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MSN Exam for Appendicitis (PM)*
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Question 1
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
C
The appendix may develop gangrene and rupture, especially in a middle-aged client.
D
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
Question 1 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 2
The appendix is located on the _____ lower side of the abdomen.
A
Right
B
Left
Question 3
The inferior rectal artery supplies blood to which part of the rectum?
A
the internal and external anal sphincters
B
the lower rectum
C
the uppper, middle, and lower rectum
D
the external sphincter only
Question 4
Common anesthesia for appendectomy is
A
Spinal
B
General
C
Caudal
D
Hypnosis
Question 4 Explanation:
Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.
Question 5
What are diagnostic features of acute appendicitis? click all that apply
A
Low grade fever less than 100.4F/38C
B
Moderate leukocytosis (10,000-20,000)
C
Ultrasound
D
CT (with contrast depending on body habitus)
E
CT (helpful if perforation is suspected to diagnose periappendiceal abscess)
Question 6
What are some possible causes of an obstructed appendix?
A
inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
B
infection, fecal stasis, calcium salts or undigested fiber-fecaliths, parasites, FB, and neoplasms, diarrhea
suppositories, FB, neoplams, undigested fiber and calcium salts, calcium salts or undigested fiber-fecaliths, infection, fecal stasis, parasites
Question 7
Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which
position?
A
Prone
B
Supine, stretched out
C
Sitting
D
Lying with legs drawn up
Question 7 Explanation:
Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
Question 8
What is the primary cause of appendicitis?
A
obstruction of the lumen between the cecum and appendix
B
inflammation due to an immune response
C
constipation
D
overuse of antibiotics
Question 9
Post op care for appendectomy include the following except
A
Early ambulation
B
Diet as tolerated after fully conscious
C
Nasogastric tube connect to suction
D
Deep breathing and leg exercise
Question 9 Explanation:
Client's peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.
Question 10
Worms do not cause appendicitis.
A
True
B
False
Question 10 Explanation:
Worms can block the opening of the appendix resulting in appendicitis. In addition, fecaliths, infection or inflammation can also block the opening of the appendix leading to appendicitis.
Question 11
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A
Appendicitis
B
Pancreatitis
C
Cholecystitis
D
Gastric ulcer
Question 11 Explanation:
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Question 12
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Which of the following complications is thought to be the most common cause of appendicitis?
A
A fecalith
B
Internal bowel occlusion
C
Bowel kinking
D
Abdominal wall swelling
Question 12 Explanation:
A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction.
Question 13
The superior mesenteric artery supplies blood to which part of the GI tract?
A
small intestine (other than duodenum) and proximal colon
B
mid-transverse colon to rectum
C
duodenum
D
cecum
Question 14
The celiac artery supplies blood to which part of the GI tract?
A
duodenum
B
jejunum
C
small intestine and proximal colon
D
mid-transverse colon to rectum
Question 15
The __________ extends from the rectosigmoid junction to the anal canal and is composed of insensitivecolumnar epithelium.
A
Anal Canal
B
Rectum
C
Colon
D
Large bowel
Question 16
What part of the colon propels retrograde waves of contraction to allow the cecum to retain liquid feces and act as a 'fermenting vat'?
A
mid-transverse colon
B
entire transverse colon
C
ascending colon
D
descending colon
Question 17
During defecation, movement of feces into the rectum initiates (click all that apply)
A
rectoanal inhibitory reflex
B
voluntary relaxation of the pelvic floor and external sphincter mechanism
C
voluntary increase in intra-abdominal pressure
D
voluntary contraction of external sphincter
Question 18
Diet does not influence the development of appendicitis.
A
True
B
False
Question 18 Explanation:
Diet lacking in fiber is a risk factor for appendicitis.
Question 19
Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the
A
left lower quadrant
B
left upper quadrant
C
right lower quadrant
D
right upper quadrant
Question 19 Explanation:
To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant.
Question 20
What type of tissue is the appendix made up of?
A
lymphatic
B
connective
C
fibrinous
D
intestinal mucosa
Question 21
Symptoms of appendicitis include ______
A
Abdominal pain
B
Nausea
C
Constipation
D
All of the above
Question 21 Explanation:
Symptoms of appendicitis include abdominal pain, nausea, vomiting, loss of appetite, low grade fever, constipation, diarrhea and an inability to pass gas. A swelling may subsequently appear in the abdomen overlying the appendix.
