NR 325 Adult Health Final Exam Concept Reviews

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

Clinical Review 

1. Identify the appropriate technique/sequence used during a focused gastrointestinal physical assessment.

A focused gastrointestinal (GI) physical assessment follows a deliberate sequence to ensure accurate findings. The patient should be positioned supine with knees slightly flexed and the head of the bed elevated slightly. The bladder should be emptied before the exam to avoid discomfort and interference with palpation.

Steps of GI Physical Assessment

1. Inspection
   Begin with visual observation of the abdomen for skin changes (e.g., striae, scars, lesions), umbilicus position, symmetry, contour (flat, rounded, scaphoid, or protuberant), visible hernias, masses, and abnormal movements such as visible peristalsis or pulsations.
2. Auscultation
   Auscultate before percussion or palpation to avoid altering bowel activity. Use the stethoscope’s diaphragm for high-pitched bowel sounds and bell for low-pitched vascular sounds. Listen to all four quadrants, starting at the right lower quadrant (RLQ), for at least two minutes per quadrant. Note whether sounds are normal, hypoactive, or hyperactive.
3. Percussion
   Evaluate organ size and detect fluid, distention, or masses. Start below the umbilicus in the right midclavicular line, percuss upward until dullness indicates the liver’s lower border. Then percuss downward from the nipple line to find the upper liver border. Tympany indicates air-filled areas; dullness suggests fluid, masses, or solid organs.
4. Palpation
   Palpate lightly (~1 cm depth) to detect tenderness, muscle guarding, or superficial masses, then deeply to assess organ size and deeper structures. Use smooth, systematic movements in all quadrants, beginning at the RLQ. Monitor both verbal and non-verbal cues of pain.

2. Describe the purpose, procedure, and nursing responsibility related to ERCP, Colonoscopy, and Liver Biopsy Procedure.

Procedure	Purpose	Procedure Steps	Nursing Responsibilities
Endoscopic Retrograde Cholangiopancreatography (ERCP)	Visualize biliary ducts, gallbladder, liver, and pancreas; detect obstructions or strictures	Endoscope inserted through the mouth into duodenum; contrast injected into biliary tree; X-rays taken	Pre: NPO 8 hrs, consent, sedation, antibiotics if ordered. Position: Semi-prone, reposition during procedure. Post: Monitor VS, gag reflex, and for perforation, infection, or pancreatitis
Colonoscopy	Inspect colon and rectum for polyps, tumors, inflammation	Flexible scope inserted via anus into entire colon	Pre: Bowel prep, clear liquid diet 24 hrs prior, NPO after midnight. Post: Monitor for bleeding, VS, encourage fluids, resume diet as tolerated
Liver Biopsy	Obtain tissue for diagnosis of liver disease or cancer	Needle inserted between 6th–7th or 8th–9th intercostal spaces	Pre: Check coagulation, crossmatch blood, teach breath-holding during insertion. Post: Flat position 12–14 hrs, frequent VS, monitor for internal bleeding

3. List the normal ranges, and purpose for these gastrointestinal-associated blood studies.

Test	Organ/System	Normal Range	Purpose
Amylase	Pancreas, small intestine	40–140 U/L	Detects pancreatic inflammation
Lipase	Pancreas	0–160 U/L	More specific for pancreatitis
Total Bilirubin	Liver, gallbladder	0.3–1.0 mg/dL	Detects liver dysfunction or bile obstruction
AST	Liver	0–35 U/L	Detects hepatocellular injury
ALT	Liver	4–36 U/L	More liver-specific enzyme
PT	Coagulation (Warfarin)	11–13.5 sec	Assesses clotting/liver function
aPTT	Coagulation (Heparin)	22–35 sec	Monitors heparin therapy
Cholesterol – Total	Blood vessels	<200 mg/dL	Cardiovascular risk
LDL	Blood vessels	<100 mg/dL	“Bad” cholesterol
HDL	Blood vessels	≥40 mg/dL	“Good” cholesterol
Serum Ammonia	Intestines, liver, muscles	6–47 mmol/L	Detects hepatic encephalopathy

4. Explain the characteristics of hepatitis viruses (i.e., modes of transmissions, sources of infection, and infectivity).

