ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
A 65-year-old man frequently regurgitates food several hours after eating, and experiences chest pain and dysphagia to both liquids and solids. He has lost 20 pounds. A CXR shows an air/fluid level in a dilated esophagus and an absent gastric air bubble. No mass in the distal esophagus or proximal stomach is identified at upper endoscopy. The best therapy for this patient is
Correct Answer: B
Rationale: The correct answer is B: Endoscopic balloon dilatation. This patient likely has achalasia based on the symptoms of regurgitation, chest pain, dysphagia, weight loss, and the CXR findings of a dilated esophagus and absent gastric air bubble. Endoscopic balloon dilatation is the initial treatment of choice for achalasia to disrupt the lower esophageal sphincter muscle fibers and improve esophageal emptying. Proton-pump inhibitors (Choice A) are not effective for achalasia. Sucralfate (Choice C) is used for mucosal protection but does not treat achalasia. Esophageal resection (Choice D) is a last resort for refractory cases.
Question 2 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 3 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 4 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.
Question 5 of 5
What is the primary symptom of a peptic ulcer?
Correct Answer: C
Rationale: The primary symptom of a peptic ulcer is abdominal pain. Peptic ulcers are sores that develop on the lining of the stomach, small intestine, or esophagus, causing a dull or burning pain in the stomach area. This pain typically occurs when the stomach is empty and can be relieved by eating or taking antacids. Nausea (choice A) and vomiting (choice D) can occur but are not typically the primary symptoms of a peptic ulcer. Heartburn (choice B) is more commonly associated with gastroesophageal reflux disease (GERD) rather than peptic ulcers.