Question 22
Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
A
the appendix is still distended
B
the appendix may have ruptured
C
an increased in intrathoracic pressure will occur
D
signs and symptoms of peritonitis occur
Question 22 Explanation:
If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.
Question 23
The inferior mesenteric artery supplies blood to which part of the GI tract?
A
mid-transverse colon to rectum
B
colon and anal canal
C
descending colon and rectum
D
colon and rectum
Question 24
A patient presents with periumbilical pain that moves to the RLQ over 24 hrs. the pain is exacerbated by walking, coughing, or a car ride. The patient presents with nausea, vomiting, and a low grade fever of less than 38C or 100.4. What is the suspected diagnosis?
A
Acute appendicitis
B
Ovarian cyst
C
Volvulus
D
Acute pancreatitis
E
Acute cholecystitis
Question 25
The superior rectal artery supplies blood to which part of the GI tract?
A
The rectum
B
The upper and middle rectum
C
lower rectum
D
anal sphincters and rectum
E
anal sphincters only
Question 26
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Which of the following would confirm a diagnosis of appendicitis?
A
The pain is localized at a position halfway between the umbilicus and the right iliac crest.
B
Mr. Liu describes the pain as occurring 2 hours after eating
C
The pain subsides after eating
D
The pain is in the left lower quadrant
Question 26 Explanation:
Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
Question 27
McBurney Point is located ________
A
Around the umbilicus
B
In the right lower abdomen
C
In the left lower abdomen
D
In the upper abdomen
Question 27 Explanation:
Pain in appendicitis normally starts around the umbilicus but later settles in the right lower abdomen near the appendix. This point is called the McBurney Point and is located midway between the umbilicus and the top of the right pelvic bone.
Question 28
What vein carries venous blood from the intestines to the liver?
A
portal vein
B
iliac veins
C
middle colic vein
D
inferior mesenteric vein
Question 29
Typical signs and symptoms of appendicitis include:
A
Nausea
B
Left lower quadrant pain
C
Pain when pressure is applied to the right lower quadrant of the abdomen.
D
High fever
Question 29 Explanation:
Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
Question 30
The _____________ is 3-4 cm long, starts at the dentate line, is supported by the internal and external anal sphincters, and composed of sensitive squamous epithelium.
A
Rectum
B
Anal Canal
C
Colon
D
Anal sphincter canal
Question 31
Other condition/s that could produce pain similar to appendicitis include
A
Inflammation of gall bladder
B
Stone in ureter
C
Inflammation of right colon
D
All of the above
Question 31 Explanation:
Other conditions like gall stones, inflammation of gall bladder, stone in the ureter, ruptured ovarian follicle, a ruptured tubal pregnancy, perforation of stomach or duodenal ulcer, and inflammation of the right colon can produce pain similar to appendicitis.
Question 32
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Stat appendectomy was indicated. Pre op care would include all of the following except?
A
Consent signed by the father
B
Enema STAT
C
Skin prep of the area including the pubis
D
Remove the jewelries
Question 33
The middle rectal artery supplies blood to which part of the rectum?
A
The lower rectum
B
The middle rectum
C
The anal sphincters
D
upper and middle rectum
Question 34
What percentage of people have appendicitis in their lifetime?
A
10%
B
20%
C
30%
D
50%
Question 35
During the rectoanal inhibitory reflex, the internal sphincter ________ allowing the contents into the anal canal, then the external sphincter ____________ and contents are pushed back into the rectum. This occurs up to 7 times daily.
A
relaxes, relaxes
B
contracts, contracts
C
relaxes, contracts
D
contracts, relaxes
Question 36
What stimulates the contraction of propulsive waves that move stool distally from the cecum?
A
distention of the colonic wall
B
distention of the small intestinal wall
C
the fermenting vat located in the cecum
D
distention of the cecum wall
Question 37
Peritonitis may occur in ruptured appendix and may cause serious problems which are
Hypovolemia, electrolyte imbalance
Elevated temperature, weakness and diaphoresis
Nausea and vomiting, rigidity of the abdominal wall
Pallor and eventually shock
A
1 and 2
B
2 and 3
C
1,2,3
D
All of the above
Question 37 Explanation:
Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.
Question 38
If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication?
A
Intussusception
B
Paralytic Ileus
C
Hemorrhage
D
Ruptured colon
Question 38 Explanation:
Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.
