Download NUR 631/ NUR631 EXAM 1 TEST | COMPLETE 2025/2026 ACTUAL EXAM WITH CORRECT VERIFIED ANSWERS and more Exams Nursing in PDF only on Docsity!
NUR 631/ NUR631 EXAM 1 TEST |
COMPLETE 2025 /2026 ACTUAL EXAM
WITH CORRECT VERIFIED ANSWERS
When do you refer a patient with dyspepsia to a gastroenterologist? When other symptoms are present such as unexplained weight loss. Initial bilirubin is unconjugated and NOT. When measured in the serum, it is reported as indirect bilirubin. This form of bilirubin is reversibly bound to albumin and transported to the liver, where it is taken up by hepatocytes and conjugated with glucuronic acid. water soluble why would a beta blocker be prescribed in hyperthyroidism? to prevent hyperthyroidism-induced atrial fibrillation
Which lab abnormality is associated with hypothyroidism? LDL What causes Jaundice? an accumulation of bilirubin in the blood jaundice is apparent when the serum bilirubin rises above what value? 2.5-3.0 (normal = 0.3 - 1.0) Hyperbilirubinemia may be caused by a number of conditions / diseases such as anemias, thalassemia, polycythemia, lead poisoning, CHF, contrast agents, neonatal liver, rare syndromes, hepatitis, pancreatitis, pancreatic cancer, and many drugs. But the most common causes are directly due to (2): Cholestasis, either because of impaired bile formation and/or bile flow, which can be the result of: **1) extrahepatic biliary tract obstruction
- hepatic parenchymal disease**
“Acetaminophen, Statins, Tequila” Levels of AST & ALT below 300 U/L are nonspecific; however, some extreme elevations can be diagnostic. For example, ALT/AST > 1, occur in patients with (3):
**1. acute viral hepatitis
- toxin or drug-induced hepatitis
- ischemic liver injury** If the ratio of AST to ALT is 3 - 5x the norm, it generally indicates severe hepatic necrosis, most often caused by: alcoholic hepatitis (or skeletal muscle injury secondary to seizure, protracted immobilization) The liver panel test includes AST, ALT, bilirubin and which other 4 labs? albumin, alkaline phosphatase, PT/INR, aPTT
Simply stated, a serum bilirubin test shows if the liver is able/not able to: rid itself of byproducts Jaundice + Pruritus + Dark Urine + Light-colored Stools + RUQ pain => intra or extra hepatic cholestasis such as:
**1. Cholelithiasis (gallstones)
- Cirrhosis
- Other biliary obstruction** An enlarged but non-painful gallbladder + jaundice is called what sign? COURVOISIER What does Courvoisier's sign indicate? chronic liver failure, gallstones, or pancreatic cancer
iron supplements, bismuth, certain foods, spices Dysphagia is difficulty swallowing with or without odynophagia (painful swallowing). Dysphagia may be caused by mechanical obstruction (strictures, tumors) or functional impaired motility (neurological or muscular problems). The NP knows that 80% of oral and pharyngeal phase abnormalities have a neurologic origin due to: CVA, Parkinson's, MS, ALS, Achalasia (esophageal nerve damage) What is the gold standard diagnostic exam for dysphagia? video fluoroscopic swallow study How is dysphagia managed?
- Positioning - upright with head tilted forward and downward
- thickened liquids
- mechanical soft diet If risk of aspiration is severe, oral feeding may be discontinued and enteral feedings provided.
