Gastrointestinal Disorders: Diagnosis and Management, Exams of Nursing

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Abdominal ProblemsREVISION QUESTIONS

MULTIPLE CHOICE

1. A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the examination? A. (^) Lumbar puncture B. (^) Family history of cardiac problems C. (^) Contrast venography D. (^) Pelvic exam ANS: D PTS: 1
2. Which of the following is a condition that results in colicky abdominal pain? A. (^) Peptic ulcers B. (^) Glisson’s capsule around the liver C. (^) Peritoneum irritation D. (^) Gallstones ANS: D PTS: 1
3. A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? A. (^) Multivitamin B. (^) Magnesium hydroxide C. (^) Pepto-Bismol® D. (^) Ibuprofen ANS: C PTS: 1
4. Which of the following is an appropriate strategy to manage constipation? A. (^) Mildly exercise after breakfast. B. (^) Five timed minutes on the toilet in which to defecate. C. (^) Drink at least 48 ounces of fluids daily. D. (^) Immediately begin pharmacologic treatment. ANS: A PTS: 1
5. A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis? A. (^) Gastroenteritis B. (^) Recent use of Imodium C. (^) Lack of dietary fiber D. (^) Decreased physical activity ANS: A PTS: 1

6. Cameron, 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes antacids with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain? A. (^) The pain seems better when he smokes to relieve his nerves. B. (^) Coffee and fried foods don’t bother him. C. (^) He wakes at night coughing with a bad taste in his mouth. D. (^) He likes to wear loose clothing. ANS: C PTS: 1
7. Gail, a 35-year-old female patient, is seen in the clinic in the morning. She complains of abrupt onset of nausea, vomiting, colicky abdominal cramps, and profuse watery diarrhea that began last night. Her vitals are BP: 110/70, HR: 110, temperature: 99°F, RR: 12. She recently came back from a vacation in Switzerland, ate leftovers for dinner last night, and had a cold 2 weeks ago. Which of the following is the most probable cause of her condition? A. (^) Staphylococcus B. (^) Shigella C. (^) Rotavirus D. (^) Entamoeba histolytica ANS: A PTS: 1
8. Hannah is a patient that just had an appendectomy after a diagnosis of appendicitis and had no complications. Which of the following patient education points is correct? A. (^) “You will need to take laxatives to encourage defecation post-surgery.” B. (^) “You will need to stay in the hospital for 2 weeks to recover.” C. (^) “Your diet will be advanced when bowel sounds return.” D. (^) “I will put you on narcotics to manage your pain.” ANS: C PTS: 1
9. Which of the following patients should be referred to a hepatologist? A. (^) Patient with persistent elevation of HBsAg B. (^) Patient with anti-HAV IgG C. (^) Patient with IgG anti-HBs D. (^) Patient with anti-HEV ANS: A PTS: 1
10. A 29-year-old is seen in the office with complaints of pain in his chest and belly. He quit smoking 6 months ago. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer® and Pepto-Bismol®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer? A. (^) His use of Pepto-Bismol B. (^) His age C. (^) His use of Alka-Seltzer D. (^) His smoking cessation

ANS: C PTS: 1

11. Which of the following causes of gastrointestinal bleeding is found in the lower gastrointestinal tract? A. (^) Erosive esophagitis B. (^) Duodenal ulcer C. (^) Meckel’s diverticulum D. (^) Gastric ulcer ANS: C PTS: 1
12. Which of the following is most effective in diagnosing acute appendicitis? A. (^) History and physical B. (^) Sedimentation rate C. (^) Kidney, ureter, and bladder x-ray D. (^) Complete blood count (CBC) with differentials ANS: A PTS: 1
13. Which of the following is true of appendicitis? A. (^) Appendicitis is more common in Asian countries. B. (^) Family history of appendicitis does not increase a patient’s risk of having appendicitis. C. (^) Appendicitis is most common between the ages of 40 and 60. D. (^) If appendicitis occurs in infants, it is associated with higher morbidity. ANS: D PTS: 1
14. Which of the following is associated with celiac disease (celiac sprue)? A. (^) Malabsorption B. (^) Constipation C. (^) Rectal bleeding D. (^) Esophageal ulceration ANS: A PTS: 1
15. A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical examination is remarkable for left lower quadrant tenderness. At this time, which of the following should be considered in the differential diagnosis? A. (^) Endometriosis B. (^) Yersinia enterocolitica infection C. (^) Appendicitis D. (^) GERD ANS: A PTS: 1
16. Robin is a 57-year-old female presenting with diffuse abdominal pain. Which of the following statements from the provider to Robin is correct? A. (^) “It does not matter that you feel pain not only in your stomach but also in your shoulder.”