Question 39
While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?
A
While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?
B
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a postivie obturator sign
C
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
D
Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
Question 40
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
C
The appendix may develop gangrene and rupture, especially in a middle-aged client.
D
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
Question 40 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 41
What best explains what happens to the appendix when it is obstructed?
A
the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
B
the inflamed tissue dies from lack of blood supply causing the appendix to burst
C
the obstruction causes pressure to build up and eventually causes the appendix to burst
D
the obstruction hardens the appendix eventually causing it to burst
Question 42
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Pre-anesthetic med of Demerol and atrophine sulfate were ordered to :
A
Allay anxiety and apprehension
B
Reduce pain
C
Prevent vomiting
D
Relax abdominal muscle
Question 42 Explanation:
Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client's anxiety pre operatively.
Question 43
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?
A
RBC 5.5 x 106/mm3
B
Hct 44 %
C
WBC 13, 000/mm3
D
Hgb 15 g/dL
Question 43 Explanation:
Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options are normal values.
Question 44
Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The nurse suspects which of the following complications?
A
Intestinal obstruction
B
Peritonitis
C
Bowel ischemia
D
Deficient fluid volume
Question 44 Explanation:
Complications of acute appendicitis are peritonitis, perforation and abscess development.
Question 45
What 3 major branches of the aorta supply blood to the intestines?
A
celiac artery, superior mesenteric artery, inferior mesenteric artery
B
celiac artery, superior mesenteric artery, and right and left gastric artery
C
superior mesenteric artery, inferior mesenteric artery, and internal and external iliac arteries
D
common iliac artery, superior mesenteric artery, inferior mesenteric arteries
Question 46
What is the blind sac that is in the RLQ below the ileocecal valve?
A
cecum
B
appendix
C
transverse colon
D
ascending colon
Question 47
What is the treatment for appendicitis?
A
surgical removal of inflamed appendix before it ruptures
B
pain control and antibiotics
C
pain control
D
antibiotics and observation
Question 48
Perforation is not a complication of appendicitis.
A
True
B
False
Question 48 Explanation:
The inflamed appendix can burst resulting in inflammation of the lining of the abdomen (peritoneum), the condition being called peritonitis.
Question 49
Surgery is the definitive treatment for appendicitis.
A
True
B
False
Question 49 Explanation:
Surgery is the definitive treatment for appendicitis. It may be performed as an open surgery or through a laparoscope. Antibiotics are also useful in treating appendicitis, but usually require to be followed by surgery due to recurrence.
Question 50
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Which result of the lab test will be significant to the diagnosis?
A
RBC : 4.5 TO 5 Million / cu. mm.
B
Hgb : 13 to 14 gm/dl.
C
Platelets : 250,000 to 500,000 cu.mm.
D
WBC : 12,000 to 13,000/cu.mm
Question 50 Explanation:
WBC increases with inflammation and infection.
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MSN Exam for Appendicitis (EM)*
Choose the letter of the correct answer. You got 50 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Appendicitis (EM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication?
A
Intussusception
B
Paralytic Ileus
C
Hemorrhage
D
Ruptured colon
Question 1 Explanation:
Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.
Question 2
The celiac artery supplies blood to which part of the GI tract?
A
duodenum
B
jejunum
C
small intestine and proximal colon
D
mid-transverse colon to rectum
Question 3
What type of tissue is the appendix made up of?
A
lymphatic
B
connective
C
fibrinous
D
intestinal mucosa
Question 4
Worms do not cause appendicitis.
A
True
B
False
Question 4 Explanation:
Worms can block the opening of the appendix resulting in appendicitis. In addition, fecaliths, infection or inflammation can also block the opening of the appendix leading to appendicitis.
Question 5
During defecation, movement of feces into the rectum initiates (click all that apply)
A
rectoanal inhibitory reflex
B
voluntary relaxation of the pelvic floor and external sphincter mechanism
C
voluntary increase in intra-abdominal pressure
D
voluntary contraction of external sphincter
Question 6
Typical signs and symptoms of appendicitis include:
A
Nausea
B
Left lower quadrant pain
C
Pain when pressure is applied to the right lower quadrant of the abdomen.
D
High fever
Question 6 Explanation:
Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
Question 7
Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which
position?
