MN 551 Unit 6 Quiz/ MN551 Week 6 Quiz (2 Latest Versions) (All correct answers, Already graded A)

MN551 Unit 6 Quiz/ MN 551 Unit 6 Quiz/ MN551 Week 6 Quiz/ MN 551 Week 6 Quiz (Latest) : Kaplan University 1. A 35­year­old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical exam? Digital rectal exam Pelvic exam Sexual history All of the above Hiatal hernia – protrusion of the stomach or regurgitation of the stomach contents into the esophagus 2. A patient is seen in the office and is complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? Multivitamin Magnesium hydroxide Pepto­Bismol Ibuprofen 3. A patient with complaints of diarrhea is seen. Which of the following should be included on the differential diagnosis list for a patient with diarrhea? Gastroenteritis Inflammatory bowel disease Lactase deficiency All of the above 4. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months for which he takes Tums 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? The pain seems better when he smokes to relieve his nerves. Coffee and fried foods do not bother him. He awakens at night coughing with a bad taste in his mouth. All of the above 5. A 29­year­old Englishman is seen in the office with complaints of pain in his chest and belly for 2 weeks. He gets temporary relief from Alka Seltzer. The burning pain wakes him at night and radiates up into his chest. Which factor favors a diagnosis of gastric ulcer?Pg 1181 His gender His age His use of Alka Seltzer 6. Which of the following is most effective in diagnosing appendicitis?Pg 1193 History and physical Sedimentation rate Kidneys, ureter, bladder (KUB) radiograph Complete blood cell (CBC) count with differential (note: there is not always and elevated WBC count) 7. Which of the following is associated with celiac disease (AKA celiac sprue or gluten-sensitivity enteropathy)?Pg 1199 Malabsorption Constipation Rectal bleeding Esophageal ulceration 8. A 45­year­old patient presents with a chief complaint of generalized abdominal pain. Her physical exam is remarkable for left lower quadrant (LLQ) tenderness. Which of the following should be considered in the differential diagnosis at this time?Pg 1192 Endometriosis Colon cancer Diverticulitis All of the above 9. A 46­year­old female is seen in the clinic with abdominal pain. Which of the following tests isessential for this patient? Complete blood cell (CBC) count with differential Urine hCG Barium enema Computed tomography (CT) of the abdomen 10. A 25­year­old accountant is seen in the clinic complaining ofcrampy abdominal pain after meals. She is often constipated and takes laxatives. Following this, she has diarrhea for a couple of days. 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? Obtain a complete history. Order a barium enema. Schedule a Bernstein’s test. (tests esophageal function) Prescribe a trial of antispasmodics. 11. A 28­year­old patient is seen in the clinic with colicky abdominal pain, particularly with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely? Pg Her age(typically seen by age 60) Frequent constipation (common with diverticulitis) Flatulence (common with diverticulitis) Colicky abdominal pain 12. A 28­year­old patient is seen with complaints of diarrhea. Which of the following questions would help the clinician establish the diagnosis of irritable bowel syndrome?Pg 1184 Feels relief after a bowel movement Sometimes is constipated Does not defecate in the middle of the night All of the above 13. A patient is diagnosed with gastroesophageal reflux disease (GERD), and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following information should the clinician include in the explanation of the pathology report?Pg 1175 This is a premalignant tissue. This tissue is resistant to gastric acid. This tissue supports healing of the esophagus. All of the above 14. Which of the following dietary information should be given to a patient with gastroesophageal reflux disease (GERD)? Eliminate coffee. Drink peppermint tea to relieve stomach distress. Recline and rest after meals. Limit the amount of antacids. Notes: Proton pump inhibitors, avoiding large meals, and remaining upright after meals helps with GERD. 15. The patient with gastroesophageal reflux disease (GERD) should be instructed to eliminate which of these activities? Swimming Weight lifting Golfing Walking 16. A patient is diagnosed with Giardia (protozoan infection) after a backpacking trip in the mountains. Which of the following would be the appropriate treatment? Vancomycin Penicillin Metronidazole Bactrim 17. A 22­year­old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis?Pg 1193 Very early 3 to 4 hours after perforation Late in inflammation Appendicitis never presents with vague pain. 18. The clinician suspects the patient has a peptic ulcer. Which of the following items on the history would lead the clinician to this conclusion? Pg 1181 Use of NSAIDs (and infection with H. pylori are two most important) Cigarette smoker Alcohol (ETOH) consumption All of the above 19. A patient is seen and a urine sample is taken. The urine dipstick reveals a high level of bilirubin, and the urine is dark colored. Which of the following could be a cause of this problem? Increased breakdown of red blood cells Inadequate hepatocyte function Biliary obstruction All of the