1 B.

“Does moving around change the nature of your pain?” C. (^) “All causes of abdominal pain do not necessitate a surgical referral.” D. (^) “I noticed on examination that your stomach is rigid, and you stated your pain is quite severe. It is only necessary for a nurse to see you concerning this problem.” ANS: B PTS: 1

17. A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by a couple of days of diarrhea. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be? A. (^) Obtain a complete history. B. (^) Order a barium enema. C. (^) Schedule a Bernstein’s test. D. (^) Prescribe a trial of antispasmodics. ANS: A PTS: 1
18. A 28-year-old patient is seen in the clinic with colicky abdominal pain, particularly after meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely? A. (^) Her age B. (^) Frequent constipation C. (^) Pain after meals D. (^) Colicky abdominal pain ANS: A PTS: 1
19. A 28-year-old patient is seen with complaints of diarrhea. Which of the following responses to the history questions would help the primary-care provider (PCP) establish the diagnosis of irritable bowel syndrome (IBS)? A. (^) Feels relief after urination B. (^) Pain wakes up patient from sleep C. (^) Defecates in the middle of the night D. (^) Pain is precipitated by eating ANS: D PTS: 1
20. Which of these is one of the most common dietary triggers of IBS? A. (^) Gluten-free items B. (^) Lactose C. (^) Honey D. (^) Meat ANS: B PTS: 1
21. Which of the following patients has an increased risk of epigastric hernia? A. (^) Mark, a 45-year-old African American male with chronic obstructive pulmonary disease

1 B.

Gladys, a 93-year-old Hispanic female with dyslipidemia C. (^) Tony, a 33-year-old Asian male with hypertension D. (^) Whitney, a 22-year-old Caucasian female with anemia ANS: A PTS: 1

22. Elaine is a 32-year-old Hispanic woman who is 33 weeks pregnant. She complains that when she wipes after defecation she noticed “a red streak on the toilet paper.” Which of the following should be included in the differential diagnosis? A. (^) Gastric ulcer B. (^) Rectal prolapse C. (^) Diverticulitis D. (^) Irritable bowel syndrome ANS: B PTS: 1
23. A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the explanation of the pathology report? A. (^) This is not premalignant tissue. B. (^) This tissue is not resistant to gastric acid. C. (^) This tissue supports healing of the esophagus. D. (^) This tissue does not have an increased risk of developing esophageal adenocarcinoma. ANS: C PTS: 1
24. Which of the following dietary instructions should be given to a patient with GERD? A. (^) Eliminate coffee. B. (^) Drink hot toddies to relieve stomach distress. C. (^) Recline and rest after meals. D. (^) Increase the amount of spicy foods. ANS: A PTS: 1
25. After typical groin hernia surgery, the patient should be instructed to: A. (^) Avoid work for 3 weeks. B. (^) Stay in the hospital for 2 weeks. C. (^) Avoid heavy lifting for 4 to 6 weeks. D. (^) Return to normal activities after 1 month. ANS: C PTS: 1
26. A patient is diagnosed with Giardia lamblia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment? A. (^) Vancomycin B. (^) Penicillin C. (^) Metronidazole D. (^) Bactrim ANS: C PTS: 1

