ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?
Correct Answer: D
Rationale: The correct answer is D: Measure gastric acid secretion. In a suspected case of gastrinoma, elevated serum gastrin levels can lead to increased gastric acid secretion. Measuring gastric acid secretion can help confirm the diagnosis of gastrinoma by assessing for increased acid production. This can be done with tests like the gastric acid stimulation test or the secretin stimulation test. Option A is incorrect as an exploratory laparotomy is an invasive procedure and should not be the first step in the diagnostic process. Option B, measuring serum gastrin in response to secretin infusion, may be helpful in confirming the diagnosis but measuring gastric acid secretion is more directly related to the pathophysiology of gastrinoma. Option C, treating for H. pylori, is not indicated in this case as the patient's symptoms are more suggestive of gastrinoma rather than H. pylori infection.
Question 2 of 5
An 82-year-old female nursing home resident was admitted with left-sided aspiration pneumonia. She improved quickly on intravenous antibiotics. During her admission, a chest x-ray incidentally revealed a large calcification in the right upper quadrant of the abdomen. Subsequent abdominal ultrasound confirmed the presence of a single large stone in the gallbladder (3 cm in diameter). She denies any abdominal discomfort or pain. What would be the best course of treatment for her gallstone disease?
Correct Answer: C
Rationale: Step-by-step rationale for choosing answer C: 1. The patient is asymptomatic with no abdominal pain or discomfort. 2. Asymptomatic gallstones do not require immediate treatment. 3. The incidental finding of a gallstone in an asymptomatic patient does not warrant surgical intervention. 4. Watchful waiting is recommended for asymptomatic gallstones to avoid unnecessary procedures. 5. Reassurance is essential to prevent unnecessary anxiety or interventions. Summary: Choice C, reassuring the patient that she does not need any additional therapy for the gallstone at this time, is the best course of action because the patient is asymptomatic, and asymptomatic gallstones do not require immediate treatment. Choices A, B, and D involve unnecessary interventions for an asymptomatic gallstone.
Question 3 of 5
A 47-year-old web designer has a 14-year history of ulcerative colitis. He recently moved to your area and presents to your office for continued management of his ulcerative colitis. He has been asymptomatic for the past two years and off all medications for one year with no rectal bleeding, diarrhea, abdominal pain, tenesmus, or fever. Before that he had very active colitis requiring steroids and immunosuppressants. He brings records from his previous physician that include his last three colonoscopy and pathology reports. The reports from 6 and 12 years ago documented active colitis with friable mucosa from the mid-transverse colon to the rectum, superficial ulcerations, crypt abscesses and crypt distortion, and acute and chronic inflammation. The most recent report, from almost three years ago, was fairly unremarkable endoscopically. Numerous random biopsies had been obtained. They showed mucosal changes on histology also consistent with a history of ulcerative colitis, but there was no evidence of active disease. What do you recommend?
Correct Answer: D
Rationale: The correct answer is D: Do not start steroids; if stools are heme-occult positive, then refer for colonoscopy. In this scenario, the patient is asymptomatic for the past two years and off all medications for one year with no signs of active disease. Initiation of steroids is not indicated as the patient is currently in remission. However, given the history of ulcerative colitis and the risk of disease flare-ups, it is important to monitor for any signs of disease recurrence. Checking for heme-occult positive stools can be an early indicator of active disease. Referring for colonoscopy if stools are heme-occult positive allows for a more thorough evaluation of disease activity without unnecessary initiation of steroids. This approach balances the need for monitoring with avoiding unnecessary treatment. Other choices are incorrect as they either recommend starting steroids in a patient in remission (A, C) or do not incorporate monitoring for disease activity (B).
Question 4 of 5
A 50-year-old woman presents with nocturnal pruritus, an elevated alkaline phosphatase of 284 U/L, and normal bilirubin and aminotransferases. She is on no medications and has a normal physical examination. Ultrasound of the liver reveals no ductal abnormalities and no gallstones. What should be the next step?
Correct Answer: D
Rationale: The correct answer is D: Check antimitochondrial antibodies. Rationale: 1. The patient's presentation of elevated alkaline phosphatase without bilirubin or aminotransferase elevation suggests a cholestatic pattern of liver injury. 2. Cholestatic pattern with elevated alkaline phosphatase in the setting of a normal physical exam and ultrasound with no ductal abnormalities points towards primary biliary cholangitis (PBC). 3. Antimitochondrial antibodies are highly specific for PBC and should be checked to confirm the diagnosis. 4. Requesting an ERCP is invasive and not indicated at this point. CT scan may not provide relevant information for this specific presentation. Checking viral serologies is not indicated based on the clinical presentation. Summary: A: Requesting an ERCP is not the next step. B: Obtaining a CT scan may not provide relevant information. C: Checking viral serologies is not indicated at this point.
Question 5 of 5
A 16-year-old woman with no significant medical history presents with quickly progressing encephalopathy and jaundice. A friend feels she may have taken a bottle of acetaminophen tablets one day prior to admission. Her bilirubin is 2.4 mg/dL, alkaline phosphatase 240 U/L, AST 2400 U/L, ALT 3200 U/L, creatinine 2.7, arterial pH 7.2, INR 6.6, and acetaminophen level 60. Which of the following is false?
Correct Answer: C
Rationale: The correct answer is C because the patient should be transferred to a transplant center immediately due to the severity of her condition, not only if she does not awaken with lactulose therapy. The patient's rapidly progressing encephalopathy, significant liver enzyme elevations, high INR, and metabolic acidosis indicate severe hepatotoxicity from acetaminophen overdose. Prompt evaluation by a transplant center is essential for potential liver transplant candidacy. Choices A, B, and D are incorrect because: A - She may indeed need a liver transplant due to the severity of her liver injury. B - Intubation and hyperventilation may be necessary for respiratory support in severe cases of acetaminophen overdose. D - N-acetylcysteine is the standard treatment for acetaminophen overdose to prevent liver damage.