above 20. A 21­year­old student presents with a chief complaint of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over­the­counter (OTC) cold preparations, but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. An examination reveals cervical adenopathy and enlarged liver and spleen. Which of the following laboratory tests would be most helpful in the differential diagnosis at this point? Stool culture Liver enzymes Anti­HDV (antibody to hepatitis D virus) Thyroid­stimulating hormone (TSH) 21. On further questioning, the 21­year­old patient with the chief 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 day­care center. Which of the following tests would be most helpful in confirming your diagnosis? HAV IgM HAV IgG Anti­HAcAg Anti­HAsAg 22. A patient is seen in the clinic with right upper quadrant (RUQ) pain that is radiating to the middle of the back. The clinician suspects acute cholelithiasis. The clinician should expect which of the following laboratory findings? Pg 1215 Decreased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) Elevated alkaline phosphatase Elevated indirect bilirubin Decreased white blood cell (WBC) count 23. The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson’s Criteria. In order to plan care, the clinician understands that this criteria score has which of the following meanings? A high mortality rate An increased chance of recurrence A 7% chance of the disease becoming chronic All of the above 24. A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the clinician to a diagnosis of inflammatory bowel disease? Intermittent constipation with periods of diarrhea Awakens at night with diarrhea History of international travel All of the above 25. Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? High­fiber diet Tylenol with codeine Daily laxatives All of the above data Question 26. Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect? Inhibition of the actions of Brunner glands Overstimulation of the oxyntic glands Suppression of cholecystokinin Inflammation of the parotid glands Rationale: Brunner glands, which produce large amounts of alkaline mucus that protects the duodenum from acid and digestive enzymes, are strongly affected by sympathetic stimulation, which causes a marked decrease in mucus production. Where the stomach contents and secretions from the liver and pancreas enter the duodenum, deficiency of mucus can cause irritation and, potentially, ulcers. Overstimulation of the oxyntic glands is not produced by the SNS. The hormone cholecystokinin, which is thought in part to control gastric emptying, is released in response to the pH, osmolality, and fatty acid composition of the chyme. The two largest salivary glands are called parotid glands. One is located in each cheek over the jaw in front of the ears. Inflammation of one or more of these glands is called parotitis. Question 27.Which of the following patients is most clearly displaying the signs and symptoms of IBD? A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation. A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.” A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day. A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress. Rationale: IBD is commonly manifested as intermittent lower abdominal pain that feels like cramping. Defecation normally relieves the pain, and symptoms are normally not present at night or during sleep. Stress commonly exacerbates symptoms. Question 28.A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her? Lamivudine Peginterferon and ribavirin Interferon-alfa-2b Corticosteroids and immunosuppressant drugs Rationale: This woman's hepatitis is probably caused by an autoimmune disorder rather than a virus. Lamivudine, peginterferon/ribavirin, and interferon alfa-2b are all antiviral agents. Autoimmune hepatitis is a chronic, usually progressive, inflammatory disease of the liver. Corticosteroids are the mainstay of treatment and have been shown to produce remission. Azathioprine, an immunosuppressant medication, is sometimes used along with prednisone. Using both medications may allow you to take a smaller dose of prednisone, reducing its side effects. Most people with this disease require long-term maintenance treatment. Question 29.Which of the following statements best captures an aspect of the process of fat digestion and absorption? Ingested triglycerides are broken down into absorbable form by gastric lipase. Simple forms of fats are absorbed in the upper jejunum. Long-chain fatty acids are absorbed more readily than medium-chain triglycerides. Stool is not excreted until all fat is absorbed. Triglycerides are digested with the aid of bile salts. Rationale: After breakdown, by pancreatic lipase, triglycerides are absorbed primarily in the upper jejunum. Long-chain fatty acids are absorbed less easily than medium-chain triglycerides, while stool often contains a certain amount of fat. Question 30.A 40-year-old female has been categorized as being obese, with a BMI of 33.2. Which of the following health problems is the patient at a significantly increased risk for compared with individuals with a BMI below 25? Cardiac arrhythmias Osteoarthritis Multiple sclerosis Atelectasis Gallbladder disease Insulin resistance Rationale: Obesity is associated with significantly increased risk for