27. A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? A. (^) Very early B. (^3) to 4 hours after perforation C. (^) Late in inflammation D. (^) Appendicitis never presents with vague pain ANS: A PTS: 1
28. The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion? A. (^) Use of fish oil vitamin B. (^) Ethanol avoidance C. (^) Cigarette smoking D. (^) Prednisone use ANS: C PTS: 1
29. A patient is seen with dark-colored urine, and the urine dipstick reveals a high level of bilirubin. Which of the following could be a cause of this problem? A. (^) Increased bilirubin uptake B. (^) Increased bilirubin excretion C. (^) Biliary obstruction D. (^) A serum bilirubin level of 0.5 mg/dL ANS: C PTS: 1
30. Angela is a 30-year-old G0P0 biracial Asian and Caucasian woman. Her body mass index (BMI) is 22 and her history includes anemia, epilepsy, and bee-sting allergy. Which of the following parts of her patient history would increase her risk of cholelithiasis? A. (^) Nulliparity B. (^) Bee-sting allergy C. (^) BMI 22 D. (^) Female gender ANS: D PTS: 1
31. A 21-year-old student presents with complaints of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the- counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about 1 month ago, and she wonders if she might have it also. Examination reveals cervical adenopathy and an enlarged liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point? A. (^) Stool culture B. (^) Liver enzymes C. (^) Antihepatitis D virus D. (^) Thyroid-stimulating hormone test ANS: C PTS: 1

32. On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis? A. (^) Anti-HAV IgM B. (^) HAV IgG C. (^) Anti-HCV D. (^) IgM anti-HBs ANS: A PTS: 1
33. A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back. The NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings? A. (^) Decreased alanine aminotransferase and decreased aspartate aminotransferase B. (^) Elevated alkaline phosphatase C. (^) Decreased indirect bilirubin D. (^) Decreased white blood cells ANS: B PTS: 1
34. Which of the following are included in the Ranson’s criteria for assessing the severity of pancreatitis at the time of diagnosis? A. (^) Blood glucose 180 mg/dL B. (^) Age 45 years old C. (^) Base deficit greater than 4 mEq/L D. (^) Serum LDH greater than 25 IU/L ANS: C PTS: 1
35. Donna is a 36-year-old African American woman with chronic pancreatitis. Which of the following are necessary to manage her condition? A. (^) One alcoholic drink a week maximum B. (^) NSAIDs, which are the only analgesic appropriate for pain relief C. (^) Treating serum glucose levels of 200 to 250 mg/dL D. (^) A low-fat diet of less than 50 g of fat per day ANS: D PTS: 1
36. Which of the following diagnostic tests is ordered for a cecal volvulus bowel obstruction? A. (^) Barium enema B. (^) Colonoscopy C. (^) Endoscopy D. (^) Magnetic resonance imaging (MRI) ANS: A PTS: 1
37. Which of the following is part of the treatment plan for the patient with IBS? A. (^) High-fiber diet

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1 B.

A discussion that the goal of treatment is to cure their disease C. (^) Daily laxatives D. (^) A conversation about their expected shorter life span ANS: A PTS: 1

38. Leslie is a 35-year-old Caucasian woman who presents with weakness, anorexia, weight loss, and fatigue. Her history is significant for inflammatory bowel disease, Hashimoto’s thyroiditis, and cigarette smoking. Which of the following pieces of her history leads the clinician to believe she has primary sclerosing cholangitis? A. (^) Age B. (^) Gender C. (^) Inflammatory bowel disease D. (^) Smoker ANS: C PTS: 1
39. Carl has been diagnosed with Wilson’s disease. Which of the following should be included in his dietary education? A. (^) Avoid calcium-containing foods. B. (^) Increase protein intake with peanut butter. C. (^) Limit shrimp intake. D. (^) Increase fat intake by eating liver. ANS: C PTS: 1
40. Ron has cirrhosis and now presents with altered mental status after increasing protein intake because he was trying to increase muscle mass. Which of the following diseases should the clinician be concerned about? A. (^) Hepatopulmonary syndrome B. (^) Hepatic encephalopathy C. (^) Hepatorenal syndrome D. (^) Spontaneous bacterial peritonitis ANS: B PTS: 1