Abdominal + oncology

Question 1

Acute pancreatitis
s/s
a) about pain
b) other findings
c) what sing will be positive?
d) watch out for?

Answer 1

a) Severe LUQ Pain(radiate to the back)
-pain after large meal or alcohol
Pain not relieved by vomiting
b)Dec bowel sounds
Low-grade fever
Jandice
c) Grey-Turner sign
Cullen sign(umbilicus)
d) Hypovolemia(possible shock)

Question 2

Lab
a) Amylase
how long it remins?
b) Lipase
how long it remins?

Answer 2

a) inc with in 12-24hr
remains 2-3days
b) inc slowely
remains in 2 weeks

Question 3

c) Glucose
d) calcium
e) LDH,AST
f) WBC, sed rate
g) platelets

Answer 3

a) inc
b) dec
e) inc
f) inc
g) dec

Question 4

A nurse is completing the admission assessment on a pt who has acute pancreatitis. Which of the following findings is the priority to be reported to the provider?
History of cholelithiasis
Serum amylase levels three times greater than the expected value.
Pt report of severe pain radiating to the back that is rated at an “8”
Hand spasms present when blood pressure is checked

Answer 4

Hand spasms present when blood pressure is checked
bacuse of low calcium

Question 5

Complication
Pseudocyst

Answer 5

Accumulated pancreatic enzymes
Resolve spontaneously or rupture → peritonitis

Question 6

Complication
Abscess

Answer 6

Infectoion leads to necrosis and that also leads perforation into adjacent organs
Surgery drainage immediately

Question 7

When assessing a patient with acute pancreatitis the nurse would expect to find:
a) Pain in the right upper quadrant radiating to the right shoulder
b) Reporting of pain being worse when sitting upright
c) Severe mid-epigastric or left upper quadrant pain
d) Pain relieved with defecation

Answer 7

c

Question 8

Pancreatitis
nursing care
a) pain
b) diet

Answer 8

a) pt upright w/knee flexed to chest, fetal position
DO NOT lay flat,inc pain
b) NPO
or small frequent meals with high protein and carb with low fat

Question 9

Nursing management of the patient with acute pancreatitis includes:SATA
Check for S/S of hypocalemia
Monitor of infection
Provide diet high in protein and fat
Restrict fluid administration

Answer 9

a.b

Question 10

Acute abdomen
common causes?

Answer 10

onset with in 24hr
Inflamamation
Perforated
Obstraction
Internal bleeding

Question 11

How to assess to pain?

Answer 11

O– onset
L – location
D – duration
C – character
A – aggravating factors
R– relieving factors
T– treatments
S – Symptoms (N,V,D or fevers, etc)

Question 12

Pain location
a) RUQ
b) LUQ
c) RLQ
d) LLQ
e) what order to assess abdominal?

Answer 12

a) Gallbladder
ascending colon
b) Pancreatitis
desending colon
spleen
stomach
c) Appendicitis
d) constipation
e) inspection
Ausculation
percussion
Palpation

Question 13

Murphy’s Sign?

Answer 13

Place hand firmly at right costal margin (RUQ)
Ask patient to breathe deeply
Pain=Positive Cholecystitis

Question 14

McBurney’s Point?

Answer 14

Deep tenderness in RLQ
Acute appendicitis

Question 15

Psoas & Obturator Sign?

Answer 15

Appendicitis
Psoas-pain passive extention on the right thigh
Obtirator-pain on passive internal rotation of the hip

Question 16

Answer 16

Question 17

Acute liver failure
a) liver produce?
b) detoxifies?
c) store?

Answer 17

a) clotting factors,bile,albumin
b) alcohol,meds
c) iron, vitamins, minerals,fat,glucose
it receives 25% of cardiac output!

Question 18

Lab Analysis
a) Blirubin
b) Liver Enzymes AST, ALT; LDH
c) albumin
d) Ammonia
e) INR
f) GGT
g) Platlet

Answer 18

a) inc
b) inc
c) dec protein
d) inc
e) prolonged
f) inc
g) dec

Question 19

Dx

Answer 19

ERCP/MRCP
PTC
US,CT

Question 20

Manifestations of Cirrhosis

Answer 20

jaundice
Spider angioma
erythema
Anemia, leukopenia
Overt bleeding, bruising
Infections
Weight loss
Dysrhythmias, tachycardia

Question 21

Portal Hypertension
a) Elevated portal pressure d/t?
b) causes?

