Lower GI - NCLEX
1. A female college student goes to the university health clinic complaining of pain that
started at the umbilicus and moved to the right lower quadrant over the last 12 hours. You
notice muscle guarding on examination. What action should you take?
A. Administer a PRN laxative per standing orders.
B. Ask about the last menstrual period.
C. Make the student NPO.
D. Assess bowel sounds.
C. Make the student NPO.
This is a classic description of appendicitis. At the very least, it is an acute abdomen, and the
student should be kept NPO until a need for surgery is ruled out. The student should be referred
to an emergency department.
2. What is a classic diagnostic finding in a patient with appendicitis?
A. Elevated white blood cell (WBC) count
B. Elevated level of lipase
C. Left lower quadrant tenderness
D. Positive Kernig's sign
A. Elevated white blood cell (WBC) count
The WBC count is mildly to moderately elevated in about 90% of cases. The classic location for
appendicitis is McBurney's point in the right lower quadrant.
3. Which is a complication in patients with ulcerative colitis?
A. Hyperkalemia
B. Toxic megacolon
C. Pancreatitis
D. Barrett's esophagus
B. Toxic megacolon
, Colonic dilation (toxic megacolon) can occur as a result of decreased tissue function, with lack
of peristalsis and enlargement of the colon. The patient is at risk for perforation.
4. How does the drug sulfasalazine (Azulfidine) work in the treatment of IBD?
A. Destroys bacteria
B. Suppresses inflammatory mediators
C. Slows gastric motility
D. Promotes electrolyte exchange across intestinal membrane
B. Suppresses inflammatory mediators
Sulfasalazine contains sulfapyridine and 5-aminosalicylic acid (5-ASA). Although the exact
action is unknown, it works by suppressing inflammatory mediators. IBD is an autoimmune
inflammatory disease; no specific infectious agent has been identified, although antimicrobials
(Flagyl, Cipro) occasionally are used.
5. The patient is admitted to the hospital with a severe exacerbation of ulcerative colitis.
What finding is most important for you to act on?
A. Blood urea nitrogen (BUN): 50 mg/dL
B. Hemoglobin (Hb): 12 g/dL
C. White blood cells (WBC): 11,000/μL
D. Sodium (Na+): 148 mEq/L
A. Blood urea nitrogen (BUN): 50 mg/dL
Patients with severe ulcerative colitis frequently have bloody diarrhea. Dehydration is present as
evidenced by the high BUN. This must be treated first before the mild anemia and mild
inflammation are addressed.
6. The immunosuppressant azathioprine (Imuran) is given to maintain remission after
corticosteroid induction therapy for an exacerbation of ulcerative colitis. What
monitoring is required?
A. Carcinogenic embryonic antigen (CEA)
B. Complete blood cell count (CBC)
C. Prostate-specific antigen (PSA)
1. A female college student goes to the university health clinic complaining of pain that
started at the umbilicus and moved to the right lower quadrant over the last 12 hours. You
notice muscle guarding on examination. What action should you take?
A. Administer a PRN laxative per standing orders.
B. Ask about the last menstrual period.
C. Make the student NPO.
D. Assess bowel sounds.
C. Make the student NPO.
This is a classic description of appendicitis. At the very least, it is an acute abdomen, and the
student should be kept NPO until a need for surgery is ruled out. The student should be referred
to an emergency department.
2. What is a classic diagnostic finding in a patient with appendicitis?
A. Elevated white blood cell (WBC) count
B. Elevated level of lipase
C. Left lower quadrant tenderness
D. Positive Kernig's sign
A. Elevated white blood cell (WBC) count
The WBC count is mildly to moderately elevated in about 90% of cases. The classic location for
appendicitis is McBurney's point in the right lower quadrant.
3. Which is a complication in patients with ulcerative colitis?
A. Hyperkalemia
B. Toxic megacolon
C. Pancreatitis
D. Barrett's esophagus
B. Toxic megacolon
, Colonic dilation (toxic megacolon) can occur as a result of decreased tissue function, with lack
of peristalsis and enlargement of the colon. The patient is at risk for perforation.
4. How does the drug sulfasalazine (Azulfidine) work in the treatment of IBD?
A. Destroys bacteria
B. Suppresses inflammatory mediators
C. Slows gastric motility
D. Promotes electrolyte exchange across intestinal membrane
B. Suppresses inflammatory mediators
Sulfasalazine contains sulfapyridine and 5-aminosalicylic acid (5-ASA). Although the exact
action is unknown, it works by suppressing inflammatory mediators. IBD is an autoimmune
inflammatory disease; no specific infectious agent has been identified, although antimicrobials
(Flagyl, Cipro) occasionally are used.
5. The patient is admitted to the hospital with a severe exacerbation of ulcerative colitis.
What finding is most important for you to act on?
A. Blood urea nitrogen (BUN): 50 mg/dL
B. Hemoglobin (Hb): 12 g/dL
C. White blood cells (WBC): 11,000/μL
D. Sodium (Na+): 148 mEq/L
A. Blood urea nitrogen (BUN): 50 mg/dL
Patients with severe ulcerative colitis frequently have bloody diarrhea. Dehydration is present as
evidenced by the high BUN. This must be treated first before the mild anemia and mild
inflammation are addressed.
6. The immunosuppressant azathioprine (Imuran) is given to maintain remission after
corticosteroid induction therapy for an exacerbation of ulcerative colitis. What
monitoring is required?
A. Carcinogenic embryonic antigen (CEA)
B. Complete blood cell count (CBC)
C. Prostate-specific antigen (PSA)
