ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
Which of the following factors registers a score of 3 in the Well's Score for diagnosis of pulmonary embolism (PE)?
Correct Answer: A
Rationale: In the Wells Score for PE, clinical symptoms of DVT or PE as the most likely diagnosis scores 3; heart rate >100 scores 1.5, making A the closest match among options.
Question 2 of 5
Which of the following would confirm the diagnosis of diabetes in a patient with symptoms of hyperglycaemia?
Correct Answer: A
Rationale: Fasting plasma glucose>=7.0 mmol/l with symptoms confirms diabetes per WHO criteria, making A the correct answer.
Question 3 of 5
A 50-year-old man is admitted to A&E with severe, tearing central chest pain radiating into his back. On examination, he has a high BP with variability between both arms. An ECG shows T-wave inversions in the inferior leads. What should be the next step in the management of the patient?
Correct Answer: B
Rationale: Symptoms suggest aortic dissection (tearing pain, BP variability); urgent BP control and CT angiogram are critical, making B the correct answer.
Question 4 of 5
A 36-year-old woman complains of reflux symptoms and intermittent diarrhea. The diagnosis of gastrinoma is suspected so a fasting serum gastrin is obtained and found to be 280 pg/mL (normal <115 pg/mL). An abdominal CT is negative. What would you do now?
Correct Answer: D
Rationale: Although the fasting serum gastrin is elevated, this finding alone is insufficient for establishing the diagnosis of gastrinoma. The serum gastrin can be elevated in other conditions, most notably recent therapy with proton-pump inhibitors or H2 antagonists and gastric achlorhydria. In fact, the serum gastrin has been reported to be elevated over 1000 pg/mL in patients with pernicious anemia. Thus, a measurement of basal acid output is required. If the gastric pH is less than 2, the diagnosis of gastrinoma is highly suspicious, and a serum secretin test should be performed. Secretin 2 IU/kg is given over 2 minutes and measurements of the serum gastrin are obtained 2.5, 5, 10, 15, and 30 minutes after infusion. A paradoxical increase in the serum gastrin of greater than 200 pg/mL is diagnostic of Z-E syndrome.
Question 5 of 5
A 65-year-old man frequently regurgitates food several hours after eating, and experiences chest pain and dysphagia to both liquids and solids. He has lost 20 pounds. A CXR shows an air/fluid level in a dilated esophagus and an absent gastric air bubble. No mass in the distal esophagus or proximal stomach is identified at upper endoscopy. The best therapy for this patient is
Correct Answer: B
Rationale: The patient has the classic presentation and radiologic findings of achalasia. The upper endoscopy and CT scan are important for ruling out secondary achalasia which is caused by a malignant growth at the GE junction, producing symptoms and findings that mimic primary achalasia. Patients with achalasia typically do not suffer from GERD since they have a lower esophageal sphincter that fails to relax appropriately. However, achalasia patients can describe heartburn and chest pain due to the accumulation of ingested material in a massively dilated esophagus. Achalasia responds well to endoscopic balloon dilatation and to myotomy. Injection of botulinum toxin at the GE junction has been helpful in nonsurgical candidates. Esophageal resection is not indicated for achalasia unless malignancy has developed.