ATI LPN
NCLEX Questions Gastrointestinal System Questions
Question 1 of 5
A patient presents to you with an exacerbation of asthma. Which of the following would make you categorise this as a SEVERE exacerbation?
Correct Answer: C
Rationale: The correct answer is C: Peak flow <33% of normal. This indicates severe airflow obstruction. A: Hypotension is a sign of severe asthma but not specific enough to categorize it as severe. B: Peak flow <50% indicates moderate exacerbation. D: Bradycardia is not typically associated with asthma exacerbation. Therefore, C is the most appropriate choice because it directly reflects the severity of the patient's condition.
Question 2 of 5
A 65-year-old white female with a history of arthritis, congestive heart failure, and osteoporosis complains of odynophagia for two weeks. A barium swallow shows a moderate-sized crater just above the gastroesophageal junction. What is the least likely contributor to this condition?
Correct Answer: D
Rationale: The correct answer is D: Calcium channel-blocker. The crater above the gastroesophageal junction is likely due to a peptic ulcer, which can be caused by NSAIDs and alendronate due to their potential to irritate the gastric mucosa. Iron sulfate can also contribute to gastrointestinal irritation but is less common compared to NSAIDs and alendronate in causing ulcers. Calcium channel-blockers, on the other hand, do not have a direct irritant effect on the gastrointestinal mucosa and are not associated with peptic ulcers. Therefore, calcium channel-blockers are the least likely contributor to the formation of the crater in this scenario.
Question 3 of 5
A 42-year-old accountant is referred to your office for evaluation of progressive weight loss. He has lost 20 pounds over the last 6 months. He has a long history (16 years) of insulin-dependent diabetes mellitus. He denies alcohol abuse but admits to heavy smoking (2 packs of cigarettes per day for 20 years). Three days ago he noticed that his urine became dark and that his skin started to itch. He had a CT scan of the abdomen last week that revealed fullness in the head of the pancreas with dilatation of intra- and extrahepatic biliary ducts. The CT scan did not demonstrate a discrete mass in the pancreas or liver, gallstones, or pancreatitis. His physical examination is normal except for obvious jaundice. His blood work reveals WBC count 6.4, total bilirubin 5.7 mg/dL, alkaline phosphatase 340 U/L, amylase 64 U/L, and lipase 47 U/L. Which of the following tests would you order next?
Correct Answer: C
Rationale: The correct answer is C: Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is the next appropriate step for this patient due to the presence of jaundice, dark urine, and dilatation of the biliary ducts on CT scan, which indicate a likely biliary obstruction. ERCP allows direct visualization of the biliary tree and pancreatic duct, as well as therapeutic interventions such as stent placement or stone removal. This procedure can help identify the cause of the jaundice and guide further management. Choice A (Hepatobiliary scintigraphy) is used to evaluate gallbladder function but is not the most appropriate test in this scenario where biliary obstruction is suspected. Choice B (Abdominal ultrasound) can help identify biliary dilatation but does not provide direct visualization or therapeutic options like ERCP. Choice D (Transcutaneous transhepatic cholangiography) is an invasive test that is typically reserved
Question 4 of 5
A 25-year-old dental technician has noticed a 10-pound weight loss despite increased appetite, generalized weakness, and constipation with infrequent but unusually voluminous and malodorous stools. On physical examination, he is thin, pale, and appears tired. His abdomen is protuberant but soft. Labs reveal a microcytic anemia. Which of the following is least likely to be helpful?
Correct Answer: D
Rationale: The correct answer is D: Colonoscopy. In this scenario, the patient's symptoms point towards malabsorption, which is typically associated with issues in the small intestine, not the colon. Therefore, a colonoscopy, which examines the large intestine, would be least likely to be helpful in diagnosing the underlying cause of his symptoms. Choices A, B, and C would be more beneficial as they can help identify potential causes of malabsorption such as celiac disease, pancreatic insufficiency, or small bowel abnormalities.
Question 5 of 5
A 62-year-old man presents complaining of abdominal pain and diarrhea. He notes that the symptoms have been going on for three months now and he has lost about 20 pounds over that span. He also complains of migratory arthralgias for the past year. He denies any past medical history. He never smoked cigarettes and drinks about two beers per week. He denies use of illicit drugs. A review of records from an evaluation done by another physician reveals a normal thyroid-stimulating hormone level, negative ANA, a normal sedimentation rate, and a negative HIV test. He had a flexible sigmoidoscopy done, which failed to reveal any abnormalities. You refer him for upper endoscopy and a duodenal biopsy is done, which reveals extensive PAS-positive material in the lamina propria and villous atrophy. What is the most appropriate therapy for this patient?
Correct Answer: D
Rationale: The correct answer is D: Trimethoprim/sulfamethoxazole. This patient has symptoms consistent with Whipple's disease, a rare systemic infection caused by Tropheryma whipplei. The PAS-positive material in the duodenal biopsy is characteristic of Whipple's disease. Trimethoprim/sulfamethoxazole is the recommended treatment for this condition. It works by targeting the bacteria responsible for the infection. A gluten-free diet (choice A) is used for celiac disease, which presents with similar symptoms but would not show PAS-positive material on biopsy. A lactose-free diet (choice B) is used for lactose intolerance and does not address the underlying cause of the symptoms. Cholestyramine (choice C) is used to lower cholesterol levels and would not treat an infectious cause like Whipple's disease.