A
Prone
B
Supine, stretched out
C
Sitting
D
Lying with legs drawn up
Question 7 Explanation:
Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
Question 8
Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The nurse suspects which of the following complications?
A
Intestinal obstruction
B
Peritonitis
C
Bowel ischemia
D
Deficient fluid volume
Question 8 Explanation:
Complications of acute appendicitis are peritonitis, perforation and abscess development.
Question 9
What vein carries venous blood from the intestines to the liver?
A
portal vein
B
iliac veins
C
middle colic vein
D
inferior mesenteric vein
Question 10
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?
A
RBC 5.5 x 106/mm3
B
Hct 44 %
C
WBC 13, 000/mm3
D
Hgb 15 g/dL
Question 10 Explanation:
Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options are normal values.
Question 11
Common anesthesia for appendectomy is
A
Spinal
B
General
C
Caudal
D
Hypnosis
Question 11 Explanation:
Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.
Question 12
What is the blind sac that is in the RLQ below the ileocecal valve?
A
cecum
B
appendix
C
transverse colon
D
ascending colon
Question 13
What percentage of people have appendicitis in their lifetime?
A
10%
B
20%
C
30%
D
50%
Question 14
What are some possible causes of an obstructed appendix?
A
inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
B
infection, fecal stasis, calcium salts or undigested fiber-fecaliths, parasites, FB, and neoplasms, diarrhea
suppositories, FB, neoplams, undigested fiber and calcium salts, calcium salts or undigested fiber-fecaliths, infection, fecal stasis, parasites
Question 15
The _____________ is 3-4 cm long, starts at the dentate line, is supported by the internal and external anal sphincters, and composed of sensitive squamous epithelium.
A
Rectum
B
Anal Canal
C
Colon
D
Anal sphincter canal
Question 16
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Stat appendectomy was indicated. Pre op care would include all of the following except?
A
Consent signed by the father
B
Enema STAT
C
Skin prep of the area including the pubis
D
Remove the jewelries
Question 17
McBurney Point is located ________
A
Around the umbilicus
B
In the right lower abdomen
C
In the left lower abdomen
D
In the upper abdomen
Question 17 Explanation:
Pain in appendicitis normally starts around the umbilicus but later settles in the right lower abdomen near the appendix. This point is called the McBurney Point and is located midway between the umbilicus and the top of the right pelvic bone.
Question 18
During the rectoanal inhibitory reflex, the internal sphincter ________ allowing the contents into the anal canal, then the external sphincter ____________ and contents are pushed back into the rectum. This occurs up to 7 times daily.
A
relaxes, relaxes
B
contracts, contracts
C
relaxes, contracts
D
contracts, relaxes
Question 19
Surgery is the definitive treatment for appendicitis.
A
True
B
False
Question 19 Explanation:
Surgery is the definitive treatment for appendicitis. It may be performed as an open surgery or through a laparoscope. Antibiotics are also useful in treating appendicitis, but usually require to be followed by surgery due to recurrence.
Question 20
A patient presents with periumbilical pain that moves to the RLQ over 24 hrs. the pain is exacerbated by walking, coughing, or a car ride. The patient presents with nausea, vomiting, and a low grade fever of less than 38C or 100.4. What is the suspected diagnosis?
A
Acute appendicitis
B
Ovarian cyst
C
Volvulus
D
Acute pancreatitis
E
Acute cholecystitis
Question 21
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Which of the following would confirm a diagnosis of appendicitis?
A
The pain is localized at a position halfway between the umbilicus and the right iliac crest.
B
Mr. Liu describes the pain as occurring 2 hours after eating
C
The pain subsides after eating
D
The pain is in the left lower quadrant
Question 21 Explanation:
Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
Question 22
The appendix is located on the _____ lower side of the abdomen.
A
Right
B
Left
Question 23
The inferior rectal artery supplies blood to which part of the rectum?
A
the internal and external anal sphincters
B
the lower rectum
C
the uppper, middle, and lower rectum
D
the external sphincter only
Question 24
The inferior mesenteric artery supplies blood to which part of the GI tract?
A
mid-transverse colon to rectum
B
colon and anal canal
C
descending colon and rectum
D
colon and rectum
Question 25
While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?
A
While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?
B
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a postivie obturator sign
C
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
D
Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
Question 26
What part of the colon propels retrograde waves of contraction to allow the cecum to retain liquid feces and act as a 'fermenting vat'?
