You read GI bleed, liver, and nutrition stems and pick the intervention that protects the patient now. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the RN exams exam guide or more RN exams practice questions.
Five gastrointestinal questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A 42-year-old accountant is referred to your office for evaluation of progressive weight loss. He has lost 20 pounds over the last 6 months. He has a long history (16 years) of insulin-dependent diabetes mellitus. He denies alcohol abuse but admits to heavy smoking (2 packs of cigarettes per day for 20 years). Three days ago he noticed that his urine became dark and that his skin started to itch. He had a CT scan of the abdomen last week that revealed fullness in the head of the pancreas with dilatation of intra- and extrahepatic biliary ducts. The CT scan did not demonstrate a discrete mass in the pancreas or liver, gallstones, or pancreatitis. His physical examination is normal except for obvious jaundice. His blood work reveals WBC count 6.4, total bilirubin 5.7 mg/dL, alkaline phosphatase 340 U/L, amylase 64 U/L, and lipase 47 U/L. Which of the following tests would you order next?
A. Hepatobiliary scintigraphy (HIDA-scan)
B. Abdominal ultrasound
C. Endoscopic retrograde cholangiopancreatography (ERCP)
D. Transcutaneous transhepatic cholangiography
Show answer and rationale
Correct answer: C — Endoscopic retrograde cholangiopancreatography (ERCP)
The patient has developed obstructive jaundice. Obstructive jaundice and severe progressive weight loss in this young male with a long history of diabetes mellitus and heavy smoking could indicate a malignant neoplasm. Dilatation of both intra- and extrahepatic ducts, along with the fullness in the head of the pancreas, are suspicious for obstructing tumor in the head of the pancreas or in the major duodenal papilla (ampullary mass). The patient clinically does not have evidence of gastric outlet or duodenal obstruction (i.e., no nausea or vomiting), so an upper GI series is not indicated. Abdominal ultrasound and HIDA scan are unlikely to provide more information in this case. ERCP will allow visualization of the major duodenal papilla and reveal information about the biliary and pancreatic ducts (e.g., diameter, location, and grade of obstruction). ERCP can also relieve the obstruction with internal biliary stenting. If cannulation of the biliary ducts during the ERCP is not successful, then more invasive transcutaneous transhepatic cholangiography is indicated. This patient may also need endoscopic ultrasound with fine-needle aspiration biopsy to rule out an early, small mass in the head of the pancreas not detected by abdominal CT scan.
Question 2
According to Allen and Summers in their JAMA article 'Medicaid Expansion and Health,' what is one reason why researchers look at condition-specific health outcomes, as stated by Allen and Sommers in their 2019 JAMA article?
A. They are not affected by patient characteristics
B. Health insurance tends to benefit those with serious health conditions the most
C. It is easy to get data from medical records
D. It is an equally plausible method for all health conditions
Show answer and rationale
Correct answer: B — Health insurance tends to benefit those with serious health conditions the most
The correct answer is B: Health insurance tends to benefit those with serious health conditions the most. This is because researchers look at condition-specific health outcomes to understand how health insurance impacts individuals with specific health conditions. By focusing on condition-specific outcomes, researchers can assess the effectiveness of health insurance in improving health outcomes for those with serious health conditions. This choice aligns with the purpose of the study mentioned in the JAMA article.
Explanation of why the other choices are incorrect:
A: They are not affected by patient characteristics - This is incorrect because patient characteristics can play a significant role in affecting health outcomes, regardless of the specific health condition being studied.
C: It is easy to get data from medical records - This is incorrect because while medical records can provide valuable data for research, the ease of obtaining data is not the primary reason why researchers focus on condition-specific health outcomes.
D: It is an equally plausible method for all health conditions - This is incorrect because different health conditions may require different approaches to studying
Question 3
According to Allen and Summers in their JAMA article 'Medicaid Expansion and Health,' what is one reason why researchers look at condition-specific health outcomes, as stated by Allen and Sommers in their 2019 JAMA article?