Type	Mode of Transmission	Source of Infection	Infectivity
HAV	Fecal–oral	Contaminated food/water, shellfish, infected stool	High
HBV	Blood, body fluids	Sexual contact, perinatal, contaminated needles	Very high; survives outside body 7 days
HCV	Bloodborne	IV drug use, blood products, unsafe tattoos	High chronic rate
HDV	Bloodborne	Co-infection with HBV	Dependent on HBV
HEV	Fecal–oral	Contaminated food/water	High in developing countries; dangerous in pregnancy

5. Describe the clinical manifestations and nursing management of the patient with viral Hepatitis B.

• Symptoms: Fatigue, anorexia, nausea, RUQ pain, arthralgia, weight loss, rash, jaundice
• Findings: Fever, vomiting, dark urine, clay stools, hepatomegaly
• Complications: Liver failure, chronic hepatitis, cirrhosis, liver cancer
• Management: Rest, high-carb/high-calorie diet, antivirals, avoid alcohol, monitor labs, patient education

NR 325 Adult Health Final Exam Concept Reviews

6. Describe the clinical manifestations and nursing management of the patient with viral Hepatitis C (HCV).

• Often asymptomatic until advanced disease
• Symptoms: Fatigue, nausea, RUQ pain, joint pain, weight loss, jaundice
• Complications: High chronicity, cirrhosis, liver cancer
• Management: Antivirals, alcohol avoidance, balanced nutrition, regular monitoring

7. Identify the etiology and clinical manifestations of cirrhosis of the liver.

• Causes: Chronic alcohol use, viral hepatitis, NASH, autoimmune hepatitis
• Symptoms: Fatigue, weight loss, ascites, jaundice, mental status changes, pruritus
• Tests: LFTs, coagulation studies, albumin, biopsy, imaging

8. What are the primary nursing responsibilities associated with cirrhosis of the liver?

• Monitor VS, I&O, weight
• Assess edema/ascites
• Provide skin care
• Administer meds (diuretics, lactulose)
• Patient education on sodium restriction

9. What are the major complications of cirrhosis, and collaborative care for each?

Complication	Care
Portal HTN & Varices	Beta-blockers, endoscopic therapy, vasopressin
Ascites	Sodium restriction, diuretics, paracentesis
Hepatic Encephalopathy	Lactulose, rifaximin, protein control
Edema	Diuretics, skin protection

10. Describe the action and purpose for the following drugs in patients with liver problems.

(See table from earlier section — maintained for accuracy.)

11. What is portal hypertension, and what are the associated complications?

Portal hypertension is an abnormal increase in the blood pressure within the portal venous system, typically resulting from obstruction of blood flow through the liver due to cirrhosis. The condition leads to the development of collateral circulation, which has significant clinical consequences.

Major Complications:

• Esophageal and gastric varices (prone to rupture and bleeding)
• Ascites
• Splenomegaly
• Hepatic encephalopathy
• Caput medusae (dilated abdominal wall veins)

12. What are esophageal varices, and how are they managed?

Esophageal varices are dilated veins in the lower esophagus, formed due to portal hypertension. They are fragile and prone to life-threatening hemorrhage.

Management Approaches:

• Primary prevention: Non-selective beta-blockers (nadolol, propranolol)
• Acute bleeding: Octreotide or vasopressin, endoscopic band ligation, balloon tamponade (temporary measure)
• Long-term: Repeat endoscopic surveillance, abstinence from alcohol, management of underlying liver disease

13. What is hepatic encephalopathy, and what are the treatment goals?

Hepatic encephalopathy is a neuropsychiatric syndrome caused by accumulation of neurotoxins, particularly ammonia, due to liver failure.

Goals of Treatment:

• Reduce ammonia levels with lactulose and/or rifaximin
• Correct precipitating factors (GI bleed, infection, constipation)
• Ensure adequate nutrition without excessive protein restriction
• Maintain patient safety due to altered mental status

14. Describe the pathophysiology and clinical manifestations of acute pancreatitis.

Acute pancreatitis results from premature activation of pancreatic enzymes within the pancreas, leading to autodigestion, inflammation, and varying degrees of necrosis. Common causes include gallstones, chronic alcohol use, hypertriglyceridemia, and certain medications.

Clinical Manifestations:

• Severe epigastric pain radiating to the back
• Nausea and vomiting
• Abdominal distention
• Low-grade fever, tachycardia, hypotension
• Grey-Turner’s sign (flank ecchymosis) and Cullen’s sign (periumbilical discoloration) in severe cases

15. What are the priority nursing interventions for acute pancreatitis?

• Pain control: IV opioids, positioning (knee-chest or side-lying)
• NPO status: Prevent stimulation of pancreatic enzymes
• IV fluids: Maintain hydration and prevent hypovolemic shock
• Electrolyte monitoring: Particularly calcium and potassium
• Respiratory assessment: Due to risk of ARDS
• Patient education: Avoid alcohol and low-fat diet once oral intake resumes

16. Describe the pathophysiology, manifestations, and treatment of cholelithiasis.

Cholelithiasis is the presence of gallstones within the gallbladder, often composed of cholesterol, bile salts, and calcium.

Manifestations:

• May be asymptomatic
• Biliary colic: Severe, intermittent RUQ pain after fatty meals
• Nausea, vomiting, bloating
• Jaundice if bile duct is obstructed

Treatment:

• Symptomatic: Cholecystectomy (laparoscopic preferred)
• Non-surgical: Oral bile acids to dissolve stones (rarely used), dietary modification

17. What are the nursing responsibilities for a patient post-cholecystectomy?

• Monitor for bleeding or bile leakage
• Manage pain and encourage deep breathing/ambulation
• Advance diet gradually (start clear liquids)
• Educate on avoiding high-fat foods initially
• Care for laparoscopic incision sites and observe for infection

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18. Describe the etiology, pathophysiology, and manifestations of peptic ulcer disease (PUD).