A
mid-transverse colon
B
entire transverse colon
C
ascending colon
D
descending colon
Question 27
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Pre-anesthetic med of Demerol and atrophine sulfate were ordered to :
A
Allay anxiety and apprehension
B
Reduce pain
C
Prevent vomiting
D
Relax abdominal muscle
Question 27 Explanation:
Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client's anxiety pre operatively.
Question 28
The middle rectal artery supplies blood to which part of the rectum?
A
The lower rectum
B
The middle rectum
C
The anal sphincters
D
upper and middle rectum
Question 29
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
C
The appendix may develop gangrene and rupture, especially in a middle-aged client.
D
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
Question 29 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 30
The superior rectal artery supplies blood to which part of the GI tract?
A
The rectum
B
The upper and middle rectum
C
lower rectum
D
anal sphincters and rectum
E
anal sphincters only
Question 31
The __________ extends from the rectosigmoid junction to the anal canal and is composed of insensitivecolumnar epithelium.
A
Anal Canal
B
Rectum
C
Colon
D
Large bowel
Question 32
The superior mesenteric artery supplies blood to which part of the GI tract?
A
small intestine (other than duodenum) and proximal colon
B
mid-transverse colon to rectum
C
duodenum
D
cecum
Question 33
What are diagnostic features of acute appendicitis? click all that apply
A
Low grade fever less than 100.4F/38C
B
Moderate leukocytosis (10,000-20,000)
C
Ultrasound
D
CT (with contrast depending on body habitus)
E
CT (helpful if perforation is suspected to diagnose periappendiceal abscess)
Question 34
What stimulates the contraction of propulsive waves that move stool distally from the cecum?
A
distention of the colonic wall
B
distention of the small intestinal wall
C
the fermenting vat located in the cecum
D
distention of the cecum wall
Question 35
Peritonitis may occur in ruptured appendix and may cause serious problems which are
Hypovolemia, electrolyte imbalance
Elevated temperature, weakness and diaphoresis
Nausea and vomiting, rigidity of the abdominal wall
Pallor and eventually shock
A
1 and 2
B
2 and 3
C
1,2,3
D
All of the above
Question 35 Explanation:
Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.
Question 36
Other condition/s that could produce pain similar to appendicitis include
A
Inflammation of gall bladder
B
Stone in ureter
C
Inflammation of right colon
D
All of the above
Question 36 Explanation:
Other conditions like gall stones, inflammation of gall bladder, stone in the ureter, ruptured ovarian follicle, a ruptured tubal pregnancy, perforation of stomach or duodenal ulcer, and inflammation of the right colon can produce pain similar to appendicitis.
Question 37
What best explains what happens to the appendix when it is obstructed?
A
the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
B
the inflamed tissue dies from lack of blood supply causing the appendix to burst
C
the obstruction causes pressure to build up and eventually causes the appendix to burst
D
the obstruction hardens the appendix eventually causing it to burst
Question 38
Post op care for appendectomy include the following except
A
Early ambulation
B
Diet as tolerated after fully conscious
C
Nasogastric tube connect to suction
D
Deep breathing and leg exercise
Question 38 Explanation:
Client's peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.
Question 39
Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the
A
left lower quadrant
B
left upper quadrant
C
right lower quadrant
D
right upper quadrant
Question 39 Explanation:
To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant.
Question 40
Perforation is not a complication of appendicitis.
A
True
B
False
Question 40 Explanation:
The inflamed appendix can burst resulting in inflammation of the lining of the abdomen (peritoneum), the condition being called peritonitis.
Question 41
Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
Which of the following complications is thought to be the most common cause of appendicitis?
A
A fecalith
B
Internal bowel occlusion
C
Bowel kinking
D
Abdominal wall swelling
Question 41 Explanation:
A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction.
Question 42
When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
A
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
B
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
C
The appendix may develop gangrene and rupture, especially in a middle-aged client.
D
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
Question 42 Explanation:
A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
Question 43
Symptoms of appendicitis include ______
A
Abdominal pain
B
Nausea
C
Constipation
D
All of the above
Question 43 Explanation:
Symptoms of appendicitis include abdominal pain, nausea, vomiting, loss of appetite, low grade fever, constipation, diarrhea and an inability to pass gas. A swelling may subsequently appear in the abdomen overlying the appendix.
Question 44
Diet does not influence the development of appendicitis.
