ATI LPN
Gastrointestinal System Nursing Exam Questions Questions
Question 1 of 5
Which statement is true regarding Barrett's esophagus?
Correct Answer: D
Rationale: Treatment with PPIs should be directed at control of GERD symptoms and not with the expectation that Barrett's epithelium will regress, as this has yet to be proven. The presence of high-grade dysplasia is an indication for esophagectomy or endoscopic ablation by photodynamic therapy because there is high likelihood that adenocarcinoma is present by the time high-grade dysplasia is identified. Although patients with Barrett's esophagus with intestinal metaplasia are at higher risk of developing adenocarcinoma compared to the general population, the reality is that the vast majority of patients will never develop adenocarcinoma. Endoscopic surveillance at periodic intervals is generally recommended in those patients with Barrett's esophagus and intestinal metaplasia.
Question 2 of 5
A 56-year-old man has had profuse watery diarrhea for three months. Measured stool electrolytes are as follows: Na 30 mmol/L, K+ 85 mmol/L, Cl- 15 mmol/L, and HCO3- 18 mmol/L. Which diagnosis is least likely?
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 3 of 5
A 24-year-old man presents with emotional lability and jaundice. Labs reveal a hemoglobin of $10 \mathrm{~g} / \mathrm{dL}$, total bilirubin of $8 \mathrm{mg} / \mathrm{dL}$ with direct fraction of 2.2, alkaline phosphatase of 89 U/L, AST and ALT in the 1500 U/L range, negative viral serologies, and negative toxicology screen. Which of the following is correct?
Correct Answer: D
Rationale: This is an acute presentation of Wilson's disease. The patient has neuropsychiatric symptoms, liver disease, and evidence of hemolytic anemia. Ceruloplasmin in this setting is not reliable because it is an acute phase reactant. The diagnosis is best made by quantifying copper in liver tissue, but a 24-hour urinary copper is also a very sensitive tool and will show greater than $100 \mathrm{~g}$ of copper.
Question 4 of 5
A 52-year-old man with a history of hypertension presents for a follow-up visit. He denies any complaints. His only medication is hydrochlorothiazide. He has some laboratory tests done that reveal mild elevations of his ALT and AST levels. His total bilirubin and alkaline phosphatase levels are normal. He is brought back to have his tests repeated and to have further testing. His AST and ALT are still elevated. His iron studies are normal. His hepatitis C antibody is negative. His hepatitis A IgM is negative. His hepatitis B surface antigen and antibody are negative. His IgM antibody to hepatitis B core antigen (IgM anti-HBc) is positive. Which of the following statements is correct?
Correct Answer: D
Rationale: The most specific marker for the diagnosis of acute hepatitis B is IgM antibody to hepatitis B core antigen (IgM anti-HBc). However, false positives can occur. Chronic carriers of hepatitis B will typically have a positive hepatitis B surface antigen (HbsAg) and a positive IgG antibody to hepatitis B core antigen (IgG anti-HBc). Patients may sometimes be low-level carriers with a negative HbsAg and only a positive IgG anti-HBc. Hepatitis D requires the presence of HbsAg to cause infection. It is associated with acute HBV infection (predominantly in intravenous drug users) but the overall incidence is low. When a patient presents with this pattern, repeating the tests in two to three months may assist in the diagnosis. If the IgM anti-HBc disappears and either a hepatitis B surface antibody or IgG anti-HBc appears, then it is likely that he had an acute infection.
Question 5 of 5
Which of the following diagnostic tests is most commonly used to confirm the presence of a peptic ulcer?
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.