GI Flashcards
A patient is diagnosed with fibrotic liver disease; a liver biopsy shows micronodular cirrhosis.
What is the most common cause of this form of cirrhosis?
a. Alcoholism
b. Hepatitis C
c. Hepatocellular carcinoma
d. Right-sided heart failure
ANS: A
Micronodular cirrhosis is often associated with alcoholic liver disease. Viral causes and
carcinoma usually cause macronodular cirrhosis. Right-sided heart failure occurs with many
other causes as part of the disease development.
A patient with a history of chronic alcoholism reports weight loss, pruritis, and fatigue. The
patient’s urine and stools appear normal. What do these findings indicate?
a. Early liver cirrhosis
b. Late liver cirrhosis
c. Liver failure and ascites
d. Probably viral hepatitis
ANS: A
Early symptoms of cirrhosis are characterized by this patient’s symptoms. As the condition
worsens, stools and urine change color and the patient develops anorexia, nausea, and
vomiting. Liver failure and ascites are late and will include abdominal pain. Viral hepatitis is a
less likely diagnosis in the patient with a history of alcoholism.
A patient diagnosed with cirrhosis develops ascites. Which medication will be ordered initially to improve symptoms? a. Cephalosporin b. Furosemide c. Lactulose d. Spironolactone
ANS: D
Spironolactone is the initial diuretic used to improve fluid diuresis in patients with ascites.
Furosemide may be used as adjunctive therapy. Cephalosporin is used when infections occur.
Lactulose is used to increase stools and reduce encephalopathy.
A patient with a history of diverticular disease asks what can be done to minimize acute
symptoms. What will the provider recommend to this patient?
a. Avoiding saturated fats and red meat
b. Consuming a diet high in fiber
c. Taking an anticholinergic medication
d. Using bran to replace high-fiber foods
ANS: B
Increasing dietary fiber reduces constipation and reduces the incidence of acute symptoms.
Avoiding saturated fats and red meats does not reduce the risk of diverticulitis but does
decrease the risk of colon cancer. Anticholinergics and antispasmodics do not prevent attacks
but may help with symptoms. Bran may be used as an adjunct to high-fiber foods but should
not replace other high-fiber sources.
A patient with a history of diverticular disease experiences left-sided pain and reports seeing
blood in the stool. What is an important intervention for these symptoms?
a. Ordering a CBC and stool for occult blood
b. Prescribing an antispasmodic medication
c. Referring the patient for a lower endoscopy
d. Reminding the patient to eat a high-fiber diet
ANS: C
Patients with suspected diverticular abscess of rectal bleeding need further evaluation and a
referral for lower endoscopy is warranted. Hemorrhage is more common from the right colon.
The other actions do not have priority over the need to evaluate the cause of the bleeding.
A patient has intermittent left-sided lower abdominal pain and fever associated with bloating
and constipation alternating with diarrhea. The provider suspects acute diverticulitis. Which
tests will the provider order? (Select all that apply.)
a. Barium enema examination
b. Computerized tomography (CT) scan of abdomen and pelvis
c. Plain abdominal radiographs
d. Rigid sigmoidoscopy
e. Stool for occult blood
ANS: B, E
For symptomatic diverticulosis, the diagnosis of diverticulosis or segmental colitis (as with
SCAD) can be established by direct view on colonoscopy or flexible sigmoidoscopy. A CT
scan of the abdomen can also diagnose diverticulosis. A barium or water-soluble enema
should not be utilized if acute diverticulitis is suspected. Plain abdominal x-ray films will be
normal and are unnecessary, although they are sometimes ordered to exclude the presence of
free air in the abdomen.
A 50-year-old, previously healthy patient has developed gastritis. What is the most likely cause of this condition? a. H. pylori infection b. NSAID use c. Parasite infestation d. Viral gastroenteritis
ANS: A
H. pylori accounts for most cases such as gastritis, duodenal ulcers, and gastric ulcers. NSAID
use is an important cause, but not likely in a previously healthy individual. Parasites are the
leading cause worldwide, but not in the United States. Viral gastroenteritis usually does not
cause chronic gastritis and usually has lower GI symptoms.