osteoarthritis due to bone and joint stress. Insulin resistance and gallbladder disease are also identified consequences of obesity. Cardiac arrhythmias are less likely to result directly from obesity, given their etiology rooted in electrical conductivity. Multiple sclerosis and other neurological effects are also unlikely, and atelectasis is not commonly a direct effect of high levels of body fat. Question 31. David has an acute exacerbation of Crohn’s disease. Which of the following lab tests would you expect to be decreased with Crohn’s Disease? Sedimenatation rate Liver enzyme levels Vitamins A, B complex and C levels Bilirubin level Question 32.A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient’s statement? “You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking. “That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.” “In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.” “When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.” Rationale: The hepatic effects of alcohol use are related to the accumulation of toxic metabolites in the hepatocytes and blood. Damage can continue even after an individual stops drinking. Specific consequences do not usually include HAV, HBV, or liver cancer. Cirrhosis represents the culmination, not the beginning, of negative hepatic effects. Question 33.A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic. (this is true for small sliding hiatal hernias) The root causes of hiatal hernias are normally treatable with medication. If esophageal acid clearance is impaired, esophagitis can result.(Pg 1174) An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias. Question 34.As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for? Inflammatory bowel disease (IBD) Gastric adenocarcinoma(pg 1178) Gastric atrophy Peptic ulcer Esophagitis Diverticular disease Question 35.A 43-year-old male who is 5 feet 10 inches tall and weighs 216 pounds has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting? Further investigation of his nutritional status is needed to supplement the BMI value. The patient faces an increased risk of type 2 diabetes and hyperlipidemia. He is classified as being obese, likely as the result of the interplay of genetic and lifestyle factors. The patient is borderline obese but is not yet at the point of significantly increased risks to health.(pg 1252) Question 36. Which of the following measures would likely be rejected as part of a first-line weight loss plan for a patient with a BMI of 30.2 type 2 DM, and HTN? Prescription drug therapy Gastric bypass Calorie reduction by 500 to 1000 kcal/day 30 minutes or more of moderate-intensity activity at least days per week Rationale: Weight loss surgery should be limited to individuals with a BMI greater than 40 or those with a BMI greater than 35 with comorbid conditions in whom medical therapy has failed. Calorie reduction is appropriate for anyone with a BMI of 25 to 29.9 plus two risk factors (in this case, type 2 diabetes and hypertension). Prescription drug therapy can be considered for those with a BMI of 30 or more, and increased physical activity, although it does not lead to significant weight loss, helps prevent further weight gain and reduces cardiovascular and diabetes risk beyond that achieved by weight loss alone. Question 37. A 20-year-old male who is addicted to crystal methamphetamine has been admitted to the hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which of the following treatment plans would the care team most likely favor? Intravenous infusion of albumin coupled with vitamin supplementation Total parenteral nutrition Incremental feeding combined with vitamin and mineral supplementation Rapid administration of normal saline and carbohydrates Rationale: Slow administration of protein and calories combined with mineral and vitamin supplementation is important in the treatment of protein-calorie malnutrition. Albumin transfusions and total parenteral feeding would likely not be necessary, and rapid administration of fluids and carbohydrates may precipitate congestive heart failure. Question 38. As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which of the following questions would a clinician be justified in excluding from an intake interview for a 16-year-old female referred by her pediatrician for the treatment of anorexia nervosa? “Do you remember when your last menstrual period was? “Have you noticed any new hair growth on your body in the last several months?” “Have you had any episodes of shortness of breath in the recent past?” “Can you tell me about some of the habits that you have related to food in your daily routine?” Rationale: Respiratory complications are not a noted consequence of anorexia nervosa. Amenorrhea, development of lanugo, and complex and important rituals around food preparation are common. Question 39. A female neonate has been in respire distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which of the following explanations should the care team provide to the infant’s parents? "We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally." "This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time." "The biggest risk that your daughter will face until this is fixed is the danger of malnutrition and dehydration." "The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs." Rationale: A/TFE necessitate surgery and preclude both normal respiration and swallowing. Aspiration is the primary immediate risk and the priority for treatment. Although the infant will require respiratory therapy to assist with proper tube placement and ventilator maintenance, the only effective treatment is surgery. Aspiration of feeding (aspiration pneumonia) is a major complication that can occur immediately and can be life threatening. Maintaining an open airway and adequate gas exchange are the priority nursing diagnoses for this infant. Question 40. While on tour, a 32-year-old male musician has presented to the emergency department of a hospital after a concert complaining of severe and sudden abdominal painHe admits to a history of copious alcohol use in recent years, and his vital signs include temperature 46.8 °C (101.8 °F), blood pressure 89/48 mm Hg, and heart rate 116 beats/minute. Blood work indicates that his serum levels of C-reactive protein, amylase, and lipase are all elevated. Which of the following diagnoses would the care team suspect first? Hepatitis C Cholecystitis Liver cirrhosis Acute pancreatitis Rationale: Alcohol use, fever, hypotension, and tachycardia are often associated with pancreatitis, as are elevated serum amylase and lipase levels. These enzymes would unlikely rise in cases of hepatitis, cholecystitis, or cirrhosis. The precise mechanisms whereby alcohol exerts its action are largely unknown. Question 41. The patient who has been consuming a very low-calorie diet (VLCD) of 450 kcal/day should be assessed for which of the following high-risk complications? Select all that apply. Irregular heart rhythms Bone/joint inflammation Abdominal pain related to gallstones Flank pain and spasm associated with kidney sludge Elevated cholesterol levels Rationale: VLCDs have higher risks, including abnormal heart rhythms and cholelithiasis. Anyone on this diet should be under direct supervision of a medical professional. Usually bone/joint pain/inflammation decreases with weight loss. Kidney sludge is usually related to the amount of water a person consumes. Question 42. During a humanitarian trip to an underdeveloped country, a medical student is assessing a 6-year-old male who has a protuberant abdomen, dry hair, and wrinkled skin. The child's heart rate is 59 beats/minute, blood pressure 89/50, and temperature 95.2°F (35.1°C). What is the most likely etiology of the child's health problems? A diet lacking in fat-soluble vitamins Fluid and electrolyte imbalances secondary to low -carbohydrate intake A diet that is low or high in carbohydrates but low in fat A diet deficient in both protein and calories Rationale: The child's presentation is typical of marasmus, a diagnosis caused by deficiencies in protein and calorie intake. Question 43. A teenage female has been admitted for complications resulting from bulimia nervosa. She has abused laxatives for many years and has been self-inducing vomiting since the age of 9. The nurse's admission assessment should pay close attention to which of the following complications that can arise from this disorder? Select all that apply. Assess for dry, cracked lips and poor skin turgor. missing tooth enamel and increased number of dental cavities. painful swallowing and stomach cramping related to reflux and esophagitis. fruity breath and labored, deep, gasping respirations. jaundice of the skin and eyes. Rationale: Distracters A, B, and C are associated with complications of bulimia nervosa. Answer choice A relates to dehydration/fluid volume deficit; answer choice B relates to dental abnormalities associated with high acid content of the vomitus; answer choice C relates to esophagitis. Answer choice D is indicative of DKA primarily caused by undiagnosed or undertreated diabetes. Jaundice of the skin and eyes is usually associated with liver disease. Question 44. A 72 year-old patient with a long-standing history of chronic nausea and vomiting but a near-insatiable appetite has had her symptoms attributed to an enzyme deficiency. What enzyme can be contributing to this? Pg 1161 Secretin Gastrin Ghrelin Cholycystokinin (CCK) Question 45. A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the client's liver and diagnostic results would the care team most likely anticipate? Hepatocellular necrosis evidenced by increased ALT and AST levels Allergic inflammation accompanied by an increase in serum IgE and basophils Cholestatic reaction with increased bilirubin count Rapid onset of hepatitis and increased GGT, ALT, and bilirubin MN551 Unit 6 Quiz / MN 551 Unit 6 Quiz / MN551 Week 6 Quiz/ MN 551 Week 6 Quiz (Latest): Kaplan University Question 1. A 42-year-old female patient with a long-standing history of chronic nausea and vomiting but a near-insatiable appetite has had her symptoms attributed to an enzyme deficiency. Further diagnostic testing indicates that she has inadequate pancreatic enzyme levels and that her large appetite is due to a lack of enzyme control of food intake inhibition. In which of the following enzymes is the woman most likely deficient? (Points : 0.4) Cholecystokinin Ghrelin Gastrin Secretin Question 2. A 20-year-old male college student has recently finished a Thanksgiving dinner of heroic proportions while home for the holiday weekend. Which of the following