ATI LPN
Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
A 26-year-old woman has been using a PPI every morning to control moderate GERD symptoms. She reports awakening at night with a nonproductive cough several times per week. Correct statements include all except
Correct Answer: B
Rationale: Patients with nocturnal GERD symptoms most likely have nonerosive esophagitis, thus deep ulcerations are not likely to be found.
Question 2 of 5
A 66-year-old woman, a recently retired social worker who cares for her disabled husband, has been experiencing left lower quadrant discomfort. For the past few months, she has been having bowel movements every other day, which is a change from her usual once or twice per day. She has a long history of noninsulin-dependent diabetes mellitus, arthritis, hypothyroidism, and hypertension. Medications are glyburide $5 \mathrm{mg}$, levothyroxine $0.1 \mathrm{mg}$, and diltiazem (extended release) $240 \mathrm{mg}$ four times a day (previously managed on propranolol but changed on her last visit to diltiazem because of depressed mood), and ibuprofen as needed. She is very worried about colon cancer although she had a normal colonoscopy last year. What is the best plan for her?
Correct Answer: D
Rationale: New onset of constipation will most often have a nonfunctional cause. In this case, the most likely cause is the change of antihypertensives to a calcium channel-blocker. These medications are more often associated with constipation than are $\alpha$-blockers. New-onset constipation can sometimes be a symptom of colon cancer (Answer A), but this would be less likely in a patient that had a recent negative colonoscopy. One could consider a repeat colonoscopy should the constipation be persistent after addressing more likely causes. Constipation may also be secondary to hypothyroidism (Answer B), and one should be suspicious of hypothyroidism (especially in females and elderly patients). However, the calcium channel-blocker is a more likely cause than is noncompliance with a reasonable dose of thyroid medication in this social worker that cares for her disabled husband. Similarly, stress may play a role in her constipation, but the correlation between medications and the constipation should be addressed first and is more likely to be helpful.
Question 3 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 4 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 5 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.