ATI LPN
Questions for Review of Systems Gastrointestinal Questions
Question 1 of 5
A 40-year-old woman presents complaining of a one-day history of intense epigastric abdominal, nausea, and vomiting. She reports that she has never had symptoms like this before. She has no significant past medical history. She denies cigarette use. She drinks about two drinks per week socially. She denies drug use. She takes no medications. Her physical examination is remarkable for a temperature of $100.2^{\circ} \mathrm{F}$, pulse of $100 / \mathrm{min}$, respiratory rate $20 / \mathrm{min}$, blood pressure 115/75. There is epigastric tenderness that extends to the right upper quadrant. There is no rebound tenderness although there is some voluntary guarding. Bowel sounds are present. Her laboratory values reveal the following: WBC 8.6/mm3, HCT 36%, Platelets 140/mm3, AST 33 U/L, ALT 22 U/L, Alkaline phosphatase 86 U/L, Amylase 300 U/L, Lipase 250 U/L, Creatinine 1.1 mg/dL, EKG Normal sinus rhythm, no evidence of ischemia, Upright chest x-ray No infiltrates, effusions, or evidence of free air under the diaphragms. What is the most appropriate next test to order?
Correct Answer: C
Rationale: This woman presents with signs and symptoms consistent with acute pancreatitis. After initial management, the goal should be to determine the underlying etiology of the attack. Gallstones and alcohol are the leading causes in the United States. Since this woman does not have a significant alcohol intake history, gallstones should be suspected. An ultrasound is the best test to detect gallstones. An abdominal x-ray is unnecessary since it would add little information and most gallstones would not be seen on plain x-ray. A CT scan is a good test for imaging the pancreas but ultrasound is better for detecting gallstones. In the absence of evidence of infection or severe pancreatitis, routine CT scanning is unnecessary. ERCP and HIDA scans do not visualize the gallbladder well.
Question 2 of 5
The diagnosis of hemochromatosis involves all of the following except
Correct Answer: D
Rationale: Slit lamp examination is performed when there is clinical suspicion of Wilson's disease. All the other markers are used in the diagnosis. Transferrin saturation is the ideal screening test, since serum ferritin is an acute phase reactant and therefore may be elevated nonspecifically. However, the gold standard for diagnosis is liver biopsy with iron quantitation. Genetic mutations (i.e., C282Y and H63D) may be seen in approximately $85 \%$ of patients with hemochromatosis and therefore is not a good test to screen for hemochromatosis.
Question 3 of 5
The following statements about liver transplantation are true except
Correct Answer: D
Rationale: The allocation of cadaveric liver organs is based on severity of liver disease (model for end stage liver disease [MELD] score), rather than solely relying on waiting times. Primary care physicians are often involved in the long-term management of liver transplant patients, especially preventative care.
Question 4 of 5
A patient with a history of PUD is experiencing severe, sharp, and sudden abdominal pain. What is the nurse's immediate action?
Correct Answer: B
Rationale: Sudden, severe pain may indicate a perforation, a medical emergency requiring immediate physician intervention to prevent complications like peritonitis.
Question 5 of 5
When monitoring a patient with PUD, what is a key indicator of gastrointestinal perforation?
Correct Answer: B
Rationale: Sudden, sharp abdominal pain is a key sign of perforation, indicating a breach in the stomach or duodenal wall requiring urgent attention.