ATI LPN
Upper Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
In a patient admitted with acute coronary syndrome, which of the following variables at admission contributes to estimating the risk of death or recurrent myocardial in the GRACE score?
Correct Answer: C
Rationale: The GRACE score includes variables like age, heart rate, systolic BP, creatinine, cardiac arrest, ST-segment deviation, and troponin, but not explicitly these options; however, oxygen saturation can indirectly reflect severity, making C the most relevant.
Question 2 of 5
A 67-year old male smoker has atrial fibrillation and a history of treated hypertension. He has symptoms of leg claudication and stable chronic kidney disease with an estimated glomerular filtration rate of 28 ml/min. He works as a food critic and enjoys trying various different foods. Which ONE of the following is the MOST APPROPRIATE anticoagulant to initiate for prevention of stroke?
Correct Answer: A
Rationale: Apixaban, a direct oral anticoagulant, is suitable for AF stroke prevention in CKD (eGFR 15-29), unlike warfarin which requires dietary stability, making A the best choice.
Question 3 of 5
Which ONE of the following should be recommended in a patient with high blood pressure?
Correct Answer: D
Rationale: A high potassium, low sodium diet helps lower BP, despite high saturated fat being suboptimal, making D the best choice among options.
Question 4 of 5
An otherwise healthy 45-year-old man presents with severe hematochezia and moderate abdominal cramping since this morning. A barium enema one year ago was normal. On examination, his blood pressure is 120/78 and pulse is 100 while lying; when standing, the blood pressure is 110/76 and pulse is 136. His hematocrit is 34. What is the most likely cause of bleeding?
Correct Answer: B
Rationale: Acute GI bleeding from a lower GI source does not cause hemodynamic compromise as commonly as GI bleeding from an upper source. Therefore, despite the absence of melena and no appearance of hematemesis, the hemodynamic compromise indicates that an upper GI source should be sought. Ulcers that arise in the duodenal bulb can erode into the gastroduodenal artery, giving rise to brisk blood loss. A negative nasogastric aspirate does not rule out the possibility. Although diverticular bleeds account for most episodes of acute lower GI bleeding and can occasionally be associated with hemodynamic compromise, the normal barium enema one year ago makes it less likely that the bleeding was of diverticular origin. Inflammatory bowel disease is rarely the cause of severe acute GI bleeding unless an ulcer has eroded into a vessel. Watermelon stomach is associated with chronic GI blood loss from vessel ectasias, presents as iron deficiency anemia, and is found primarily in older women. The presentation is not suggestive of a Mallory-Weiss tear because there was no vomiting, and hematochezia was present.
Question 5 of 5
A 56-year-old white male complains of intermittent dysphagia for the past three months, particularly with the ingestion of meat. He has no difficulties swallowing liquids. He has no history of smoking, uses no medications, and has had no weight loss. What test would be best to evaluate him?
Correct Answer: C
Rationale: Dysphagia should almost always first be evaluated by barium swallow. The patient's presentation is classic for a Schatzki's ring (congenital web at the GE junction). The diagnosis is best made by barium study because Schatzki's rings cannot always be visualized by endoscopy. CT scan and esophageal manometry cannot detect Schatzki's rings. Schatzki's rings are easily disrupted by bougie dilatation, and usually no further therapy is needed.