PUD involves erosion of the gastric or duodenal mucosa due to imbalance between mucosal defense mechanisms and acid-pepsin activity. Causes include H. pylori infection, chronic NSAID use, stress, smoking, and alcohol.

Symptoms:

• Epigastric pain (burning, gnawing)
• Duodenal ulcer pain relieved by food; gastric ulcer pain worsens with food
• Bloating, nausea, melena, hematemesis

19. What are the complications of PUD, and how are they managed?

Complication	Management
Hemorrhage	Endoscopic hemostasis, PPI infusion, fluid/blood resuscitation
Perforation	Surgical repair, antibiotics, NG decompression
Gastric outlet obstruction	NG tube suction, endoscopic dilation, surgery

20. Identify the classes of drugs used to treat PUD and their actions.

• PPIs (omeprazole): Inhibit gastric acid secretion
• H2 blockers (ranitidine): Reduce acid secretion
• Antacids: Neutralize gastric acid
• Sucralfate: Protects ulcer from acid/pepsin
• Antibiotics: Eradicate H. pylori

21. Describe the nursing management of GI bleeding.

• Maintain hemodynamic stability (IV fluids, blood products)
• NG tube insertion for lavage if indicated
• Frequent VS and orthostatic BP
• Endoscopic therapy for definitive control
• Administer acid suppression medications

22. Explain the differences between ulcerative colitis (UC) and Crohn’s disease.

Feature	UC	Crohn’s
Location	Colon only, continuous lesions	Anywhere GI tract, skip lesions
Depth	Mucosa/submucosa	Entire bowel wall
Symptoms	Bloody diarrhea, urgency	Diarrhea, weight loss, abdominal pain
Complications	Toxic megacolon, perforation	Fistulas, strictures

23. List nursing priorities for inflammatory bowel disease (IBD).

• Monitor fluid/electrolyte status
• Administer anti-inflammatory or immunosuppressive drugs
• Provide low-residue, high-protein diet
• Monitor for complications (bleeding, perforation)

24. Describe the clinical picture of colorectal cancer.

• Change in bowel habits
• Rectal bleeding or occult blood in stool
• Anemia, weight loss, abdominal pain
• Often asymptomatic until advanced

25. Nursing care post-colorectal surgery.

• Monitor for infection, anastomotic leak
• Ostomy care education if needed
• Pain control and early mobilization
• Gradual dietary progression

26. Describe benign prostatic hyperplasia (BPH) and its management.

BPH is a non-cancerous enlargement of the prostate gland causing urinary obstruction.

Symptoms: Hesitancy, weak stream, nocturia, incomplete emptying.

Management:

• Meds: Alpha-blockers (tamsulosin), 5-alpha-reductase inhibitors (finasteride)
• Surgery: TURP if severe symptoms

27. Post-TURP nursing responsibilities.

• Continuous bladder irrigation to prevent clots
• Monitor urine color and output
• Assess for bladder spasms and treat
• Educate on temporary urinary incontinence

28. Describe testicular cancer risk factors and manifestations.

• Risks: Cryptorchidism, family history, HIV infection
• Symptoms: Painless lump/swelling, heaviness in scrotum, dull ache in groin

29. Nursing care post-orchiectomy.

• Pain management
• Incision care
• Emotional support regarding fertility and body image
• Education on self-exam of remaining testicle

30. Describe breast cancer risk factors and early detection.

• Risks: Family history, BRCA mutations, early menarche, late menopause, nulliparity
• Detection: Mammography, clinical breast exam, breast self-awareness

31. Nursing management post-mastectomy.

• Arm care to prevent lymphedema
• Pain control
• Emotional support
• Exercise to maintain ROM

32. Describe cervical cancer risk factors and prevention.

• Risks: HPV infection, multiple partners, smoking
• Prevention: HPV vaccine, regular Pap tests, safe sex

33. Endometrial cancer basics.

• Postmenopausal bleeding is hallmark symptom
• Diagnosed via endometrial biopsy
• Treated with surgery, possibly radiation/chemo

34. Ovarian cancer overview.

• Risks: BRCA mutations, nulliparity, family history
• Symptoms: Bloating, pelvic pain, early satiety
• Often diagnosed late

35. Nursing priorities for patients receiving chemotherapy.

• Monitor CBC for myelosuppression
• Manage nausea/vomiting
• Provide infection prevention measures
• Monitor for fatigue and mucositis

NR 325 Adult Health Final Exam Concept Reviews

36. Palliative care principles in end-stage GI or cancer patients.

Support for family and caregivers

Focus on symptom control (pain, nausea, dyspnea)

Emotional and spiritual support

Advance care planning