A
True
B
False
Question 44 Explanation:
Diet lacking in fiber is a risk factor for appendicitis.
Question 45
What 3 major branches of the aorta supply blood to the intestines?
A
celiac artery, superior mesenteric artery, inferior mesenteric artery
B
celiac artery, superior mesenteric artery, and right and left gastric artery
C
superior mesenteric artery, inferior mesenteric artery, and internal and external iliac arteries
D
common iliac artery, superior mesenteric artery, inferior mesenteric arteries
Question 46
Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
A
Appendicitis
B
Pancreatitis
C
Cholecystitis
D
Gastric ulcer
Question 46 Explanation:
Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
Question 47
Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis.
Which result of the lab test will be significant to the diagnosis?
A
RBC : 4.5 TO 5 Million / cu. mm.
B
Hgb : 13 to 14 gm/dl.
C
Platelets : 250,000 to 500,000 cu.mm.
D
WBC : 12,000 to 13,000/cu.mm
Question 47 Explanation:
WBC increases with inflammation and infection.
Question 48
What is the primary cause of appendicitis?
A
obstruction of the lumen between the cecum and appendix
B
inflammation due to an immune response
C
constipation
D
overuse of antibiotics
Question 49
What is the treatment for appendicitis?
A
surgical removal of inflamed appendix before it ruptures
B
pain control and antibiotics
C
pain control
D
antibiotics and observation
Question 50
Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.
After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
A
the appendix is still distended
B
the appendix may have ruptured
C
an increased in intrathoracic pressure will occur
D
signs and symptoms of peritonitis occur
Question 50 Explanation:
If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.
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1) What are diagnostic features of acute appendicitis? click all that apply
Low grade fever less than 100.4F/38C
Moderate leukocytosis (10,000-20,000)
Ultrasound
CT (with contrast depending on body habitus)
CT (helpful if perforation is suspected to diagnose periappendiceal abscess)
2) What best explains what happens to the appendix when it is obstructed?
the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
the inflamed tissue dies from lack of blood supply causing the appendix to burst
the obstruction causes pressure to build up and eventually causes the appendix to burst
the obstruction hardens the appendix eventually causing it to burst
3) Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the
left lower quadrant
left upper quadrant
right lower quadrant
right upper quadrant
4) The celiac artery supplies blood to which part of the GI tract?
duodenum
jejunum
small intestine and proximal colon
mid-transverse colon to rectum
cecum
5) During defecation, movement of feces into the rectum initiates (click all that apply)
rectoanal inhibitory reflex
voluntary relaxation of the pelvic floor and external sphincter mechanism
voluntary increase in intra-abdominal pressure
voluntary contraction of external sphincter
6) What is the primary cause of appendicitis?
obstruction of the lumen between the cecum and appendix
inflammation due to an immune response
constipation
overuse of antibiotics
7) Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The nurse suspects which of the following complications?
Intestinal obstruction
Peritonitis
Bowel ischemia
Deficient fluid volume
8) What are some possible causes of an obstructed appendix?
inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
infection, fecal stasis, calcium salts or undigested fiber-fecaliths, parasites, FB, and neoplasms, diarrhea
suppositories, FB, neoplams, undigested fiber and calcium salts, calcium salts or undigested fiber-fecaliths, infection, fecal stasis, parasites
9) What is the blind sac that is in the RLQ below the ileocecal valve?
cecum
appendix
transverse colon
ascending colon
10) The middle rectal artery supplies blood to which part of the rectum?
The lower rectum
The middle rectum
The anal sphincters
upper and middle rectum
11) Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which position?
Prone
Supine, stretched out
Sitting
Lying with legs drawn up
12) A patient presents with periumbilical pain that moves to the RLQ over 24 hrs. the pain is exacerbated by walking, coughing, or a car ride. The patient presents with nausea, vomiting, and a low grade fever of less than 38C or 100.4. What is the suspected diagnosis?
Acute appendicitis
Ovarian cyst
Volvulus
Acute pancreatitis
Acute cholecystitis
13) What type of tissue is the appendix made up of?
lymphatic
connective
fibrinous
intestinal mucosa
14) The inferior mesenteric artery supplies blood to which part of the GI tract?
mid-transverse colon to rectum
colon and anal canal
descending colon and rectum
colon and rectum
colon, cecum, and rectum
15) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. Which of the following would confirm a diagnosis of appendicitis?
