ATI LPN
Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
A 25-year-old man with a history of AIDS presents to the emergency room with severe abdominal pain and episodic nausea and vomiting. He describes the pain as constant; it is located in the epigastric area and radiates to the back. The pain started 12 hours ago and is becoming more intense. His current medications include dideoxyinosine (ddI), ganciclovir, and pentamidine. Physical examination reveals a low-grade fever and tenderness in the epigastric area without guarding or rebound. Blood tests demonstrate white blood cells of 6900/ L, amylase of 362 U/L, lipase of 428 U/L, and total bilirubin of 1.1 mg/dL. What is/are the possible cause(s) of this patient's problem?
Correct Answer: D
Rationale: This patient has acute pancreatitis as evidenced by his symptoms and elevated amylase and lipase. Cytomegalovirus is the most commonly reported viral infection that can involve the pancreas. HIV and many AIDS-related infections can affect the pancreas (e.g., cryptococcus, Mycobacterium tuberculosis, candida, and Toxoplasma gondii). Numerous medications may also cause acute pancreatitis (e.g., ddI, pentamidine, trimethoprim/sulfamethoxazole, and metronidazole).
Question 2 of 5
A 48-year-old woman presents with an elevated ALT found on an insurance screening examination. Her hepatitis C antibody test is positive. She denies any risk factors for hepatitis C. What should you do?
Correct Answer: D
Rationale: This woman has a positive antibody test in the setting of an elevated ALT. She denies any risk factors for hepatitis C, so it is imperative to rule out a false positive test. Hepatitis C RNA is a highly specific test to confirm the diagnosis. Because ALT levels do not predict severity of disease, there is no need to follow enzyme levels. All hepatitis C patients should be referred for consideration of therapy with interferon and ribavirin, not prednisone.
Question 3 of 5
A 50-year-old woman presents complaining of pruritus. She reports that for the last eight months she has been itching, particularly around her trunk. Her medical history is notable only for hypertension and obesity. Her current medications include hydrochlorothiazide, estrogen, and progesterone. Her labs are notable for an alkaline phosphatase of 487 U/L, an alanine aminotransferase (ALT) of 46 U/L, and an aspartate aminotransferase of 52 U/L. Her total bilirubin is 2.5 mg/dL with a direct bilirubin of 1.6 mg/dL. Which of the following statements is correct?
Correct Answer: A
Rationale: This woman presents with an elevated alkaline phosphatase, mildly elevated transaminases, and an elevated bilirubin level. The alkaline phosphatase elevation is out of proportion to the other tests, suggesting a biliary process. Primary biliary cirrhosis (PBC) would present as such. Antimitochondrial antibodies are seen in most cases of PBC. Ceruloplasmin is usually low in Wilson's disease which can present with elevation of the transaminases and neuropsychiatric disturbances in young patients. Likewise estrogen administration, fatty liver, and autoimmune hepatitis should present with primary elevations of the transaminases rather than the alkaline phosphatase.
Question 4 of 5
A patient with PUD is prescribed proton pump inhibitors (PPIs). What is the primary action of PPIs in treating PUD?
Correct Answer: B
Rationale: PPIs reduce gastric acid production by inhibiting the proton pump in parietal cells, promoting ulcer healing by decreasing acid-related damage.
Question 5 of 5
Which of the following is a typical sign of a bleeding peptic ulcer?
Correct Answer: C
Rationale: Black, tarry stools (melena) result from digested blood due to upper GI bleeding, a common sign of a bleeding peptic ulcer.