CHAPTER 08- Gastrointestinal System Flashcards Preview

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Flashcards in CHAPTER 08- Gastrointestinal System Deck (40)
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1

One pharmacological intervention for a patient with diabetes or pre-diabetes with NASH is:

  1. Tenofovir.
  2. Acetylsalicylic Acid.
  3. Gabapentin.
  4. Metformin.

4. Metformin.

While you the FNP could encourage the patient to lose weight,make lifestyle changes to decrease risk of cardiovascular risk factors, and avoid alcohol, a pharmacological intervention for a patient with diabetes or pre-diabetes with NASH is Metformin.

2

Of the following options, which two are factors that may lead to faster progression of hepatitis C (HCV) disease?

  1. Female gender, comorbid cardiovascular disease
  2. Male gender, comorbid HIV infection
  3. Male gender, comorbid pulmonary disease
  4. Female gender, comorbid irritable bowel syndrome

2. Male gender, comorbid HIV infection

Factors associated with increased progression and severity are age of 40+, HIV co-infection, chronic HBV co-infection, increased alcohol intake, and being a male.

3

A 33-year-old male patient is new to the FNP’s practice. During the health history, he mentions he was told he had hepatitis. He is unsure which type of hepatitis and asks what it is. The FNP tells him that hepatitis is:

  1. Fibrosis of the liver.
  2. Infection of the liver.
  3. Cirrhosis of the liver.
  4. Inflammation of the liver.

4. Inflammation of the liver.

Hepatitis is liver inflammation arising from an autoimmune disorder or viral infection.

4

A 33-year-old male patient is new to the FNP’s practice. During the health history, he mentions he was told he had hepatitis. He is unsure which type of hepatitis and asks what it is. The FNP is ordering bloodwork for this new patient. To evaluate which hepatitis the patient was previously diagnosed with, the initial laboratory testing will include:

  1. HAV viral load, HDV IgG.
  2. HCV Ag, HBV eAg, HAV viral load.
  3. HAV total Ab, HCV Ab, HBV sAg and HBsAb.
  4. HCV IgG, HAV IgG, HBV viral load.

3. HAV total Ab, HCV Ab, HBV sAg and HBsAb.

The FNP is ordering bloodwork for this new patient. To evaluate which hepatitis the patient was previously diagnosed with the initial laboratory testing will include: HAV total Ab, HCV Ab, HBV sAg and HBsAb.

5

A 33-year-old male patient is new to the FNP’s practice. During the health history, he mentions he was told he had hepatitis. He is unsure which type of hepatitis and asks what it is. The patient’s labs return. What do these results indicate?: HBsAg = positive; HBsAb = negative; IgM HbcAB = negative; HAV Ab total = positive; HCV Ab = nonreactive

  1. Acute hepatitis C infection, past hepatitis A infection
  2. Chronic hepatitis B infection, acute hepatitis A infection
  3. Past hepatitis A infection, chronic hepatitis B infection
  4. Past hepatitis B infection, past hepatitis A infection

3. Past hepatitis A infection, chronic hepatitis B infection

For hepatitis A, the causative agent is RNA Picornavirus--a single serotype worldwide. The virus is transmitted via fecal or oral routes and has an incubation period of 15-20 days. There is a vaccination. 

6

Which type of hepatitis is most commonly caused by contaminated foods?

  1. HBV
  2. HCV
  3. HDV
  4. HAV

4. HAV

The type of hepatitis most commonly caused by contaminated foods is HAV.

7

A 50-year-old female patient thinks she may have gotten hepatitis C from a previous sexual partner. She asks what the signs and symptoms of acute infection are. The FNP responds by listing which options?

  1. Nausea, vomiting, bloody diarrhea
  2. Fever, fatigue, body aches
  3. Sweating, dyspepsia, tachycardia
  4. Vomiting, headache, diarrhea

2. Fever, fatigue, body aches

 Fever, fatigue, body aches are all symptoms of Hepatitus C. This is transmitted through blood products and can occur in sexual transmission. 

8

Peter is a 50-year-old African American male who is HCV+ from IVDU (intravenous drug users) many years ago. He has not used street drugs for over 15 years and works long hours as a train conductor. He is asking about his routine health maintenance in regard to HCV. Which of the following yearly exams are recommended by the FNP?