A patient has both occasional “coffee ground” emesis and melena stools. What is the most
probably source of bleeding in this patient?
a. Hepatic
b. Lower gastrointestinal (GI) tract
c. Rectal
d. Upper gastrointestinal (GI) tract
ANS: D
Coffee ground emesis is usually old blood from an upper GI source and melena is black,
shiny, foul-smelling as a result of blood degradation and is usually upper GI in origin. Lower
GI and rectal bleeding will cause bright red blood in stools. Hepatic bleeding usually does not
affect the GI tract.
What initial action is appropriate when admitting a patient who has a gastrointestinal (GI)
tract bleed, hypotension, and a hematocrit decrease of 6% from baseline?
a. Administer packed red blood cells.
b. Place a Foley catheter to monitor output.
c. Place two large-bore intravenous lines.
d. Prepare for surgical repair of the bleed.
ANS: C
The first interventions should involve restoring circulatory status to normal in patients with
hypotension and low hematocrit. Placement of two large-bore intravenous lines or a central
line is essential to allow transfusions of PRCs and fluids. The other interventions will be
carried out but are not the initial action.
A patient reports lower abdominal cramping and occasional blood in stools. The provider
suspects inflammatory bowel disease. Which test will the provider order to determine whether
the patient has ulcerative colitis (UC) or Crohn’s disease (CD)?
a. Barium enema
b. Colonoscopy
c. Genetic testing
d. Small bowel series
ANS: B
Colonoscopy is useful in differentiating UC from CD. Barium enema has limited use in
diagnosis, but is used to detect distension, strictures, tumors, fistulas, or obstructions. Genetic
testing may be helpful in the future with further advances. Small bowel series are used
infrequently to determine small bowel involvement.
A patient is diagnosed with mild to moderate ulcerative colitis. Which medication will be
prescribed initially to establish remission?
a. Azathioprine
b. Budesonide
c. Infliximab
d. Sulfasalazine
ANS: D
Sulfasalazine is a 5-aminosalicyclic acid used to induce remission in UC and is a first-line
medication. Budesonide is a synthetic corticosteroid used for moderate to severe disease, but
not as a first-line agent. Azathioprine is an immunomodulator used to minimize the need for
corticosteroids. Infliximab is a biologic medication and is more useful for treating Crohn’s
disease.
Which are characteristics of Crohn’s disease (CD)? (Select all that apply.)
a. Fistulous tracts may occur as disease complications.
b. Half of patients will not have significant remission of symptoms.
c. Inflammation affects all layers of the intestinal tract wall.
d. The disease may be limited to the small intestine.
e. The inflammation is diffuse and continuous
ANS: A, C, D
CD may be complicated by fistulous tracts. Inflammation affects all layers of the intestinal
wall tract. The disease may be limited to the small intestine. UC causes inflammation that is
diffuse and continuous and about 50% of patients with UC may never have significant
remission of symptoms.
What is the probable underlying pathology of irritable bowel syndrome (IBS), according to
research over the last decade?
a. Alteration in processing of sensory information
b. Changes in intestinal secretory mucosa
c. Intestinal tissue disease
d. Malabsorption of specific nutrients
ANS: A
Recent research has yielded information about alterations in sensory processing that are
different in persons with IBS. Changes in intestinal mucosa, intestinal tissue disease, and
malabsorption syndromes are structural disorders and this is a functional disease.
Which symptom must be present for a diagnosis of irritable bowel syndrome (IBS)?
a. Abdominal pain
b. Bloating
c. Constipation
d. Diarrhea
ANS: A
Abdominal pain must be present to diagnose IBS. The other symptoms may or may not occur
A patient has irritable bowel syndrome (IBS) with alternating diarrhea and constipation and
asks the provider about dietary changes that may help with symptoms. What will the provider
recommend?
a. Avoiding all beverages containing caffeine
b. Consuming a high-fiber diet
c. Eliminating all foods containing dairy
D. keep food diary
ANS: D
Because all patients with IBS are different and there are no specific foods that cause
symptoms, each patient should keep a diary to determine which foods may trigger symptoms
before adding or eliminating foods.
Which is the most common cause of pancreatitis in the United States?
a. Ethyl alcohol
b. Gallstones
c. Hyperlipidemia
d. Trauma
ANS: B
Gallstones are the most common cause of pancreatitis in the United States.
