CEN Gastrointestinal and Genitourinary Emergencies 1 — 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.
CEN Gastrointestinal and Genitourinary Emergencies 1
A patient presents with sudden onset severe epigastric pain, a rigid 'board-like' abdomen, and absent bowel sounds.
Which condition is most likely?