ATI LPN
Questions for Review of Systems Gastrointestinal Questions
Question 1 of 5
A 56-year-old woman presents complaining of chest discomfort. She had seen a cardiologist who performed a stress test and reported that the problem was not cardiac in nature. She notes that the pain is worse at times of stress. There is no relationship with eating but sometimes it can occur while lying flat. A barium swallow reveals uncoordinated contractions along the esophageal wall consistent with 'corkscrew esophagus.' All of the following are appropriate therapies to try for this condition except:
Correct Answer: B
Rationale: This patient has chest pain due to diffuse esophageal spasm. Given that there is often underlying gastroesophageal reflux, it is appropriate to try proton-pump inhibitors. Other therapies are geared to relaxing the smooth muscle. Nitrates, calcium channel-blockers, and benzodiazepines may be helpful in individual patients. Additionally, antidepressants (e.g., SSRIs, tricyclics) and antipsychotic medications have been used. Pseudoephedrine has not been found to be helpful for this condition. It can cause some degree of smooth-muscle contraction, so theoretically it should not be used.
Question 2 of 5
A 75-year-old man presents two days after having sudden onset of abdominal pain in his left lower quadrant, which lasted for one day and was associated with the passage of several episodes of bloody stool. His pain has now resolved. He had a similar episode one month previously. His past medical history is notable for hypertension, diabetes mellitus, atrial fibrillation, and previous coronary artery bypass surgery. His medications include a $\beta$-blocker, metformin, and digoxin. His last screening colonoscopy four years ago was unremarkable. His abdominal exam is notable for mild tenderness in his left lower quadrant but is otherwise unremarkable. His cardiovascular exam is notable for an irregular heart rhythm with a normal ventricular rate. His labs reveal mild anemia, mildly elevated glucose levels, a normal white count and lactate levels and his abdominal x-ray is unremarkable. Which of the following statements are incorrect?
Correct Answer: B
Rationale: Colonic ischemia is the most likely diagnosis. Although diverticulitis and inflammatory bowel disease are possible, the short history is against IBD and to a lesser extent diverticulitis because the symptoms resolved without antibiotics. Colonic ischemia can present with mild transient symptoms that resolve without evidence on colonoscopy or persist with segmental hemorrhagic colitis, bleeding into the submucosa, gangrene, and eventually structuring. In addition to the causes listed in Answer C, other well-recognized causes of colonic ischemia include emboli, hypotension, vasculitis, hypercoagulable states, vascular surgery, and other drugs such as cocaine.
Question 3 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 4 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 5 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.