A patient reports a sudden onset of constant, sharp abdominal pain radiating to the back. The
examiner notes both direct and rebound tenderness with palpation of the abdomen. What is the
significance of this finding?
a. Compression of the common bile duct
b. Presence of a pancreatic pseudocyst
c. Retroperitoneal hemorrhage
d. Severe acute pancreatitis with peritonitis
ANS: D
Direct and rebound tenderness is an ominous sign suggesting severe peritonitis. Jaundice is
present with compression of the common bile duct. Palpation of a mass suggests the presence
of a pancreatic pseudocyst. Bruising of the periumbilicus or flank suggests retroperitoneal
hemorrhage.
The provider suspects that a patient has chronic pancreatitis. Which diagnostic tests will be most helpful to confirm this diagnosis? a. Blood glucose and fecal fat b. Complete blood count (CBC) c. Liver function tests (LFTs) d. Serum amylase and lipase levels
ANS: A
Patients with pancreatic insufficiency will have elevated blood glucose levels and steatorrhea.
The CBC, LFTs, and serum amylase and lipase are typically normal with chronic pancreatitis.
A patient with a history of esophageal reflux reports difficulty swallowing. The provider notes
fixed cervical and axillary lymphadenopathy on exam. What is the significance of these
findings if esophageal carcinoma is suspected?
a. A tumor is likely confined to the upper esophagus.
b. Lymphadenopathy indicates advanced disease.
c. The prognosis for cure is poor.
d. This type of cancer responds well to radiation
ANS: C
Supraclavicular, cervical, and axillary lymphadenopathy are signs of advanced disease and
suggestive of metastatic disease. Hepatomegaly and superior vena cava syndrome indicate a
poor prognosis. Esophageal cancer usually has a high mortality rate.
A patient is diagnosed with gastric cancer after presenting with cachexia, small bowel
obstruction, hepatomegaly, and ascites. What will the provider tell this patient about treatment
and possible cure?
a. A complete resection will be curative.
b. Chemotherapy is the only option.
c. Palliative resection may be performed.
d. Radiation therapy is preferred for metastasis
ANS: C
This patient presented with signs of advanced disease, which has a poor prognosis. Palliative
resection may be performed. Curative treatment involves surgery, chemotherapy, and
radiation. Chemotherapy is not the only option and is usually combined with other therapies.
Chemotherapy is preferred for metastatic disease.
A patient is diagnosed with cancer of the colon and is scheduled for surgical resection. A
carcinoembryonic antigen (CEA) test prior to surgery is not elevated. What is the significance
of this finding?
a. A negative CEA indicates a reduced need for surgery.
b. The CEA should be repeated every 3 months.
c. The test is not informative and will not be repeated.
d. This result indicates a better prognosis for cure.
ANS: C
A negative CEA indicates that this test is not informative and will not be useful
postoperatively. A positive CEA indicates the usefulness of this test and the measurement
should be repeated every 3 months after surgery to detect tumor recurrence. It does not
indicate whether surgery should be performed and does not predict cure rates.
The parent of an infant asks about using a probiotic medication. What will the
primary care pediatric nurse practitioner tell this parent?
A. Probiotic medications have demonstrated efficacy in treating colic.
B. Probiotics are not safe to use to treat infants who have colic.
C. There are no studies showing usefulness of probiotics to manage colic.
D. There is no conclusive evidence about using probiotics to treat
colic.
D. There is no conclusive evidence about using probiotics to treat
colic.
A toddler is seen in the clinic after a 2day history of intermittent vomiting and
diarrhea. An assessment reveals an irritable child with dry mucous membranes, 3second capillary refill, 2second recoil of skin, mild tachycardia and tachypnea, and cool hands and feet. The child has had two wet diapers in the past 24 hours. What will the primary care pediatric nurse practitioner
recommend?
A. Antidiarrheal
medication and clear fluids for 24 hours
B. Bolus of IV normal saline in the clinic until improvement
C. Hospital admission for IV rehydration and oral fluids
D. Oral rehydration solution with followup in 24 hours
D. Oral rehydration solution with followup in 24 hours
A 9 yearold girl has a history of frequent vomiting and her mother has frequent
migraine headaches. The child has recently begun having more frequent and prolonged episodes accompanied by headaches. An exam reveals abnormal eye movements and mild ataxia. What is the
correct action?
A. Begin using an antimigraine medication to prevent headaches.
B. Prescribe ondansetron and lorazepam to help manage symptoms.
C. Reassure the parent that this is expected with cyclic vomiting syndrome.
D. Refer to a pediatric gastroenterologist for further workup.
D. Refer to a pediatric gastroenterologist for further workup.
