ATI LPN
NCLEX Questions Gastrointestinal System Questions
Question 1 of 5
Which of the following complications best describes a microvascular complication of diabetes mellitus?
Correct Answer: C
Rationale: Diabetic retinopathy is a classic microvascular complication of diabetes, affecting small vessels, making C the correct answer.
Question 2 of 5
All of the following statements about Helicobacter pylori (H. pylori) are true except
Correct Answer: C
Rationale: H. pylori resides in the mucus layer of the stomach, where it exerts its urease activity. It does not invade the epithelium. The production of ammonia, the stimulation of acid secretion, and the disruption to the protective mucus layer are three mechanisms by which H. pylori promotes injury. H. pylori also stimulates interleukin-8, a cytokine associated with inflammation. H. pylori is causally associated with gastric adenocarcinoma and MALT lymphoma of the stomach. Eradication of H. pylori has been shown to cause regression of MALT lymphoma, but it has not been shown to prevent adenocarcinoma of the stomach. Three- or four-drug regimens are superior to two-drug regimens.
Question 3 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: All of the other medications have been associated with pill-induced esophagitis. Pill-induced esophagitis is usually associated with the failure to ingest at least 8 ounces of water with the medication while upright and, less commonly, an underlying motility disorder. Resolution of pill-induced esophagitis and ulceration occurs rapidly once the offending medication is discontinued. Acid suppressive therapy is usually prescribed to prevent reflux-related injury.
Question 4 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 patient has developed obstructive jaundice. Obstructive jaundice and severe progressive weight loss in this young male with a long history of diabetes mellitus and heavy smoking could indicate a malignant neoplasm. Dilatation of both intra- and extrahepatic ducts, along with the fullness in the head of the pancreas, are suspicious for obstructing tumor in the head of the pancreas or in the major duodenal papilla (ampullary mass). The patient clinically does not have evidence of gastric outlet or duodenal obstruction (i.e., no nausea or vomiting), so an upper GI series is not indicated. Abdominal ultrasound and HIDA scan are unlikely to provide more information in this case. ERCP will allow visualization of the major duodenal papilla and reveal information about the biliary and pancreatic ducts (e.g., diameter, location, and grade of obstruction). ERCP can also relieve the obstruction with internal biliary stenting. If cannulation of the biliary ducts during the ERCP is not successful, then more invasive transcutaneous transhepatic cholangiography is indicated. This patient may also need endoscopic ultrasound with fine-needle aspiration biopsy to rule out an early, small mass in the head of the pancreas not detected by abdominal CT scan.
Question 5 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: This young man with weight loss, malodorous, bulky stools, increased appetite, and iron deficiency anemia has celiac disease as the most likely diagnosis. Patients occasionally may feel constipated; however, the stools are unusually bulky and consistently malodorous. The disease is diagnosed by biopsy of the small bowel by upper endoscopy (Answer A). Elevated anti-endomysial antibodies are highly suggestive. Fat malabsorption can be rigorously established by fecal fat collection. The differential diagnosis includes chronic pancreatitis, which is best evaluated by CT scan. A colonoscopy is helpful to evaluate iron deficiency anemia to rule out colonic tumors or other causes of occult blood loss or to assess for inflammatory bowel disease. However, in this patient with malabsorption, increased appetite, and young age, sprue is more likely to explain the constipation and iron deficiency anemia. He does not have abdominal pain, blood in the stools, or diarrhea, the most common symptoms of inflammatory bowel disease. Colonoscopy will be less useful.