Answer 21

a) obstructed blood flow into cirrhotic liver
b) Splenomegaly
Destroys RBC, WBC, platelets → hematologic disorders
Esophageal/gastric varices
Ascites

Question 22

Esophageal/gastric varices
a) s/s?
b) waht kind of stool?

Answer 22

medical emergence
a) sudden onset bright red or coffee ground emesis
b) Melena(dark sticky bloody feces)
Increased ammonia levels
Compromises airway

Question 23

Care for esophagal varices
a) avoid?
b) monitor for?
c) if it ruptured?

Answer 23

a) alcohol,asprin,NSAIDS
b) hypovolimic shock
c) HOB
O2
IV w/fluid,blood
NPO

Question 24

Ascites
Result of?

Answer 24

Portal hypertension
Failure to produce albumin
Fluid leaks from liver capsule
Increased hydrostatic pressure
Increase aldosterone & ADH
Can develop spontaneous bacterial peritonitis (SBP)

Question 25

Hepatic Encephalopathy a) cause? b) s/s?

Answer 25

a) Liver cannot pee pit ammonia--toxic to brain b) Changes in LOC Inc ammonia level Sleep disturbances **Asterixis** Lethargy musty,sweet breath

Question 26

Hepatorenal Syndrome (HRS) a) what is it? b) what to do?

Answer 26

a) Sudden renal failure with hepatic failure b) Give adequate fluids, vasopressors, dialysis, consider liver transplant

Question 27

Paracentesis a) Pre b) during c) post

Answer 27

a) informed consent, void, be sure foley draining. Why?? because we don't want to puncture the bladder by accident Check INR b) supine with HOB elevated c) monitor for hypovolemia (may give Albumin post procedure)

Question 28

hepatic encephalopathy Decrease Ammonia levels a) meds? b) diet?

Answer 28

a) Rifazimin, Flagyl, Vancomycin Lactulose b) high protein

Question 29

The client is diagnosed with esophageal bleeding. Which of the following assessment findings warrant immediate intervention by the nurse? H/H 11.4/32 Abdomen soft to touch, non tender T99, BP 88/60, HR 119 NGT has coffee ground emesis Old blood, slow bleed

Answer 29

T99, BP 88/60, HR 119 Watch for S/S hypovolemic shock

Question 30

Fulminant Hepatic Failure a) what is it? b) causes? c) s/s

Answer 30

a) Rapidly develop liver failure with no prior history of liver dysfunction b) Drug overdose Viral hepatitis (HBV) c) Hypoglycemia Cerebral edema MODS

Question 31

oncology spinal cord compression a) s/s b) tratment

Answer 31

a) back pain(d/t pressure) bowel, bladder dysfunction paralysis b) **Radiation rapidly!!** Neuro check q1 Limit activity(further harm to spinal)

Question 32

Oncology SIADH a) patho a) s/s b) treatment

Answer 32

a) body retains urine **S=stop pee** **more fluid in the blood, less in urine** a) Weight gain personality change Seizure b) Restric fluid Weight 2time/day Inc diately Na

Question 33

Oncology Hypercalcemia a) Normal range and medical emergency b) s/s c) treatment

Answer 33

a) normal 8.5-10.5 **emergency greater than 12** b) seizures bone pain dysrhythmias real insufficiency c) bisphosphonate hydration mobilize(ca will leave blood to bone)

Question 34

Oncology tumor lysis syndrome a) s/s b) treatment

Answer 34

a) hyperuricemia=itchiyng hyperkalemia hypocalcemia b) diuresis restrict dietary potassium insulin(move to potassium)

Question 35

Oncology Superior vena cava syndrome a) s/s b) tratment

Answer 35

a) neck vein distention facial edema,redness SOB,dyspnea chest pain,cough **Think about what fluid buildup in the upper body** b) O2 diuretics Semi-fowelers position avoid straining