A. They are not affected by patient characteristics
B. Health insurance tends to benefit those with serious health conditions the most
C. It is easy to get data from medical records
D. It is an equally plausible method for all health conditions
Show answer and rationale
Correct answer: B — Health insurance tends to benefit those with serious health conditions the most
The correct answer is B: Health insurance tends to benefit those with serious health conditions the most. This is because researchers look at condition-specific health outcomes to understand how health insurance impacts individuals with specific health conditions. By focusing on condition-specific outcomes, researchers can assess the effectiveness of health insurance in improving health outcomes for those with serious health conditions. This choice aligns with the purpose of the study mentioned in the JAMA article.
Explanation of why the other choices are incorrect:
A: They are not affected by patient characteristics - This is incorrect because patient characteristics can play a significant role in affecting health outcomes, regardless of the specific health condition being studied.
C: It is easy to get data from medical records - This is incorrect because while medical records can provide valuable data for research, the ease of obtaining data is not the primary reason why researchers focus on condition-specific health outcomes.
D: It is an equally plausible method for all health conditions - This is incorrect because different health conditions may require different approaches to studying
Question 4
A nurse in the medical-surgical unit is giving a patient with low blood pressure a hypertonic solution, which will increase the number of dissolved particles in his blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Which of the following terms is associated with this process?
A. Hydrostatic pressure
B. Osmosis and osmolality
C. Diffusion
D. Active transport
Show answer and rationale
Correct answer: B — Osmosis and osmolality
Osmosis is the movement of fluid from a region of low solute concentration to a region of high solute concentration across a semipermeable membrane. The number of dissolved particles contained in a unit of fluid determines the osmolality of a solution, which influences the movement of fluid between the fluid compartments. Giving a patient who has a low blood pressure a hypertonic solution will increase the number of dissolved particles in the blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Option A is incorrect; hydrostatic pressure refers to changes in water or volume related to water pressure. Option C is incorrect; diffusion is the movement of solutes from an area of greater concentration to lesser concentration. The solutes in an intact vascular system are unable to move, so diffusion should not normally take place. Option D is incorrect; active transport is the movement of molecules against the concentration gradient and requires ATP as an energy source. This process typically takes place at the cellular level and is not involved in vascular volume changes.
Question 5
Which of the following is a common challenge for healthcare providers in rural areas?
A. High patient volume
B. Lack of specialized training for providers
C. Limited healthcare infrastructure
D. Too many healthcare providers
Show answer and rationale
Correct answer: C — Limited healthcare infrastructure
The correct answer is C: Limited healthcare infrastructure. In rural areas, healthcare facilities, equipment, and resources are often scarce, leading to challenges in providing comprehensive care. This can result in limited access to services, longer wait times, and difficulties in managing emergencies.
Rationale:
1. Limited resources: Rural areas typically have fewer hospitals, clinics, and medical professionals, making it harder to meet the healthcare needs of the population.
2. Transportation barriers: Patients may have to travel long distances to reach healthcare facilities due to the limited infrastructure, leading to delays in seeking care.
3. Lack of technology: Rural areas may lack advanced medical equipment and technology, affecting the quality and efficiency of healthcare services.
Summary of Incorrect Choices:
A. High patient volume: This is not a common challenge in rural areas where the population density is lower, leading to fewer patients compared to urban areas.
B. Lack of specialized training for providers: While this can be a challenge, limited healthcare infrastructure is a more pressing issue
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Question 6
Which of the following is a common challenge for healthcare providers in rural areas?
A. High patient volume
B. Lack of specialized training for providers
C. Limited healthcare infrastructure
D. Too many healthcare providers
Correct answer:
The correct answer is C: Limited healthcare infrastructure. In rural areas, healthcare facilities, equipment, and resources are often scarce, leading to challenges in providing comprehensive care. This can result in limited access to services, longer wait times, and difficulties in managing emergencies.