phenomena would most likely have produced his sensation of satiety? (Points : 0.4) Stretch receptors in the stomach and small intestine signal the feeding center in the medulla. Increased levels of leptin stimulate a decrease in appetite by way of the vagus nerve. The breakdown of products of lipids such as ketoacids produces a decrease in appetite. Cholecystokinin and glucagon-like peptide-1 suppress the hunger impulse. Question 3. A 20-year-old male who is addicted to crystal methamphetamine has been admitted to the hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which of the following treatment plans would the care team most likely favor? (Points : 0.4) Intravenous infusion of albumin coupled with vitamin supplementation Total parenteral nutrition Incremental feeding combined with vitamin and mineral supplementation Rapid administration of normal saline and carbohydrates Question 4. Which of the following measures would likely be rejected as part of a first-line weight loss plan for a patient with a BMI of 30.2, type 2 diabetes, and hypertension? (Points : 0.4) Prescription drug therapy Gastric bypass Calorie reduction by 500 to 1,000 kcal/day 30 minutes or more of moderate-intensity activity at least 3 days per week Question 5. Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?(Points : 0.4) Inhibition of the actions of Brunner glands Overstimulation of the oxyntic glands Suppression of cholecystokinin Inflammation of the parotid glands Question6. A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias? (Points : 0.4) Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic. The root causes of hiatal hernias are normally treatable with medication. If esophageal acid clearance is impaired, esophagitis can result. An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias. Question 7. Cheryl has celiac disease. Which diet should you place her on? (Points : 0.4) Low fat diet Low residue diet Gluten free diet High protein diet Question8. A male patient complaining of chronic cramping, bloating, and diarrhea has been determined to have a deficiency in brush border enzymes within his small intestine. Which of the following meals or snacks is most likely to exacerbate the patient's signs and symptoms? (Points : 0.4) Bran cereal and prunes Tossed salad with an oil and vinegar dressing Roast beef and a baked potato Tortilla chips and guacamole Question9. As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for? (Points : 0.4) Inflammatory bowel disease (IBD) Gastric adenocarcinoma Gastric atrophy Peptic ulcer Esophagitis Diverticular disease Question 10. Which of the following patients is most clearly displaying the signs and symptoms of IBD? (Points : 0.4) A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation. A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.” A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day. A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress. Question11. For several years, a 39-year-old female has been averaging two to three bottles of wine each night after her children go to sleep, and has included several ounces of brandy in recent years as well. Despite negative consequences to her career and the dissolution of her marriage, her drinking continued and now has culminated in a diagnosis of cirrhosis. Which of the following physical manifestations of the health problem would her care team anticipate? (Points : 0.4) Ascites Anorexia Fever Cognitive changes Epigastric pain Obesity Question12. Which of the following statements best captures an aspect of the process of fat digestion and absorption? (Points : 0.4) Ingested triglycerides are broken down into absorbable form by gastric lipase. Simple forms of fats are absorbed in the upper jejunum. Long-chain fatty acids are absorbed more readily than medium-chain triglycerides. Stool is not excreted until all fat is absorbed. Question13. A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient's statement? (Points : 0.4) “You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking. “That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.” “In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.” “When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.” Question14. A 43-year-old male patient has presented to the emergency department with vomiting that he claims is of sudden onset. The patient also states that the emesis has often contained frank blood in the hours prior to admission. Which of the following potential contributing factors would the care team first suspect? (Points : 0.4) Overuse of aspirin Alcohol consumption Staphylococcal enterotoxins Effects of Helicobacter pylori Question 15. A 48-year-old woman has been diagnosed with extrahepatic cholestasis following a thorough history, ultrasound, and blood work. Which of the following symptoms most likely caused her to seek medical treatment, and what consequences of her health problem would the medical team anticipate? (Points : 0.4) Complaints of lower flank pain with consequences of impaired fat metabolism Anorexia with consequences of impaired drug metabolism and blood filtration Skin xanthomas (focal accumulations of cholesterol) with consequences of increased risk of bleeding due to deficient clotting factors Pruritus with consequences of deficient levels of fat-soluble vitamins Question 