Which are the 2 particular viral hepatitis that lead to chronic disease in hundreds of millions of people are the most common cause of liver cirrhosis and cancer? Hepatitis B & C Hepatitis D travels with Hepatitis : B Which are the hepatitis types that are contracted from contaminated food and water? A & E The Hepatitis A vaccine, which should be offered to to patients who reside or travel to areas where disease is endemic, food handlers, day care and long term care workers, consists of: 2 injections, 6 months apart (Hepatitis B requires 3 doses)
Implies clearance of HBV and recovery from infection. The patient is immune to HBV either from infection or immunization. Positive IgM antibody to hepatitis B core antigen (IgM anti-HBc) indicates recent/acute infection (<6 mos), whereas the presence of anti-HBc indicates previous or ongoing infection in an time frame. undefined
50% of cases of HCV is caused by: IV drug use with needle sharing What is another name for the prodromal stage of hepatitis infection and what are the symptoms? PREICTERIC stage Flu-like symptoms, N/V/D, elevated bilirubin, AST, ALT
In which stage do these symptoms appear in hepatitis infection? Jaundice Pruritus Brown-colored urine Lighter-colored stools ICTERIC STAGE (5- 10 days after onset of flu-like symptoms) Positivity of this test (anti-HAV IgG) indicates that: the patient has recovered / is immune to hepatitis A appears about 2 weeks after the IgM appears and persists for more than 10 years What does a positive Anti-HCV mean? Confirms ACTIVE disease with presence of antibodies that persist in the presence of the virus and are NOT protective. What is the treatment of chronic Hep B? interferon alfa-2a and lamivudine
Alcoholic cirrhosis is known as: Laennec's cirrhosis What is the pathophysiology of cirrhosis? Hepatic cells exposed to toxins become inflamed, are infiltrated with fat and WBCs, and replaced by fibrotic tissue. If the damage continues over many years, scar tissue develops and the liver becomes hardened and lumpy. Early in the disease the liver is enlarged from the inflammatory process, but then it shrinks and blood flow through the liver becomes impaired. Objective findings in Advanced Liver Disease include (8): Spider Nevi Caput medusae Ascites (↓Albumin) Encephalopathy CBC shows macrocytic anemia Pancytopenia ↑ PT (bleeding)
Management of Cirrhosis may include (7): High calorie diet Daily vitamin and mineral supplementation Cholestyramine (Questran) for pruritus Lactulose or neomycin for encephalopathy Fluid restriction Diuretics Paracentesis 4 - 10 bloody diarrheas daily is a hallmark sign of: Severe Ulcerative Colitis feeling of incomplete evacuation tenesmus (ulcerative colitis) Crohn's begins in the and continues into other layers of intestinal tissue, whereas Ulcerative Colitis is limited to the layer.
KUB
presence of air in the abdominal cavity indicating perforation from toxic megacolon is called pneumoperitoneum What score in the DCAI calculator indicates remission from CD and what score indicates fulminant disease? < 150
450 What is the pathophysiology of Crohn's and Colitis? pro-inflammatory cytokines erode the intestinal tissue 50% of patients with Crohn's have perianal involvment including (2): anal & peri-anal fissures edematous skin tags
(rectum is typically spared) skipped lesions along intestines with cobblestone appearance => CD When are anti-diarrheals contraindicated? acute phase of UC Drug of choice for UC: Mesalamine Drug of choice for CD: prednisone 40 - 60mg/day initially in outpatient setting Which drug class is used to treat UC & CD that is refractory to initial therapies? anti-tumor necrosis factor (TNF) agents such as infliximab (Remicade) & adalimumab (Humira)
pathophysiology of IBS hypercontraction of intestinal walls; may begin after bacterial gastroenteritis usually before age 50 Which drug class may be given to patients with IBS to decrease spasms? anticholinergics (dicyclomine, hyoscyamine) Causes of acute bowel obstruction (3):
- torsion
- herniation
- intussusception Tool to diagnose internal hemorrhoids: anoscopy Internal hemorrhoids (superior plexus)
External hemorroids (inferior plexus) Common in the elderly & 3rd trimester NP may management hemorrhoids with:
- Bulk laxatives
- Sitz baths
- increase H2O
- topical hydrocortisone What is normal value of CEA? What is normal CEA value in smokers? < 2. < 5 Tumor Node Metastasis (TNM) class, earliest stage = T0, N0, M What do T3 & T4 mean in TNM?
