ATI LPN
NCLEX Questions on Gastrointestinal System Questions
Question 1 of 5
Which of the following statements relating to asthma is most accurate?
Correct Answer: C
Rationale: The most accurate statement is C: "Asthma is associated with breathlessness particularly on lying flat." This is correct because asthma symptoms often worsen when lying flat due to increased pressure on the chest and airways. Option A is incorrect because a long-acting beta2-agonist is not recommended for mild intermittent asthma as it is a step-up therapy for persistent asthma. Option B is incorrect as chronic productive cough is more commonly associated with conditions like chronic bronchitis. Option D is incorrect because a reversibility of <10% in FEV1 is not consistent with a diagnosis of asthma, as asthma typically shows significant reversibility in lung function tests.
Question 2 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: The correct answer is B. Lowering blood pressure and urgent CT angiogram are crucial in suspected aortic dissection. High BP with variability between arms and tearing chest pain are classic signs. T-wave inversions in inferior leads may occur but are not specific to aortic dissection. Choice A is incorrect as antibiotics are not indicated unless infective endocarditis is confirmed. Choice C is incorrect as antiplatelet therapy and heparin are not first-line treatments for aortic dissection. Choice D is incorrect as NSAIDs can worsen aortic dissection, and echocardiogram is not the initial imaging modality of choice for this condition.
Question 3 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: The correct answer is D: Measure gastric acid secretion. In a suspected case of gastrinoma, elevated serum gastrin levels can lead to increased gastric acid secretion. Measuring gastric acid secretion can help confirm the diagnosis of gastrinoma by assessing for increased acid production. This can be done with tests like the gastric acid stimulation test or the secretin stimulation test. Option A is incorrect as an exploratory laparotomy is an invasive procedure and should not be the first step in the diagnostic process. Option B, measuring serum gastrin in response to secretin infusion, may be helpful in confirming the diagnosis but measuring gastric acid secretion is more directly related to the pathophysiology of gastrinoma. Option C, treating for H. pylori, is not indicated in this case as the patient's symptoms are more suggestive of gastrinoma rather than H. pylori infection.
Question 4 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 correct answer is B: Endoscopic balloon dilatation. This patient likely has achalasia based on the symptoms of regurgitation, chest pain, dysphagia, weight loss, and the CXR findings of a dilated esophagus and absent gastric air bubble. Endoscopic balloon dilatation is the initial treatment of choice for achalasia to disrupt the lower esophageal sphincter muscle fibers and improve esophageal emptying. Proton-pump inhibitors (Choice A) are not effective for achalasia. Sucralfate (Choice C) is used for mucosal protection but does not treat achalasia. Esophageal resection (Choice D) is a last resort for refractory cases.
Question 5 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: Step-by-step rationale for choosing answer C: 1. The patient is asymptomatic with no abdominal pain or discomfort. 2. Asymptomatic gallstones do not require immediate treatment. 3. The incidental finding of a gallstone in an asymptomatic patient does not warrant surgical intervention. 4. Watchful waiting is recommended for asymptomatic gallstones to avoid unnecessary procedures. 5. Reassurance is essential to prevent unnecessary anxiety or interventions. Summary: Choice C, reassuring the patient that she does not need any additional therapy for the gallstone at this time, is the best course of action because the patient is asymptomatic, and asymptomatic gallstones do not require immediate treatment. Choices A, B, and D involve unnecessary interventions for an asymptomatic gallstone.