16. A 29-year-old female has been admitted to the emergency department following a suicide attempt by overdose of acetaminophen. What changes in the patient's liver and diagnostic results would the care team most likely anticipate? (Points : 0.4) Centrilobular necrosis evidenced by increased ALT and AST levels Allergic inflammation accompanied by an increase in serum IgE and basophils Cholestatic reaction with increased bilirubin count Rapid onset of hepatitis and increased GGT, ALT, and bilirubin levels Question17. A female neonate has been in respiratory distress since delivery and is unresponsive to oxygen therapy. Endoscopy has confirmed a diagnosis of esophageal atresia and tracheoesophageal fistula (EA/TEF). Which of the following explanations should the care team provide to the infant's parents? (Points : 0.4) “We will have to perform surgery to correct the hole in her throat to make sure that she is able to swallow and breathe normally.” “This problem will require respiratory therapy and supplementary feeding, but it will likely resolve itself over time.” “The biggest risk that will face your daughter until this is fixed is the danger of malnutrition and dehydration.” “The priority in our immediate treatment prior to her surgery will be pain management, as the contents of her stomach can burn her lungs.” Question 18. A gastroenterologist is teaching a group of nurse practitioner students about the enteric nervous system in preparation for a consultation on a patient who has suffered a spinal cord injury. Which of the physician's teaching points is most accurate? (Points : 0.4) “The myenteric plexus is responsible for controlling the function of each segment of the intestinal tract.” “The enteric nervous system is made up of the myenteric and submucosal plexuses; these are located in the wall of the GI tract.” “Sympathetic innervation of much of the GI tract occurs by way of the vagus nerve.” “Parasympathetic stimulation blocks the release of the excitatory neuromediators and inhibits GI motility.” Question19. The mother of a 19-week-old infant has brought her baby to a nurse practitioner for assessment because of the baby's persistent weight loss and diarrhea. An intestinal biopsy has confirmed a diagnosis of celiac disease, and the child's mother is anxious to know what caused the disease. Which of the following aspects of the etiology of celiac disease would underlie the explanation that the nurse practitioner provides? (Points : 0.4) Bacterial or chemical invasion of the peritoneum leads to decreased nutrient absorption and transport. An inappropriate T-cell mediated response results in increased levels of antibodies and an inflammatory response. Neurogenic or muscular inhibition of peristalsis results in inappropriate motility of ingested food in the lower small intestine and the colon. Inability to process or absorb the fat content of breast milk results in malnutrition and deficiency of fat-soluble vitamins. Question20. A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her? (Points : 0.4) Lamivudine Peginterferon and ribavirin Interferon-alfa-2b Corticosteroids and immunosuppressant drugs Question21. After several months of persistent heartburn, a 57-year-old female patient has been diagnosed with gastroesophageal reflux disease (GERD). Which of the following treatment regimens is likely to best address the woman's health problem? (Points : 0.4) Surgical correction of the incompetent pylorus Antacids, avoiding positions that exacerbate reflux, and a soft-textured diet Weight loss and administration of calcium channel blocking medications Proton pump inhibitors, avoiding large meals, and remaining upright after meals Question22. A 43-year-old male who is 5 feet 10 inches tall and weighs 216 pounds has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting? (Points : 0.4) Further investigation of his nutritional status is needed to supplement the BMI value. The patient faces an increased risk of type 2 diabetes and hyperlipidemia. He is classified as being obese, likely as the result of the interplay of genetic and lifestyle factors. The patient is borderline obese but is not yet at the point of significantly increased risks to health. Question 23. David has an acute exacerbation of Crohn’s disease. Which of the following lab tests would you expect to be decreased? (Points : 0.4) Sedimenatation rate Liver enzyme levels Vitamins A, B complex and C levels Bilirubin level Question24. A 40-year-old female has been categorized as being obese, with a BMI of 33.2. Which of the following health problems is the patient at a significantly increased risk for compared with individuals with a BMI below 25? (Points : 0.4) Cardiac arrhythmias Osteoarthritis Multiple sclerosis Atelectasis Gallbladder disease Insulin resistance Question25. Which of the following patients on a hospital medical unit is most clearly demonstrating the signs and symptoms of liver failure?(Points : 0.4) A 44-year-old man with low hemoglobin levels, low platelet levels, and spider angiomas A 50-year-old woman with blood pressure of 189/103, jaundice, and multiple thrombosis A 68-year-old female patient with sudden onset of confusion, a history of alcohol abuse, and low levels of serum AST and ALT A 55-year-old man with ascites, fever, and recent onset of atrial fibrillation