The pain is localized at a position halfway between the umbilicus and the right iliac crest.
Mr. Liu describes the pain as occurring 2 hours after eating
The pain subsides after eating
The pain is in the left lower quadrant
16) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Stat appendectomy was indicated. Pre op care would include all of the following except?
Consent signed by the father
Enema STAT
Skin prep of the area including the pubis
Remove the jewelries
17) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to :
Allay anxiety and apprehension
Reduce pain
Prevent vomiting
Relax abdominal muscle
18) Which condition is most likely to have a nursing diagnosis of fluid volume deficit?
Appendicitis
Pancreatitis
Cholecystitis
Gastric ulcer
19) Post op care for appendectomy include the following except
Early ambulation
Diet as tolerated after fully conscious
Nasogastric tube connect to suction
Deep breathing and leg exercise
20) Other condition/s that could produce pain similar to appendicitis include
Inflammation of gall bladder
Stone in ureter
Inflammation of right colon
All of the above
21) When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The appendix may develop gangrene and rupture, especially in a middle-aged client.
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
22) The superior rectal artery supplies blood to which part of the GI tract?
The rectum
The upper and middle rectum
lower rectum
anal sphincters and rectum
anal sphincters only
23) Typical signs and symptoms of appendicitis include:
Nausea
Left lower quadrant pain
Pain when pressure is applied to the right lower quadrant of the abdomen.
High fever
24) What stimulates the contraction of propulsive waves that move stool distally from the cecum?
distention of the colonic wall
distention of the small intestinal wall
the fermenting vat located in the cecum
distention of the cecum wall
25) The superior mesenteric artery supplies blood to which part of the GI tract?
small intestine (other than duodenum) and proximal colon
mid-transverse colon to rectum
duodenum
cecum
rectum only
26) Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:
the appendix is still distended
the appendix may have ruptured
an increased in intrathoracic pressure will occur
signs and symptoms of peritonitis occur
27) During the rectoanal inhibitory reflex, the internal sphincter ________ allowing the contents into the anal canal, then the external sphincter ____________ and contents are pushed back into the rectum. This occurs up to 7 times daily.
relaxes, relaxes
contracts, contracts
relaxes, contracts
contracts, relaxes
28) While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?
Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a positive obturator sign
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a postivie obturator sign
Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
29) The __________ extends from the rectosigmoid junction to the anal canal and is composed of insensitive columnar epithelium.
Anal Canal
Rectum
Colon
Large bowel
30) Surgery is the definitive treatment for appendicitis.
True
False
31) If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication? [1]
Intussusception
Paralytic Ileus
Hemorrhage
Ruptured colon
32) The _____________ is 3-4 cm long, starts at the dentate line, is supported by the internal and external anal sphincters, and composed of sensitive squamous epithelium.
Rectum
Anal Canal
Colon
Anal sphincter canal
33) The inferior rectal artery supplies blood to which part of the rectum?
the internal and external anal sphincters
the lower rectum
the upper, middle, and lower rectum
the external sphincter only
the internal sphincter only
34) What percentage of people have appendicitis in their lifetime?
10%
20%
30%
50%
35) The appendix is located on the _____ lower side of the abdomen.
Right
Left
36) Peritonitis may occur in ruptured appendix and may cause serious problems which are
Hypovolemia, electrolyte imbalance
Elevated temperature, weakness and diaphoresis
Nausea and vomiting, rigidity of the abdominal wall
Pallor and eventually shock
1 and 2
2 and 3
1,2,3
All of the above
37) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. Which of the following complications is thought to be the most common cause of appendicitis?
A fecalith
Internal bowel occlusion
Bowel kinking
Abdominal wall swelling
38) What part of the colon propels retrograde waves of contraction to allow the cecum to retain liquid feces and act as a ‘fermenting vat’?
mid-transverse colon
entire transverse colon
ascending colon
descending colon
ileum
39) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Which result of the lab test will be significant to the diagnosis?
RBC : 4.5 TO 5 Million / cu. mm.
Hgb : 13 to 14 gm/dl.
Platelets : 250,000 to 500,000 cu.mm.
WBC : 12,000 to 13,000/cu.mm
40) Worms do not cause appendicitis.
True
False
41) When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?
Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
The appendix may develop gangrene and rupture, especially in a middle-aged client.
Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.
