ATI LPN
Gastrointestinal System NCLEX Questions Questions
Question 1 of 5
Which regimen is most effective to treat H. pylori?
Correct Answer: C
Rationale: Regimen A fails to include an H2-blocker or proton-pump inhibitor. Regimen B uses only two drugs, and two drugs are not as effective as three- or four-drug regimens for eradicating H. pylori. Regimen D treats only for 7 days, when 10 to 14 days regimens have been shown to have greater efficacy. Regimen C is recommended by the FDA for the eradication of H. pylori. Answer E is not a regimen that has been tested.
Question 2 of 5
A 25-year-old man with a history of AIDS presents to the emergency room with severe abdominal pain and episodic nausea and vomiting. He describes the pain as constant; it is located in the epigastric area and radiates to the back. The pain started 12 hours ago and is becoming more intense. His current medications include dideoxyinosine (ddI), ganciclovir, and pentamidine. Physical examination reveals a low-grade fever and tenderness in the epigastric area without guarding or rebound. Blood tests demonstrate white blood cells of 6900/ L, amylase of 362 U/L, lipase of 428 U/L, and total bilirubin of 1.1 mg/dL. What is/are the possible cause(s) of this patient's problem?
Correct Answer: D
Rationale: This patient has acute pancreatitis as evidenced by his symptoms and elevated amylase and lipase. Cytomegalovirus is the most commonly reported viral infection that can involve the pancreas. HIV and many AIDS-related infections can affect the pancreas (e.g., cryptococcus, Mycobacterium tuberculosis, candida, and Toxoplasma gondii). Numerous medications may also cause acute pancreatitis (e.g., ddI, pentamidine, trimethoprim/sulfamethoxazole, and metronidazole).
Question 3 of 5
A 66-year-old woman, a recently retired social worker who cares for her disabled husband, has been experiencing left lower quadrant discomfort. For the past few months, she has been having bowel movements every other day, which is a change from her usual once or twice per day. She has a long history of noninsulin-dependent diabetes mellitus, arthritis, hypothyroidism, and hypertension. Medications are glyburide $5 \mathrm{mg}$, levothyroxine $0.1 \mathrm{mg}$, and diltiazem (extended release) $240 \mathrm{mg}$ four times a day (previously managed on propranolol but changed on her last visit to diltiazem because of depressed mood), and ibuprofen as needed. She is very worried about colon cancer although she had a normal colonoscopy last year. What is the best plan for her?
Correct Answer: D
Rationale: New onset of constipation will most often have a nonfunctional cause. In this case, the most likely cause is the change of antihypertensives to a calcium channel-blocker. These medications are more often associated with constipation than are $\alpha$-blockers. New-onset constipation can sometimes be a symptom of colon cancer (Answer A), but this would be less likely in a patient that had a recent negative colonoscopy. One could consider a repeat colonoscopy should the constipation be persistent after addressing more likely causes. Constipation may also be secondary to hypothyroidism (Answer B), and one should be suspicious of hypothyroidism (especially in females and elderly patients). However, the calcium channel-blocker is a more likely cause than is noncompliance with a reasonable dose of thyroid medication in this social worker that cares for her disabled husband. Similarly, stress may play a role in her constipation, but the correlation between medications and the constipation should be addressed first and is more likely to be helpful.
Question 4 of 5
A 48-year-old woman presents with an elevated ALT found on an insurance screening examination. Her hepatitis C antibody test is positive. She denies any risk factors for hepatitis C. What should you do?
Correct Answer: D
Rationale: This woman has a positive antibody test in the setting of an elevated ALT. She denies any risk factors for hepatitis C, so it is imperative to rule out a false positive test. Hepatitis C RNA is a highly specific test to confirm the diagnosis. Because ALT levels do not predict severity of disease, there is no need to follow enzyme levels. All hepatitis C patients should be referred for consideration of therapy with interferon and ribavirin, not prednisone.
Question 5 of 5
A 50-year-old woman presents complaining of pruritus. She reports that for the last eight months she has been itching, particularly around her trunk. Her medical history is notable only for hypertension and obesity. Her current medications include hydrochlorothiazide, estrogen, and progesterone. Her labs are notable for an alkaline phosphatase of 487 U/L, an alanine aminotransferase (ALT) of 46 U/L, and an aspartate aminotransferase of 52 U/L. Her total bilirubin is 2.5 mg/dL with a direct bilirubin of 1.6 mg/dL. Which of the following statements is correct?
Correct Answer: A
Rationale: This woman presents with an elevated alkaline phosphatase, mildly elevated transaminases, and an elevated bilirubin level. The alkaline phosphatase elevation is out of proportion to the other tests, suggesting a biliary process. Primary biliary cirrhosis (PBC) would present as such. Antimitochondrial antibodies are seen in most cases of PBC. Ceruloplasmin is usually low in Wilson's disease which can present with elevation of the transaminases and neuropsychiatric disturbances in young patients. Likewise estrogen administration, fatty liver, and autoimmune hepatitis should present with primary elevations of the transaminases rather than the alkaline phosphatase.