ATI LPN
Gastrointestinal System Nursing Exam Questions Questions
Question 1 of 5
An 80-year-old woman with background history of Type 2 Diabetes, hypertension and mild renal impairment is admitted with symptoms of haemoptysis and pleuritic chest pain. She is suspected to have a pulmonary embolism and a CT pulmonary angiogram is booked. She normally takes Metformin 500 mg TDS. What advice would you give her regarding metformin?
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 2 of 5
Which statement is true regarding Barrett's esophagus?
Correct Answer: D
Rationale: Treatment with PPIs should be directed at control of GERD symptoms and not with the expectation that Barrett's epithelium will regress, as this has yet to be proven. The presence of high-grade dysplasia is an indication for esophagectomy or endoscopic ablation by photodynamic therapy because there is high likelihood that adenocarcinoma is present by the time high-grade dysplasia is identified. Although patients with Barrett's esophagus with intestinal metaplasia are at higher risk of developing adenocarcinoma compared to the general population, the reality is that the vast majority of patients will never develop adenocarcinoma. Endoscopic surveillance at periodic intervals is generally recommended in those patients with Barrett's esophagus and intestinal metaplasia.
Question 3 of 5
A 62-year-old woman presents to the emergency room complaining of abdominal pain. The patient had a laparoscopic cholecystectomy for multiple small gallbladder stones eight months ago. She did not have any symptoms after the surgery until last week, when she suddenly developed pain in the right upper quadrant. The painful episode lasted 15 minutes. The next day, the pain returned and became constant. The intensity of pain gradually increased. Today she started to have nausea and vomiting, and her daughter brought her to the emergency room. The patient is febrile (her temperature is 38.6°C) and is jaundiced. Physical examination revealed localized tenderness in the right upper quadrant without a palpable mass. Her blood work showed white blood cell count 16.4/ L, total bilirubin 6.3 mg/dL, alkaline phosphatase 347 IU/L, amylase 53 U/L, and lipase 32 U/L. Which of the following would you order next for this patient?
Correct Answer: C
Rationale: The patient presents with obstructive jaundice and cholangitis. The most likely cause is a retained gallstone or a stricture that developed postcholecystectomy. An HIDA scan, viral hepatitis screening, and liver biopsy are not indicated in this patient with obvious bile duct obstruction. An ERCP may identify the cause of obstruction. Endoscopic sphincterotomy with removal of the stone, or dilatation and stenting of the biliary stricture, will restore patency of the biliary system to cure cholangitis and obstructive jaundice. If ERCP is not successful, the patient will need percutaneous transhepatic drainage of the biliary ducts or laparotomy with the common bile duct exploration.
Question 4 of 5
A 56-year-old man has had profuse watery diarrhea for three months. Measured stool electrolytes are as follows: Na 30 mmol/L, K+ 85 mmol/L, Cl- 15 mmol/L, and HCO3- 18 mmol/L. Which diagnosis is least likely?
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 5 of 5
A 24-year-old man presents with emotional lability and jaundice. Labs reveal a hemoglobin of $10 \mathrm{~g} / \mathrm{dL}$, total bilirubin of $8 \mathrm{mg} / \mathrm{dL}$ with direct fraction of 2.2, alkaline phosphatase of 89 U/L, AST and ALT in the 1500 U/L range, negative viral serologies, and negative toxicology screen. Which of the following is correct?
Correct Answer: D
Rationale: This is an acute presentation of Wilson's disease. The patient has neuropsychiatric symptoms, liver disease, and evidence of hemolytic anemia. Ceruloplasmin in this setting is not reliable because it is an acute phase reactant. The diagnosis is best made by quantifying copper in liver tissue, but a 24-hour urinary copper is also a very sensitive tool and will show greater than $100 \mathrm{~g}$ of copper.