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1. A patient is experiencing epigastric pain, heartburn, nausea, vomiting, and
post-prandial fullness over the last month. The patient is likely suffering
from: - ANSWER Dyspepsia
2. Causes of dyspepsia - ANSWER Food or drug intolerance
Functional dyspepsia
Luminal GI dysfunction (peptic ulcer dz, gastroparesis)
H. Pylori
Pancreatic dz
Bilary tract dz
3. A patient reports having: hematemesis, weight loss, and N/V with post-
pradial fullness. The NP orders an abdominal CT and endoscopy. You expect
the findings to be: - ANSWER Dyspepsia
4. What are the initial labs for dyspepsia? - ANSWER CBC, CMP, and
thyroid panel
, 5. A patient's results come back negative for H. Pylori but the patient seems
to have persistent dyspepsia after being treated for H. Pylori. What is likely
going on and what is the treatment? - ANSWER Atypical gerd or
functional dyspepsia
Tx with 4 weeks of PPI
6. PPIs - ANSWER Examples: -prazole (Omeprazole)
Tx: GERD, duodenal ulcers, reduce risk of GI bleed
MOA: binds to enzyme on parietal cells in presence of acidic gastric pH which
stops final transport of hydrogen ions into gastric lumen to diminish accumulation
of acid
Dose: 20-40mg QD
SE: abdominal pain. Monitor for anaphylaxis, Cdiff
7. Tricyclic Antidepressants that can treat functional dyspepsia - ANSWER
Nortriptyline 25-50mg PO QHS
Used for MDD but unlabeled use can be chronic neuropathic pain.
SE: hypotension, CANT pee/see/spit/shit
*Avoid chamomile, St Johns and kava-kava due to >serotonin syndrome.
8. Metoclopramide (reglan) - ANSWER Dose: 5-10mg TID
*Short term risk due to high risk of tardive dyskinesia
Tx: GERD, N/V (unlabeled: hiccups)
, MOA: blocks dopamine receptors in chemoreceptor trigger zone of CNS and
stimulates motility of upper GI & accelerates gastric emptying
SE: Drowsy, restless, NMS, restlessness
9. Neuroleptic malignant Syndrome - ANSWER Symptoms caused by
neuroleptic or anti-psychotic meds
S/S: AMS, hyperthermia, autonomic dysfunction (wide pulse
pressures/hyperhidrosis sweating), Stiff muscles due to blocked dopamine
receptors in hypothalamus.
DX: CMP, CPK, UA
10. The NP knows that within the medulla; there are group of neuronal areas that
consist of: area postrema, nucleus tractus solitiarus, and central pattern generator.
These make up the: - ANSWER Brainstem vomiting center that coordinates
emesis
11. Visceral afferent (sensory) stimulation which causes emesis - ANSWER
mechanical obstruction (ex: SBO, hernias)
Dysmotility (ex: gastroparesis)
peritoneal irritation (ex: peritonitis or appendicitis)
Infections (ex: food poinsoning)
Hepatobilary or pancreatic disorders
GI irritants (Nsaids etc)
post-op