Rationale:
1. Limited resources: Rural areas typically have fewer hospitals, clinics, and medical professionals, making it harder to meet the healthcare needs of the population.
2. Transportation barriers: Patients may have to travel long distances to reach healthcare facilities due to the limited infrastructure, leading to delays in seeking care.
3. Lack of technology: Rural areas may lack advanced medical equipment and technology, affecting the quality and efficiency of healthcare services.
Summary of Incorrect Choices:
A. High patient volume: This is not a common challenge in rural areas where the population density is lower, leading to fewer patients compared to urban areas.
B. Lack of specialized training for providers: While this can be a challenge, limited healthcare infrastructure is a more pressing issue
Priority Decision: The nurse admitting a patient for bariatric surgery obtains the following information from the patient. Which finding should be brought to the surgeon's attention before proceeding with further patient preparation?
A. History of hypertension
B. History of untreated depression
C. History of multiple attempts at weight loss
D. History of sleep apnea treated with continuous positive airway pressure (CPAP)
Correct answer:
The correct answer is B: History of untreated depression. Before proceeding with further patient preparation for bariatric surgery, it is crucial to address untreated depression as it can significantly impact the patient's mental and emotional well-being post-operatively. Untreated depression can lead to poor compliance with post-operative instructions, medication management issues, and potentially increase the risk of complications. It is essential to involve the surgeon to assess the patient's psychological readiness for surgery and ensure appropriate support and resources are in place.
Incorrect choices:
A: History of hypertension - While hypertension should be managed pre-operatively, it is not a critical factor that would require immediate attention before further preparation.
C: History of multiple attempts at weight loss - This is a common issue in patients undergoing bariatric surgery and does not pose an immediate risk that needs urgent attention.
D: History of sleep apnea treated with CPAP - While sleep apnea is a relevant consideration for bariatric surgery, the fact that it is being treated with
Priority Decision: The nurse admitting a patient for bariatric surgery obtains the following information from the patient. Which finding should be brought to the surgeon's attention before proceeding with further patient preparation?
A. History of hypertension
B. History of untreated depression
C. History of multiple attempts at weight loss
D. History of sleep apnea treated with continuous positive airway pressure (CPAP)
Correct answer:
The correct answer is B: History of untreated depression. Before proceeding with further patient preparation for bariatric surgery, it is crucial to address untreated depression as it can significantly impact the patient's mental and emotional well-being post-operatively. Untreated depression can lead to poor compliance with post-operative instructions, medication management issues, and potentially increase the risk of complications. It is essential to involve the surgeon to assess the patient's psychological readiness for surgery and ensure appropriate support and resources are in place.
Incorrect choices:
A: History of hypertension - While hypertension should be managed pre-operatively, it is not a critical factor that would require immediate attention before further preparation.
C: History of multiple attempts at weight loss - This is a common issue in patients undergoing bariatric surgery and does not pose an immediate risk that needs urgent attention.
D: History of sleep apnea treated with CPAP - While sleep apnea is a relevant consideration for bariatric surgery, the fact that it is being treated with
Which healthcare issue is particularly common in rural areas due to limited access to specialty care?
A. Chronic disease management
B. Access to routine vaccinations
C. Trauma care
D. All of the above
Correct answer:
The correct answer is A: Chronic disease management. Limited access to specialty care in rural areas makes managing chronic conditions challenging. Patients may not have easy access to specialists, leading to delays in treatment and poor disease management. This can result in exacerbation of chronic conditions and increased healthcare costs.
B: Access to routine vaccinations is not particularly impacted by limited access to specialty care in rural areas. Vaccinations are often provided by primary care providers or public health clinics, which are more widely available in rural communities.
C: Trauma care, while important, is not the healthcare issue that is particularly common in rural areas due to limited access to specialty care. Trauma care is usually provided by emergency departments in hospitals, which may be more limited in rural areas but is not directly related to specialty care access.
D: "All of the above" is incorrect because only chronic disease management is specifically affected by limited access to specialty care in rural areas, not routine vaccinations or trauma care.
