CEN Gastrointestinal and Genitourinary Emergencies 2

Question 1

A patient with a history of heavy alcohol use presents with epigastric pain radiating to the back, nausea, and vomiting. Serum lipase is 1,800 U/L. What is the priority nursing intervention?

Accepted Answer

Establish IV access and initiate aggressive fluid resuscitation

Answer

Administer broad-spectrum IV antibiotics

Answer

Prepare patient for emergent ERCP

Answer

Insert nasogastric tube for decompression

Question 2

A 17-year-old male presents with sudden onset severe scrotal pain without trauma, nausea, and vomiting. The affected testicle is high-riding with a horizontal lie. The nurse's priority action is:

Accepted Answer

Prepare the patient for emergent surgical consultation

Answer

Administer IV antibiotics and arrange urology follow-up

Answer

Apply ice and administer analgesics

Answer

Obtain urine culture and start oral antibiotics

Question 3

Which ECG finding in a dialysis patient with missed sessions is most immediately life-threatening?

Accepted Answer

Peaked T waves with widened QRS

Answer

Prolonged PR interval

Answer

ST segment depression

Answer

U waves

Question 4

A patient with suspected hyperkalemia (K+ 7.1 mEq/L) and peaked T waves on ECG is being treated. What is the priority first intervention?

Accepted Answer

Administer calcium gluconate IV

Answer

Administer sodium bicarbonate IV

Answer

Prepare the patient for emergent hemodialysis

Answer

Administer IV insulin with dextrose

Question 5

Which urine finding best differentiates prerenal azotemia from intrinsic renal failure?

Accepted Answer

Urine sodium <20 mEq/L with concentrated urine indicates prerenal

Answer

Urine specific gravity <1.010 indicates prerenal failure

Answer

Urine sodium >40 mEq/L indicates prerenal failure

Answer

Gross hematuria indicates prerenal failure

Question 6

A patient with ureteral calculi presents with colicky right flank pain radiating to the groin and hematuria. Which analgesic strategy is most effective?

Accepted Answer

IV ketorolac combined with IV opioid analgesics

Answer

Oral acetaminophen only until imaging is complete

Answer

Intramuscular morphine only

Answer

Ice pack to the flank with oral ibuprofen

Question 7

A patient presents with painless bright red rectal bleeding noticed only on toilet paper after defecation, without abdominal pain or change in bowel habits. Which condition is most likely?

Accepted Answer

Internal hemorrhoids

Answer

Colorectal carcinoma

Answer

Diverticulosis

Answer

Anal fissure