  1. CT scan, liver biopsy, HCV viral load, and liver enzymes
  2. Liver ultrasound, liver enzymes, AFP, HCV viral load
  3. Liver biopsy, liver ultrasound, liver enzymes, CBC
  4. HCV viral load, genotype, and CT scan

2. Liver ultrasound, liver enzymes, AFP, HCV viral load

Yearly exams recommended: Liver ultrasound, liver enzymes, AFP, HCV viral load.

9

A 62-year-old female patient comes to the FNP’s office with complaints of constipation for the past few months. She has tried to increase her intake of water and fiber without much success. A yearly physical exam and colonoscopy were negative for any significant findings 6 months prior to this visit. Which of the following options would be most appropriate for the next step?

  1. Recommend daily Dulcolax use as an addition to the fiber and water.
  2. Recommend an increase in exercise, such as walking, and daily Miralax use for 2 weeks, then have her return for evaluation in one month.
  3. Recommend daily Fleet enema use upon arising in addition to current approach. Refer to GI specialist if no improvement.
  4. Recommend CT scan of abdomen to rule out malignancy.

2. Recommend an increase in exercise, such as walking, and daily Miralax use for 2 weeks, then have her return for evaluation in one month.

Being fiber isn't working, Miralax is the best choice. It is a Osmotic laxative and it works with lactulose to pull water into  the intestine. 

10

A 50-year-old male with a BMI of 29 comes in for an annual physical exam. Upon review of systems, he mentions he has a lot of heartburn and is taking over-the-counter omeprazole twice a day. He also takes Tums throughout the day. When deciding whether to refer this patient to a gastroenterologist as the next step, what should the FNP take into consideration?

  1. How long the patient has had this problem
  2. How often he is taking the medications
  3. The severity of his symptoms
  4. His age

1. How long the patient has had this problem

The FNP should find out how long the patient has been having this problem and how long they have been taking the medications.

11

The FNP is treating a patient for an H. pylori infection. The patient has a penicillin allergy. Which regimen would be the best choice for this patient?

  1. Omeprazole 20 mg bid, clarithromycin 500 mg bid, and metronidazole 500 mg bid
  2. Lansoprazole 30 mg bid, amoxicillin 1 gm bid, and metronidazole 500 mg bid
  3. Omeprazole 20 mg daily, metronidazole 1 gm bid, and clarithromycin 1 gm bid
  4. Lansoprazole 30 mg bid, metronidazole 500 mg daily, tetracycline 500 mg daily

1. Omeprazole 20 mg bid, clarithromycin 500 mg bid, and metronidazole 500 mg bid

This is the best choice for a patient with a penicillin allergy. 

12

An 80-year-old male patient comes to the clinic with complaints of diarrhea for 2 days. The FNP notes that the patient had been hospitalized 2 weeks ago for pneumonia. What is the most appropriate next question to ask the patient?

  1. What type of antibiotic were you given in the hospital?
  2. How many days were you hospitalized?
  3. How many times per day are you passing stool?
  4. What over-the-counter medications are you taking for the diarrhea?

3. How many times per day are you passing stool?

Individual perception of constipation or diarrhea can vary greatly.

13

A patient with generalized lower abdominal pain and nausea is being evaluated. The patient has a low-grade fever (100.4 degrees F). Which of the following signs if found upon physical examination would suggest appendicitis?

  1. Mittleschmerz
  2. Psoas
  3. Murphy’s
  4. Kernig

2. Psoas

Have the patient lift his or her leg while your hand is placed on the thigh, creating resistance. In appendicitis, the psoas contraction produces pain.

14

The correct sequence for physical examination of the abdomen is:

  1. Inspection, auscultation, percussion, palpation
  2. Inspection, percussion, auscultation, palpation
  3. Auscultation, inspection, percussion, palpation
  4. Auscultation, inspection, palpation, percussion

1. Inspection, auscultation, percussion, palpation

This is the proper order:

Inspection- Examine the abdomen and report scars, rashes, striae, symmetry, contour, masses, pulastions, peristalsis, hernias, and skin discoloration. 

Auscultation- Listen over all four quadrants for bowel sounds and for bruits over the aorta, iliac, renal, and femoral arteries.

Percussion- Note areas of dullness indicative of solid or fluid-filled masses rather than air. Percuss for the liver span and spleen to assess for organomegaly.

Palpation- Start with light palpation in non-tender areas and then move on to deep palpation to assess for organomegaly or masses.

