ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
An 82-year-old female nursing home resident was admitted with left-sided aspiration pneumonia. She improved quickly on intravenous antibiotics. During her admission, a chest x-ray incidentally revealed a large calcification in the right upper quadrant of the abdomen. Subsequent abdominal ultrasound confirmed the presence of a single large stone in the gallbladder (3 cm in diameter). She denies any abdominal discomfort or pain. What would be the best course of treatment for her gallstone disease?
Correct Answer: C
Rationale: Asymptomatic gallbladder stones do not require treatment. Only $13 \%$ of patients with silent gallstones will become symptomatic in the future. For this reason, open or laparoscopic cholecystectomy is not indicated for this patient with a silent gallbladder stone. Oral dissolution is only beneficial for small gallstones, preferably less than $5 \mathrm{~mm}$ (smaller stones dissolve faster). Stones larger than $2 \mathrm{~cm}$ will rarely be dissolved with this method. Extracorporeal shock wave lithotripsy has limited rate of success and high rate of recurrence and is rarely used in the United States.
Question 2 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: This presentation is typical of primary biliary cirrhosis. Viral hepatitis does not present with only alkaline phosphatase elevation. With a normal ultrasound, no pain, and no jaundice, common bile duct stone is unlikely. A CT scan will not add any more information in this setting. Antimitochondrial antibodies are positive in over $90 \%$ of patients with primary biliary cirrhosis.
Question 3 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: This young woman has a poor prognosis for recovery using the King's College criteria, and will likely need a liver transplant. She should be intubated immediately for airway protection, given N-acetylcysteine, and transferred to a transplant center. Lactulose has no efficacy in acute liver failure.
Question 4 of 5
What is the primary symptom of a peptic ulcer?
Correct Answer: C
Rationale: Abdominal pain, typically epigastric and burning in nature, is the hallmark symptom of a peptic ulcer due to irritation of the ulcerated mucosa by gastric acid.
Question 5 of 5
Which dietary advice is most appropriate for a patient with PUD?
Correct Answer: A
Rationale: Spicy foods can irritate the gastric mucosa and exacerbate PUD symptoms, making avoidance the most appropriate advice.