endoscopy.
Question 3: A cirrhotic patient presents with confusion, asterixis, and jaundice. The nurse anticipates which primary diagnosis?
- Hepatic encephalopathy (Correct answer)
- Spontaneous bacterial peritonitis
- Esophageal variceal bleeding
- Acute portal vein thrombosis
Correct 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.
Question 4: Which medication is the priority pharmacological intervention for a patient with suspected esophageal variceal bleeding?
- IV pantoprazole
- IV octreotide (Correct answer)
- IV metoclopramide
- Oral propranolol
Correct 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.
Question 5: 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?
- Ovarian cyst rupture
- Inguinal hernia incarceration
- Acute appendicitis (Correct answer)
- Mesenteric lymphadenitis
Correct answer: Acute appendicitis
Acute appendicitis classically presents with RLQ pain at McBurney's point, fever, nausea, and rebound tenderness due to peritoneal inflammation.
Question 6: Which finding is characteristic of a positive Murphy's sign?
- Rebound tenderness at the right lower quadrant
- Pain and inspiratory arrest during deep RUQ palpation (Correct answer)
- Referred shoulder pain during splenic palpation
- Flank pain with percussion over the CVA
Correct 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.
Question 7: 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?
- Anal fistula formation
- Toxic megacolon (Correct answer)
- Rectal prolapse
- Perianal abscess
Correct 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.
Question 8: 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?
- Abdominal plain film (KUB)
- Non-contrast CT scan of abdomen and pelvis (Correct answer)
- Renal ultrasound
- IV pyelogram (IVP)
Correct 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.
Question 9: A patient with acute liver failure develops worsening confusion, decorticate posturing, and papilledema. The most immediately life-threatening complication is:
- Hepatorenal syndrome
- Cerebral edema with increased intracranial pressure (Correct answer)
- Spontaneous bacterial peritonitis
- Acute variceal hemorrhage
Correct 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.
Question 10: Which nursing intervention is the highest priority for a patient with confirmed small bowel obstruction presenting with abdominal distension and bilious vomiting?
- Administer a Fleet enema to stimulate passage
- Encourage small sips of clear fluids
- Insert a nasogastric tube and connect to low intermittent suction (Correct answer)
- Position the patient in Trendelenburg
Correct 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.
Question 11: 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?
- Salmonella typhi
- Clostridioides difficile (Correct answer)
- Escherichia coli O157:H7
- Campylobacter jejuni
Correct 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.
Question 12: 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?
- Apply topical antifungal and antibacterial cream to the area
- Prepare the patient for emergent surgical debridement (Correct answer)
- Insert a Foley catheter and obtain wound cultures only
- Apply warm compresses and administer IV analgesics
Correct 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.
Question 13: Which sign, elicited on abdominal examination, is most specific for peritonitis?
- Cullen's sign (periumbilical ecchymosis)
- Rebound tenderness (Blumberg's sign) (Correct answer)
- Grey Turner's sign (flank ecchymosis)
- Chvostek's sign (facial muscle twitch)
Correct 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.
Question 14: 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?
- 0.9% Normal saline with potassium chloride (KCl) (Correct answer)
- Lactated Ringer's solution
- D5W with sodium bicarbonate
- 3% Hypertonic saline
Correct 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.
