ATI LPN
Upper Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
A 46-year-old man presents complaining of heartburn, hoarseness, and a 'sour taste' in his mouth upon awakening. He has a history of reflux disease and has been taking proton-pump inhibitors for the last three years. He recently started taking the medication twice per day. His symptoms have improved somewhat but are still present. He is referred for EGD, which reveals high-grade dysplasia in distal esophagus but no evidence of carcinoma. How should this patient best be managed?
Correct Answer: A
Rationale: This patient presents with severe symptomatic reflux, refractory to twice per day proton-pump inhibitor therapy. His EGD reveals evidence of Barrett's esophagus with high-grade dysplasia. Since the potential for malignant transformation is high with such pathologic findings, esophagectomy is recommended. Management of Barrett's esophagus of lesser severity requires routine surveillance, although the ideal frequency of repeat endoscopy is yet unknown. Depending on the severity of dysplasia, endoscopies may be repeated every six months to two years.
Question 2 of 5
A 46-year-old man had profuse diarrhea for two months. He notes that the diarrhea continues throughout the day. Fasting does not decrease the diarrheal episodes. He has tried using loperamide, but the relief is temporary. He notes a 10-pound weight loss over the last two months. He notes that he is not taking any medications except for the loperamide. Upon questioning, he recently quit smoking and has been chewing a lot of sugarless gum. You measure his stool electrolytes. The results are as follows: Na+ 40 mmol/L, K+ 90 mmol/L, Cl- 15 mmol/L, HCO3- 18 mmol/L. What is the most likely diagnosis?
Correct Answer: C
Rationale: This patient has chronic diarrhea that does not improve with fasting. This is a key feature in distinguishing between osmotic and secretory diarrhea. Additionally, his stool electrolytes do not reveal an osmolar gap (as seen with osmotic diarrhea). His osmolar gap is $290-[(40+90) \times 2]=30$, which is normal. An osmolar gap of greater than 50 is suggestive of osmotic diarrhea. Lactase deficiency, sucrase deficiency, and sorbitol ingestion would all cause an osmotic diarrhea. A VIPoma is the only one of the choices that causes a secretory diarrhea.
Question 3 of 5
Patients with autoimmune hepatitis disease may have the following presentations except
Correct Answer: C
Rationale: Autoimmune hepatitis may present with a fulminant or subfulminant course with new onset of hepatic encephalopathy and transaminases greater than 2000. It tends to relapse without maintenance treatment, and responds well to oral prednisone in a vast majority of cases. However, autoimmune hepatitis does not tend to present with a cholestatic picture as described in C, unless associated with overlap syndromes with PBC or cholangiopathy.
Question 4 of 5
All of the following are absolute contraindications to immediate liver transplantation except
Correct Answer: B
Rationale: Patients with acute infection outside the liver, severe cardiac or pulmonary disease, or metastatic cancer are not eligible for liver transplantation. Patients with HIV, however, are candidates for transplant if they do not have advanced disease (CD4 <200, viral load >400 copies/mL).
Question 5 of 5
Which medication is often used in the treatment regimen for PUD to eradicate H. pylori?
Correct Answer: A
Rationale: Antibiotics (e.g., amoxicillin, clarithromycin) are essential to eradicate H. pylori, a primary cause of PUD, as part of combination therapy.