A 62-year-old man presents complaining of abdominal pain and diarrhea. He notes that the symptoms have been going on for three months now and he has lost about 20 pounds over that span. He also complains of migratory arthralgias for the past year. He denies any past medical history. He never smoked cigarettes and drinks about two beers per week. He denies use of illicit drugs. A review of records from an evaluation done by another physician reveals a normal thyroid-stimulating hormone level, negative ANA, a normal sedimentation rate, and a negative HIV test. He had a flexible sigmoidoscopy done, which failed to reveal any abnormalities. You refer him for upper endoscopy and a duodenal biopsy is done, which reveals extensive PAS-positive material in the lamina propria and villous atrophy. What is the most appropriate therapy for this patient?
A. A gluten-free diet
B. A lactose-free diet
C. Cholestyramine
D. Trimethoprim/sulfamethoxazole
Correct answer:
This man presents with the hallmarks of Whipple's disease (i.e., abdominal pain, diarrhea, weight loss, and arthralgias). His workup has made the diagnoses of thyroid disease, HIV, inflammatory bowel disease, and collagen vascular diseases unlikely. His small bowel biopsy is consistent with changes seen in Whipple's disease. Electron microscopy of the specimen should be able to identify the Whipple bacillus. In contrast, the pathologic findings in celiac disease include decreased villous height to crypt depth, decreased epithelial surface cell height, and increased lymphocytic infiltration of the mucosa. PAS-positive material in the lamina propria is not seen. The treatment for Whipple's disease is one year of trimethoprim/sulfamethoxazole. A gluten-free diet would be used for celiac disease. A lactose-free diet is indicated for patients with lactose intolerance. Cholestyramine is used for patients with bile acid diarrhea, usually in the setting of ileal disease. Prednisone can be used in some cases of inflammatory bowel disease and refractory celiac sprue but is not appropriate for Whipple's.
Which healthcare issue is particularly common in rural areas due to limited access to specialty care?
A. Chronic disease management
B. Access to routine vaccinations
C. Trauma care
D. All of the above
Correct answer:
The correct answer is A: Chronic disease management. Limited access to specialty care in rural areas makes managing chronic conditions challenging. Patients may not have easy access to specialists, leading to delays in treatment and poor disease management. This can result in exacerbation of chronic conditions and increased healthcare costs.
B: Access to routine vaccinations is not particularly impacted by limited access to specialty care in rural areas. Vaccinations are often provided by primary care providers or public health clinics, which are more widely available in rural communities.
C: Trauma care, while important, is not the healthcare issue that is particularly common in rural areas due to limited access to specialty care. Trauma care is usually provided by emergency departments in hospitals, which may be more limited in rural areas but is not directly related to specialty care access.
D: "All of the above" is incorrect because only chronic disease management is specifically affected by limited access to specialty care in rural areas, not routine vaccinations or trauma care.
The amount of neurotransmitter that is present in a synapse at any given time must be carefully controlled in order to prevent excessive stimulation of the post synaptic terminal. In general, which of the following represent ways in which excessive accumulation of a transmitter can be prevented?
A. reuptake of the transmitter at the presynaptic terminal
B. enzymatic degradation of the transmitter within the synapse
C. negative feedback to inhibit further release of the transmitter
D. all of the above
Correct answer:
Step 1: Reuptake of the transmitter at the presynaptic terminal: This process involves the retrieval of excess neurotransmitter molecules back into the presynaptic neuron, preventing excessive accumulation in the synapse.
Step 2: Enzymatic degradation of the transmitter within the synapse: Enzymes break down excess neurotransmitter molecules in the synapse, helping to maintain optimal levels and preventing overstimulation of the post synaptic terminal.
Step 3: Negative feedback to inhibit further release of the transmitter: When neurotransmitter levels are high, negative feedback mechanisms can inhibit further release, preventing excessive accumulation and maintaining synaptic balance.
Summary:
- Option A and B are correct because reuptake and enzymatic degradation help prevent excessive accumulation of neurotransmitters.
