ATI LPN
Chapter 15 The Gastrointestinal System Review Questions Questions
Question 1 of 5
In a patient with chronic obstructive pulmonary disease, what is cor pulmonale?
Correct Answer: A
Rationale: The correct answer is A because cor pulmonale refers to right-sided heart failure caused by lung disease. In chronic obstructive pulmonary disease (COPD), the lungs are diseased, leading to pulmonary hypertension and subsequent strain on the right side of the heart. This results in right ventricular hypertrophy and eventually right-sided heart failure. Choice B is incorrect because left-sided heart failure is not the primary cause of cor pulmonale in COPD. Choice C is incorrect as it suggests that lung disease is secondary to left-sided heart failure, which is not the case in cor pulmonale. Choice D is also incorrect as it implies that lung disease leads to right-sided heart failure, which is the opposite of the actual relationship in cor pulmonale.
Question 2 of 5
A 56-year-old woman with rheumatoid arthritis has severe joint pain and swelling in her hands. She has a history of peptic ulcer disease five years ago but presently has no GI symptoms. You elect to start her on an NSAID. Which of the following is correct?
Correct Answer: B
Rationale: The correct answer is B: Misoprostol is superior to an H2-blocker in prophylaxis against NSAID-related GI toxicity. Misoprostol is a prostaglandin analog that helps protect the stomach lining, reducing the risk of NSAID-induced ulcers. H2 blockers only reduce acid production and do not address the underlying mechanism of NSAID-induced injury. Sucralfate does not provide as effective prophylaxis as misoprostol. H. pylori infection can increase the risk of NSAID-induced ulcers; eradication of H. pylori can reduce this risk.
Question 3 of 5
A 45-year-old woman with occasional indigestion has had episodes of chest pain and dysphagia to both solids and liquids. An upper GI series and EGD fail to disclose any structural abnormalities. What is the most appropriate initial therapy?
Correct Answer: B
Rationale: The correct answer is B: Proton-pump inhibitor. The patient's symptoms of chest pain and dysphagia suggest possible gastroesophageal reflux disease (GERD). Proton-pump inhibitors reduce gastric acid production, providing relief for symptoms of GERD. This is the most appropriate initial therapy given the symptoms. Choice A: Sucralfate is a cytoprotective agent that forms a protective barrier over ulcers but does not address the underlying issue of acid reflux. Choice C: Prokinetic agents help with motility disorders but are not the first-line treatment for GERD. Choice D: Benzodiazepines are not indicated for the treatment of GERD and would not address the underlying cause of the patient's symptoms.
Question 4 of 5
A 56-year-old Brazilian woman with a history of idiopathic cardiomyopathy presents complaining of weight loss, dysphagia, and regurgitation. A chest x-ray is done that reveals an air-fluid level at the level of the esophagus. No gastric bubble is appreciated. A barium swallow reveals a dilated esophagus that tapers at the lower esophageal sphincter. Which of the following is appropriate in this patient's evaluation/treatment?
Correct Answer: D
Rationale: The correct answer is D: Obtain serologic studies for antibodies to Trypanosoma cruzi. This patient's presentation is consistent with Chagas disease, caused by Trypanosoma cruzi. The patient is from Brazil, where Chagas disease is endemic. The dilated esophagus and lower esophageal sphincter tapering are classic findings of megaesophagus, a complication of Chagas disease. Serologic studies for antibodies to Trypanosoma cruzi are necessary for definitive diagnosis. Choice A: Refer for partial esophagectomy - Not appropriate as surgery is not indicated without confirming the diagnosis. Choice B: Thick and thin smears of peripheral blood looking for parasites - Not appropriate as Chagas disease is diagnosed through serologic testing, not blood smears. Choice C: Therapeutic trial of a proton pump inhibitor - Not appropriate as the patient's symptoms are likely due to Chagas disease, not gastroesophageal reflux disease.
Question 5 of 5
A 46-year-old woman with a history of alcohol abuse is admitted for acute pancreatitis due to alcohol. She is treated with supportive care but continues to deteriorate over 72 hours. A CT scan is obtained that reveals extensive pancreatic inflammation with the suggestion of necrosis. All of the following statements are correct regarding this patient's management except
Correct Answer: A
Rationale: The correct answer is A: Endoscopic retrograde cholangiopancreatography (ERCP) should be performed urgently. ERCP is not indicated in the acute setting of pancreatitis unless there is evidence of biliary obstruction or cholangitis. The priority in this case would be to manage the acute pancreatitis and potential pancreatic necrosis. Antibiotic therapy (Choice B) may be considered in cases of infected necrosis. A CT-guided needle aspirate (Choice C) may be helpful for diagnosing infected necrosis but is not typically done urgently. Surgical debridement (Choice D) is indicated if there is evidence of infected pancreatic necrosis on culture results, but this should be done after appropriate medical management.