15

Crohn’s disease differs from ulcerative colitis because:

  1. Crohn’s disease causes more severe abdominal cramping.
  2. Crohn’s may affect any part of the gastrointestinal GI tract. Ulcerative colitis is limited to the large intestine.
  3. Ulcerative colitis symptoms tend to flare up more often around menses.
  4. Ulcerative colitis is a chronic condition, whereas Crohn’s disease may occur once and no further flare-ups happen.

2. Crohn’s may affect any part of the gastrointestinal GI tract. Ulcerative colitis is limited to the large intestine.

Crohn’s disease differs from ulcerative colitis because Crohn’s may affect any part of the gastrointestinal GI tract. Ulcerative colitis is limited to the large intestine.

16

A 52-year-old male patient is in the office for a physical examination. He has not been seen in three years. The FNP discusses three screening options for detecting colon cancer with the patient. These options include:

  1. Yearly fecal immunochemical testing (FIT), colonoscopy every 10 years, FIT every year along with flexible sigmoidoscopy every 5 years
  2. Colonoscopy every 5 years, FIT annually
  3. Annual FIT along with flexible sigmoidoscopy or colonoscopy every 3 years
  4. Yearly colonoscopy and FIT for those with genetic predisposition to colon cancer

1. Yearly fecal immunochemical testing (FIT), colonoscopy every 10 years, FIT every year along with flexible sigmoidoscopy every 5 years

To detect colon cancer, a patient should have yearly fecal blood tests, stool DNA tests every three years and if these tests are positive a colonoscopy should be performed. That said, a colonoscopy should be performed every 10 years and a Flexible sigmoidoscopy every 5 years. These time frames alter if the patient has a strong family history of polyposis.

17

A positive Murphy’s sign occurs when:

  1. The diaphragm releases the inflamed gallbladder during percussion.
  2. The intestines push against the diaphragm.
  3. The diaphragm moves the inflamed gallbladder into the palpating hand.
  4. The colon moves the diaphragm against the costovertebral column.

3. The diaphragm moves the inflamed gallbladder into the palpating hand.

A positive Murphy’s sign occurs when the diaphragm moves the inflamed gall bladder into the palpating hand.

18

Which of the following is true concerning the hepatitis B vaccine?

  1. The vaccine contains live hepatitis B virus.
  2. The nurse practitioner should consider post-vaccination HBsAB titers for those at the highest risk of infection.
  3. The vaccine is contraindicated in the presence of HIV infection.
  4. Post-vaccine arthralgias are often reported.

2. The nurse practitioner should consider post-vaccination HBsAB titers for those at the highest risk of infection.

The nurse practitioner should consider post vaccination HBsAB titers for those at the highest risk of infection.

19

Serologic features of acute hepatitis B are:

  1. HBsAg reactive, and high titer of immunoglobulin M(IgM).
  2. HBsAg reactive and high titer of immunoglobin G (IgG).
  3. HBeAg and HBsAg negative.
  4. IgM anti-HBc- (high titer) HBsAg-nonreactive.

1. HBsAg reactive, and high titer of immunoglobulin M(IgM).

Serologic features, or those that are serum relate, of acute hepatitis B are HBsAg reactive and high titer of immunoglobulin M(IgM).

20

Monitoring for hepatocellular carcinoma in a patient with chronic hepatitis B or C often includes the periodic evaluation of which of the following?

  1. Erythrocyte sedimentation rate
  2. HBsAB
  3. Alpha-fetoprotein
  4. Serum creatinine level

3. Alpha-fetoprotein

AFP is made by a fetus’ liver and is found in low levels in adults unless they have certain cancers, in particular hepatocellular cancer.

21

An acute febrile illness with jaundice, anorexia, malaise, and an incubation period of 45–150 days; having a chronic and an acute form; and transmitted by parenteral, sexual activity, and perinatal routes best describes which of the following?

  1. Hepatitis A
  2. Hepatitis B
  3. Hepatitis C
  4. Hepatitis D

2. Hepatitis B

HDV can co-occur with HBV, hepatitis A is typically food/water borne and is not chronic, HCV is not commonly spread via heterosexual transmission in a monogamous relationship.

22

Which of the following laboratory studies is used to determine whether a client has hepatitis A?