- Option C is also correct as negative feedback mechanisms play a role in regulating neurotransmitter release.
- Therefore, the correct answer is D, as all of the above mechanisms work together to prevent excessive accumulation of neurotransmitters.
The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, 'I just can't see myself with this thing.'Â What is the best nursing intervention for this patient?
A. Encourage the patient to share concerns and ask questions.
B. Refer the patient to a chaplain to help cope with this situation.
C. Explain that there is nothing the patient can do about it and must take care of it.
D. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.
Correct answer:
The correct answer is A: Encourage the patient to share concerns and ask questions. This option promotes therapeutic communication and allows the patient to express their fears and anxieties, which can help in addressing their concerns and building trust. By encouraging the patient to share their feelings, the nurse can provide emotional support and offer appropriate education tailored to the patient's needs. This approach empowers the patient to take an active role in their care and decision-making process.
Summary:
- Option B (Refer the patient to a chaplain): While spiritual support can be beneficial, in this case, the patient's immediate need is to address their concerns about the colostomy.
- Option C (Explain that there is nothing the patient can do about it): This response is dismissive and not empowering for the patient, undermining their ability to cope effectively.
- Option D (Tell the patient that learning about it will prevent issues): While education is important, forcing information on the patient without addressing their emotional needs may result in
The amount of neurotransmitter that is present in a synapse at any given time must be carefully controlled in order to prevent excessive stimulation of the post synaptic terminal. In general, which of the following represent ways in which excessive accumulation of a transmitter can be prevented?
A. reuptake of the transmitter at the presynaptic terminal
B. enzymatic degradation of the transmitter within the synapse
C. negative feedback to inhibit further release of the transmitter
D. all of the above
Correct answer:
Step 1: Reuptake of the transmitter at the presynaptic terminal: This process involves the retrieval of excess neurotransmitter molecules back into the presynaptic neuron, preventing excessive accumulation in the synapse.
Step 2: Enzymatic degradation of the transmitter within the synapse: Enzymes break down excess neurotransmitter molecules in the synapse, helping to maintain optimal levels and preventing overstimulation of the post synaptic terminal.
Step 3: Negative feedback to inhibit further release of the transmitter: When neurotransmitter levels are high, negative feedback mechanisms can inhibit further release, preventing excessive accumulation and maintaining synaptic balance.
Summary:
- Option A and B are correct because reuptake and enzymatic degradation help prevent excessive accumulation of neurotransmitters.
- Option C is also correct as negative feedback mechanisms play a role in regulating neurotransmitter release.
- Therefore, the correct answer is D, as all of the above mechanisms work together to prevent excessive accumulation of neurotransmitters.
The nurse plans teaching for the patient with a colostomy but the patient refuses to look at the nurse or the stoma, stating, 'I just can't see myself with this thing.' What is the best nursing intervention for this patient?
A. Encourage the patient to share concerns and ask questions.
B. Refer the patient to a chaplain to help cope with this situation.
C. Explain that there is nothing the patient can do about it and must take care of it.
D. Tell the patient that learning about it will prevent stool leaking and the sounds of flatus.
Correct answer:
The correct answer is A: Encourage the patient to share concerns and ask questions. This option promotes therapeutic communication and allows the patient to express their fears and anxieties, which can help in addressing their concerns and building trust. By encouraging the patient to share their feelings, the nurse can provide emotional support and offer appropriate education tailored to the patient's needs. This approach empowers the patient to take an active role in their care and decision-making process.
Summary:
- Option B (Refer the patient to a chaplain): While spiritual support can be beneficial, in this case, the patient's immediate need is to address their concerns about the colostomy.
- Option C (Explain that there is nothing the patient can do about it): This response is dismissive and not empowering for the patient, undermining their ability to cope effectively.
- Option D (Tell the patient that learning about it will prevent issues): While education is important, forcing information on the patient without addressing their emotional needs may result in
RN exams gastrointestinal practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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