ATI LPN
Questions About Gastrointestinal System Questions
Question 1 of 5
A 78-year-old woman presents to you after having a total body CT scan done at a local facility. She was told that she has a few gallstones in her gallbladder and should discuss this with her primary physician. An ultrasound was apparently also done, which revealed the presence of a few 1-cm gallstones but no ductal dilatation or gallbladder thickening. She denies any abdominal discomfort or pain. Her aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase are normal. She is concerned because her mother died of complications from a 'gallbladder attack.' What course of action would you recommend in this patient?
Correct Answer: D
Rationale: Asymptomatic gallbladder stones usually do not require treatment. Only $13 \%$ of patients with silent gallstones will become symptomatic in future. That is why open or laparoscopic cholecystectomy is not indicated for this patient with a silent gallbladder stone. Oral dissolution is only indicated for small gallstones, preferably less than $5 \mathrm{~mm}$ (smaller stones dissolve faster). Stones larger than $2 \mathrm{~cm}$ will rarely be dissolved. Extracorporeal shock wave lithotripsy has a limited rate of success and a high rate of recurrence; it is rarely used in the United States. Direct dissolution of stones is an option in patients with large stones and at high risk for surgery.
Question 2 of 5
A 35-year-old male patient presents with right upper quadrant pain, fever for the past 48 hours, preceded by new onset jaundice over the past few weeks. He states that he has had diarrhea on and off for several years but never had this investigated. A liver ultrasound is negative for gallstones or evidence of cholecystitis. His lab tests reveal total bilirubin 6.2, alkaline phosphatase 450, AST 150, ALT 120, albumin 2.6. The next diagnostic test of choice would be
Correct Answer: B
Rationale: Magnetic resonance cholangiopancreatography to diagnose intrahepatic strictures associated with primary sclerosing cholangitis, and to exclude other causes of intrahepatic cholestasis. The patient likely has undiagnosed ulcerative colitis. If confirmed, an urgent endoscopic retrograde cholangiopancratogram may be helpful to drain any pockets of obstructed bile flow. Liver biopsy is nondiagnostic in PSC, and should not be performed in the setting of acute cholangitis.
Question 3 of 5
A 46-year-old man with a history of cirrhosis is brought in by his wife because he has been acting strangely. On examination, he is disoriented, is ataxic, and has slurred speech. He is also hyperreflexic. His white blood cell count is normal. His hematocrit is $34 \%$. Coagulation times are elevated. His ammonia level is normal. Which of the following statements regarding his management is correct?
Correct Answer: A
Rationale: This patient has stage 2 hepatic encephalopathy. He should be treated with lactulose despite the normal ammonia level because this test is neither sensitive nor specific as a marker for encephalopathy. A low-protein diet is also recommended. All potentially nephrotoxic (e.g., NSAIDs, gentamicin) or sedating (e.g., lorazepam) medications should be avoided. Acetaminophen should be avoided as well.
Question 4 of 5
What is the purpose of a urea breath test in the context of PUD?
Correct Answer: A
Rationale: The urea breath test detects H. pylori by measuring urease activity, which is crucial for diagnosing and managing PUD caused by this bacteria.
Question 5 of 5
What nursing intervention is appropriate for a patient with PUD who is experiencing nausea?
Correct Answer: B
Rationale: Clear fluids and a light diet can soothe the stomach and reduce nausea without exacerbating PUD symptoms.