  1. Serum protein
  2. Protein electrophoresis
  3. Antibody testing
  4. Immunoglobulin levels

3. Antibody testing

Antibody testing is the study used for Hepatitis A because it is an acute condition and antibodies from the infuction will provide lifelong immunity.

23

What is the most common source for hepatitis A infection?

  1. Needle sharing
  2. Raw shellfish
  3. Contaminated water supplies
  4. Intimate person-to-person contact

3. Contaminated water supplies

The most common source for hepatitis A Infection is contaminated water supplies as the virus is transmitted fecally or orally.

24

When answering questions about the hepatitis A vaccine, the FNP responds that it:

  1. Should be offered to patients with chronic hepatitis C.
  2. Should be offered to those who have traveled to western Europe
  3. Usually is a required immunization for all health care workers.
  4. Is protective after a single vaccine dose.

1. Should be offered to patients with chronic hepatitis C.

Patients with HCV infection need to be protected against other liver damaging infections such as HAV and HBV.

25

Diarrhea is often generally associated with:

  1. Infectious gastroenteritis, inflammatory bowel disease, and diverticulitis.
  2. Diseases of the colon or rectum.
  3. Fever and abdominal pain in sexually transmitted diseases.
  4. Dysuria and flank pain in urinary tract infections.

1. Infectious gastroenteritis, inflammatory bowel disease, and diverticulitis.

Diarrhea is often generally associated with: Infectious gastroenteritis, inflammatory bowel disease, diverticulitis.

26

Potential complications of gastroesophageal reflux disease (GERD) include:

  1. Esophageal ulcers, Barrett’s esophagitis, and esophageal stricture.
  2. Gastric ulcers, esophageal dilatation, and stricture of the lower esophageal sphincter.
  3. Peptic ulcers, esophageal ulcers, and gastric distension.
  4. Aspiration pneumonia, gastric ulcers, and esophageal bleeding.

1. Esophageal ulcers, Barrett’s esophagitis, and esophageal stricture.

Gastroesophageal reflux disease occurs when the gastric stomach contents ascend to the esophagus and cause symptoms such as burning, discomfort, or pain. Esophageal ulcers, Barrett’s esophagitis, and esophageal stricture are possible complications of this.

27

In terms of (GERD), Patient education issues that need to be addressed with the goal of improved patient outcome include:

  1. Reinforce smoking cessation, weight reduction, avoidance of alcohol and caffeine.
  2. Eating no later than midnight, portion control or dietary restrictions, cough suppressants at bedtime.
  3. Elevate the head of the bed on blocks, prn (pro re nata) antacids, bland high-fat diet.
  4. Encourage bland snacks, use H2 blockers, maintain weight restrictions.

1. Reinforce smoking cessation, weight reduction, avoidance of alcohol and caffeine.

These are all good ways to treat GERD and ways to avoid getting triggers of it. 

28

Biliary colic may radiate to the:

  1. Infrascapular area.
  2. Right shoulder.
  3. Neck and left arm.
  4. Periumbilical area.

1. Infrascapular area.

Biliary colic may radiate to the infrascapular area.

29

A 55-year-old schoolteacher with type 2 diabetes presents to your office with complaints of low-grade fever for 3 days and cramping right upper quadrant pain, radiating to the right scapula. Laboratory diagnostics indicate: WBC—13,000; (NL 4.5–11,000); SGOT (AST)—55; (NL 5–40); SGPT (ALT)—65; (NL 5–55); BUN 25 (NL 6–25); Alk. Phos.—140; (NL 35–110); Amylase—130; (NL 20–90). Physical exam reveals epigastric tenderness, guarding, and a positive Murphy’s sign. The FNP suspects:

  1. Acute cholecystitis.
  2. Acute appendicitis.
  3. Hepatitis.
  4. Peptic ulcer disease.

1. Acute cholecystitis.

 The FNP suspects Acute cholecystitis. Mild elevation of white blood cells, liver enzymes, and amylase are found in patients with choleycystitis.

30

The most important contributing factor to the development of a peptic ulcer is:

  1. Eating spicy/acidic foods.
  2. Use of nonsteroidals (NSAIDs).
  3. Stress.
  4. Drinking alcohol.

2. Use of nonsteroidals (NSAIDs).

The most important contributing factor to the development of peptic ulcer is the use of nonsteroidals (NSAIDs). Overuse of NSAIDS or infection with H. Pylori are risk factors for the development of peptic ulcer disease.