42) What 3 major branches of the aorta supply blood to the intestines?
celiac artery, superior mesenteric artery, inferior mesenteric artery
celiac artery, superior mesenteric artery, and right and left gastric artery
superior mesenteric artery, inferior mesenteric artery, and internal and external iliac arteries
common iliac artery, superior mesenteric artery, inferior mesenteric arteries
43) What is the treatment for appendicitis?
surgical removal of inflamed appendix before it ruptures
pain control and antibiotics
pain control
antibiotics and observation
44) What vein carries venous blood from the intestines to the liver?
portal vein
iliac veins
middle colic vein
inferior mesenteric vein
superior mesenteric vein
45) McBurney Point is located ________
Around the umbilicus
In the right lower abdomen
In the left lower abdomen
In the upper abdomen
46) Perforation is not a complication of appendicitis.
True
False
47) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?
RBC 5.5 x 106/mm3
Hct 44 %
WBC 13, 000/mm3
Hgb 15 g/dL
48) Diet does not influence the development of appendicitis.
True
False
49) Symptoms of appendicitis include ______
Abdominal pain
Nausea
Constipation
All of the above
50) Common anesthesia for appendectomy is
Spinal
General
Caudal
Hypnosis
Answers and Rationales
A. Low grade fever less than 100.4F/38C , B. Moderate leukocytosis (10,000-20,000) , C. Ultrasound , D. CT (with contrast depending on body habitus) , E. CT (helpful if perforation is suspected to diagnose periappendiceal abscess)
A. the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
C. right lower quadrant . To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant.
A. duodenum
B. voluntary relaxation of the pelvic floor and external sphincter mechanism, C. voluntary increase in intra-abdominal pressure
A. obstruction of the lumen between the cecum and appendix
B. Peritonitis . Complications of acute appendicitis are peritonitis, perforation and abscess development.
A. inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
A. cecum
A. The lower rectum
D. Lying with legs drawn up . Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
A. Acute appendicitis
A. lymphatic
A. mid-transverse colon to rectum
A. The pain is localized at a position halfway between the umbilicus and the right iliac crest. Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
B. Enema STAT
A. Allay anxiety and apprehension . Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client’s anxiety pre operatively.
B. Pancreatitis . Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
B. Diet as tolerated after fully conscious. Client’s peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.
D. All of the above . Other conditions like gall stones, inflammation of gall bladder, stone in the ureter, ruptured ovarian follicle, a ruptured tubal pregnancy, perforation of stomach or duodenal ulcer, and inflammation of the right colon can produce pain similar to appendicitis.
B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
B. The upper and middle rectum
A. Nausea . Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
A. distention of the colonic wall
A. small intestine (other than duodenum) and proximal colon
B. the appendix may have ruptured . If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.
C. relaxes, contracts
A. Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a positive obturator sign
B. Rectum
A. True. Surgery is the definitive treatment for appendicitis. It may be performed as an open surgery or through a laparoscope. Antibiotics are also useful in treating appendicitis, but usually require to be followed by surgery due to recurrence.
B. Paralytic Ileus . Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.
B. Anal Canal
A. the internal and external anal sphincters
A. 10%
A. Right
D. All of the above . Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.
A. A fecalith . A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction.
A. mid-transverse colon
D. WBC : 12,000 to 13,000/cu.mm . WBC increases with inflammation and infection.
B. False . Worms can block the opening of the appendix resulting in appendicitis. In addition, fecaliths, infection or inflammation can also block the opening of the appendix leading to appendicitis.
B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
A. celiac artery, superior mesenteric artery, inferior mesenteric artery
A. surgical removal of inflamed appendix before it ruptures
A. portal vein
B. In the right lower abdomen. Pain in appendicitis normally starts around the umbilicus but later settles in the right lower abdomen near the appendix. This point is called the McBurney Point and is located midway between the umbilicus and the top of the right pelvic bone.
B. False. The inflamed appendix can burst resulting in inflammation of the lining of the abdomen (peritoneum), the condition being called peritonitis.
C. WBC 13, 000/mm3 . Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options are normal values.
B. False . Diet lacking in fiber is a risk factor for appendicitis.
D. All of the above . Symptoms of appendicitis include abdominal pain, nausea, vomiting, loss of appetite, low grade fever, constipation, diarrhea and an inability to pass gas. A swelling may subsequently appear in the abdomen overlying the appendix.
A. Spinal . Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.