CEN Gastrointestinal and Genitourinary Emergencies 2 — Questions and Answers
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?
- Administer broad-spectrum IV antibiotics
- Establish IV access and initiate aggressive fluid resuscitation (Correct answer)
- Prepare patient for emergent ERCP
- Insert nasogastric tube for decompression
Correct answer: Establish IV access and initiate aggressive fluid resuscitation
Aggressive IV fluid resuscitation is the cornerstone of acute pancreatitis management to prevent hypovolemia, systemic inflammatory response, and organ failure.
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:
- Administer IV antibiotics and arrange urology follow-up
- Apply ice and administer analgesics
- Prepare the patient for emergent surgical consultation (Correct answer)
- Obtain urine culture and start oral antibiotics
Correct answer: Prepare the patient for emergent surgical consultation
Testicular torsion is a surgical emergency requiring manual detorsion or operative intervention within 4-6 hours to preserve testicular viability.
Question 3: Which ECG finding in a dialysis patient with missed sessions is most immediately life-threatening?
- Prolonged PR interval
- Peaked T waves with widened QRS (Correct answer)
- ST segment depression
- U waves
Correct answer: Peaked T waves with widened QRS
Peaked T waves with widened QRS indicate severe hyperkalemia with impending cardiac dysrhythmia, requiring immediate calcium gluconate administration.
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?
- Administer sodium bicarbonate IV
- Administer calcium gluconate IV (Correct answer)
- Prepare the patient for emergent hemodialysis
- Administer IV insulin with dextrose
Correct answer: Administer calcium gluconate IV
Calcium gluconate IV is the immediate priority as it stabilizes cardiac membranes within minutes, protecting against fatal dysrhythmias before potassium-lowering measures take effect.
Question 5: Which urine finding best differentiates prerenal azotemia from intrinsic renal failure?
- Urine sodium <20 mEq/L with concentrated urine indicates prerenal (Correct answer)
- Urine specific gravity <1.010 indicates prerenal failure
- Urine sodium >40 mEq/L indicates prerenal failure
- Gross hematuria indicates prerenal failure
Correct answer: Urine sodium <20 mEq/L with concentrated urine indicates prerenal
Urine sodium <20 mEq/L indicates prerenal azotemia because functional kidneys are avidly conserving sodium in response to reduced renal perfusion.
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?
- Oral acetaminophen only until imaging is complete
- IV ketorolac combined with IV opioid analgesics (Correct answer)
- Intramuscular morphine only
- Ice pack to the flank with oral ibuprofen
Correct answer: IV ketorolac combined with IV opioid analgesics
Combination IV NSAID (ketorolac) and opioid therapy provides superior analgesia for renal colic by addressing both smooth muscle spasm and pain transmission.
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?
- Colorectal carcinoma
- Diverticulosis
- Internal hemorrhoids (Correct answer)
- Anal fissure
Correct answer: Internal hemorrhoids
Internal hemorrhoids commonly cause painless bright red bleeding on toilet paper because they are above the dentate line, where somatic pain fibers are absent.
CEN Gastrointestinal and Genitourinary Emergencies 2
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?