Medsurg Exam 2 Hep/ GI

25 Questions | By Kaytlin.edwards | Updated: Mar 20, 2022 | Attempts: 56

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1.

A patient with a gastric ulcer develops high residuals, though he is not being fed. Your concern is which ulcer complication?
- A.
  
  The risk for peritonitis from perforation or penetration.
- B.
  
  The risk of ascites.
- C.
  
  The risk of pyloric obstruction
- D.
  
  He risk of bleeding.
2.

Which of the following is on the Child Pugh score? Choose all that apply
- A.
  
  PT/INR
- B.
  
  Glucose levels
- C.
  
  Cholesterol levels
- D.
  
  Clinical indicators of ascites and encephalopathy
- E.
  
  Albumin levels
- F.
  
  Bilirubin levels
3.

Which is true regarding gastric (as opposed to duodenal) ulcers?
- A.
  
  They are often associated with weight loss because eating worsens pain
- B.
  
  They are more likely to perforate than bleed.
- C.
  
  They are relieved by eating
- D.
  
  They are associated with increased acid secretion.
4.

A patient with encephalopathy from liver disease has been comatose and receiving lactulose enemas q 4 hours. Which of the following is an indication that therapy is working?
- A.
  
  Patient remains unresponsive
- B.
  
  Patient's serum Na and CL- levels are normalizing.
- C.
  
  Patient has a positive fluid balance.
- D.
  
  Patient is increasingly combative and trying to climb out of bed.
5.

Which of the following can be completely cured by surgery?
- A.
  
  Ulcerative Colitis
- B.
  
  Both are cured by colostomy.
- C.
  
  Chrohn's disease
- D.
  
  Neither are cured by colostomy.
6.

In a patient with hepatic cirrhosis, which laboratory values do you expect to increase?
- A.
  
  Albumin levels.
- B.
  
  Conjugated bilirubin.
- C.
  
  Hematocrit and hemoglobin.
- D.
  
  Coagulation (PT/INR and PTT) times.
7.

A patient had his last drink last evening. His wife tells you he drinks daily and more than a 12 pack a day. You would initiate/recommend to the team which of the following?
- A.
  
  Monitoring of his CIWA score at least q 4 hours (with vital sign checks)
- B.
  
  IV benzodiazepine therapy.
- C.
  
  TC oral benzodiazapines starting NOW.
- D.
  
  Administration of Clonipine and Haldol in the early hours of potential withdrawal.
8.

What questions do you ask to determine if your patient needs to be fed enterally (there are, of course 3)?
- A.
  
  Will he be able to eat in the next 2 days?
- B.
  
  What was his albumin on admission.
- C.
  
  Has his albumin improved or gone down since admission?
- D.
  
  Is he febrile, tachycardic or healing from a major wound?
- E.
  
  Does he have diabetes mellitus?
9.

Which of the following IV fluids would be appropriate in a patient with end stage liver disease and cirrhosis?
- A.
  
  D5LR
- B.
  
  D5 Normal Saline
- C.
  
  LR.
- D.
  
  D10
10.

A patient with suspected appendicitis has had a full workup. Which of the following suggests a surgical emergency?
- A.
  
  Increased pain in the knee chest position.
- B.
  
  A WBC count >20,000/mm³and >5% bands
- C.
  
  Increased pain when bending forward.
- D.
  
  Right lower quadrant pain and rebound tenderness.
11.

Early management of ascites includes:
- A.
  
  IV administration of Bumex or Lasix AND Paracentesis.
- B.
  
  Sodium restriction and Spirolactone (Aldactone), possibly followed by loop diuretics
- C.
  
  Paracentesis (tapping the belly to remove fluid)
- D.
  
  IV administration of salt poor albumin.(SPA)
12.

Which of the following is true of a duodenal ulcer?
- A.
  
  It is often associated with weight loss
- B.
  
  It is often associated with pyloric obstruction.
- C.
  
  Food soothes
- D.
  
  Food aggravates
13.

Your patient has a CIWA score of 19 and you are administering medications. The most critical medication to administer to prevent seizures in this patient in AWS is which of the following?
- A.
  
  Opiods
- B.
  
  Sympathetic nervous system suppressants
- C.
  
  Benzodiazapines.
- D.
  
  Haldol.
14.

Which of the following alterations might you see in the chemistry of a patient in hepatic failure with no renal involvement?
- A.
  
  Alterations in Sodium, Potassium and calcium
- B.
  
  Alterations in BUN, creatinine, K+ and magnesium.
- C.
  
  Alterations in BUN (not creatinine), Na+ and Cl- and possibly in Bicarb
- D.
  
  Alterations in BUN, creatinine, sodium and calcium
15.

What is restricted in liver failure?
- A.
  
  Potassium, magnesium and phosphorous.
- B.
  
  Protein and sodium.
- C.
  
  Activity
- D.
  
  Green leafy vegetables
16.

Which of the following is a classic finding on chemistry in a patient in liver failure?
- A.
  
  Low serum sodium levels.
- B.
  
  Low serum Ca+ levels
- C.
  
  Elevated serum K+ levels
- D.
  
  Low serum glucose levels
17.

In a patient who is bleeding what clinical/laboratory indication even before patient has hematemesis (blood in vomitus) or melena (blood in stool) might you see?
- A.
  
  Changes in Hematacrit (HCT)or Hemoglobin (Hgb) levels are early indicators
- B.
  
  Earliest indication is changes in capillary refill.
- C.
  
  Changes in vital signs (increased HR and narrowed pulse pressure) are often the early indicators
- D.
  
  Changes in serum chemistries are often the first indication of a bleed.
18.

Which of the following is true about the CIWA scale?
- A.
  
  It represents an approach to preventing only the most complex of alcohol withdrawal complications-delirium tremons. It should be initiated within 24 hours of the last drink.
- B.
  
  A patient with a CIWA score of 8-10 is considered at VERY HIGH RISK for AWS.
- C.
  
  CIWA scores are not useful in patients who are actively withdrawing from alcohol, but can be used to prevent alcohol withdrawal if initiated on admission
- D.
  
  CIWA scores >10 indicate a need for symptom triggered response in the form of short or long acting benzodiazapines, with continued assessment of CIWA to assess effect.
19.

In a patient with hepatic encephalopathy assessment and treatment of which of the following is MOST critical?
- A.
  
  Treatment of jaundice
- B.
  
  Treatment of ammonia levels.
- C.
  
  Treatment of nutritional deficiencies.
- D.
  
  Treatment of electrolyte abnormalities
20.

In a patient with hepatic cirrhosis, which laboratory values is the best indication of hepatic function?
- A.
  
  PT and INR.
- B.
  
  Serum potassium and magnesium levels
- C.
  
  Albumin levels
- D.
  
  Hematocrit and hemoglobin.
21.

Which of the following is DECREASED in hepatic failure?
- A.
  
  Glucose levels
- B.
  
  Conjugated Bilirubin levels
- C.
  
  BUN
- D.
  
  Calcium levels
22.

Which of the following is ELEVATED in chronic hepatic failure
- A.
  
  Conjugated bilirubin
- B.
  
  Unconjugated bilirubin
- C.
  
  Amylase
- D.
  
  Lipase
23.

Which of the following is the best laboratory indicator of a GI bleed?
- A.
  
  BUN
- B.
  
  Albumin
- C.
  
  Hematocrit and Hemoglobin
- D.
  
  PT/INR
24.

Which of the following lab values is associated with encephalopathy
- A.
  
  Hypoglycemia
- B.
  
  Hypo-albunemia
- C.
  
  Elevated unconjugated bilirubin
- D.
  
  Ammonia levels
25.

Which of the following is the BEST marker of chronic hepatic failure?
- A.
  
  AST
- B.
  
  ALT
- C.
  
  Albumin
- D.
  
  PT/INR