Medsurg Exam 2 Hep/ GI
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Questions and Answers
- 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.
Correct Answer
C. The risk of pyloric obstructionExplanation
A gastric ulcer is a type of peptic ulcer that forms in the lining of the stomach. Pyloric obstruction occurs when the pylorus, the opening between the stomach and small intestine, becomes blocked. This can be caused by inflammation or scarring from a gastric ulcer. High residuals, which refer to undigested food or liquid remaining in the stomach after a meal, can indicate a blockage in the pylorus. Therefore, the patient's high residuals suggest a risk of pyloric obstruction as a complication of the gastric ulcer.Rate this question:
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- 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
Correct Answer(s)
A. PT/INR
D. Clinical indicators of ascites and encephalopathy
E. Albumin levels
F. Bilirubin levelsExplanation
The Child Pugh score is used to assess the severity of liver disease in patients with cirrhosis. It includes various clinical and laboratory parameters. PT/INR is included in the score as it reflects the liver's ability to produce clotting factors. Clinical indicators of ascites and encephalopathy are included as they indicate the presence and severity of liver dysfunction. Albumin levels are included as they reflect the liver's synthetic function. Bilirubin levels are included as they indicate impaired liver function and can be used to assess the severity of liver disease. Glucose levels and cholesterol levels are not included in the Child Pugh score.Rate this question:
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- 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.
Correct Answer
A. They are often associated with weight loss because eating worsens painExplanation
Gastric ulcers are often associated with weight loss because eating worsens the pain. This is because the act of eating stimulates the production of stomach acid, which can further irritate and worsen the ulcer. The pain caused by gastric ulcers is typically relieved by taking antacids or acid-reducing medications. Unlike duodenal ulcers, gastric ulcers are more likely to perforate (create a hole) in the stomach lining rather than bleed. They are also associated with increased acid secretion, which contributes to their development and symptoms.Rate this question:
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- 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.
Correct Answer
D. Patient is increasingly combative and trying to climb out of bed.Explanation
The correct answer is "Patient is increasingly combative and trying to climb out of bed." This is an indication that therapy is working because it suggests that the patient's mental status is improving. Encephalopathy from liver disease can cause altered mental status and confusion, and lactulose is often used to treat this condition by reducing ammonia levels in the blood. The fact that the patient is becoming more combative and alert suggests that the lactulose is effectively reducing the ammonia levels and improving the patient's mental function.Rate this question:
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- 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.
Correct Answer
A. Ulcerative ColitisExplanation
Ulcerative colitis can be completely cured by surgery, specifically through a procedure called colectomy. Colectomy involves the removal of the entire colon and rectum, which eliminates the source of inflammation and symptoms associated with ulcerative colitis. This surgical intervention offers a potential cure for the condition, as it removes the affected area and allows the body to heal. However, it is important to note that surgery is typically considered as a last resort when other treatment options have failed to provide relief or manage symptoms effectively.Rate this question:
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- 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.
Correct Answer
D. Coagulation (PT/INR and PTT) times.Explanation
In a patient with hepatic cirrhosis, the liver function is impaired, leading to a decrease in the production of clotting factors. This results in prolonged coagulation times, as indicated by increased PT/INR and PTT values. Other laboratory values, such as albumin levels, conjugated bilirubin, hematocrit, and hemoglobin, may be affected in hepatic cirrhosis, but the question specifically asks for the values that are expected to increase. Therefore, the correct answer is coagulation (PT/INR and PTT) times.Rate this question:
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- 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.
Correct Answer
A. Monitoring of his CIWA score at least q 4 hours (with vital sign checks)Explanation
Based on the information provided, the patient is at risk for alcohol withdrawal. Monitoring his CIWA (Clinical Institute Withdrawal Assessment) score at least every 4 hours, along with vital sign checks, is the appropriate course of action. This will allow the healthcare team to assess the severity of withdrawal symptoms and determine if medication intervention is necessary.Rate this question:
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- 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?
Correct Answer(s)
A. Will he be able to eat in the next 2 days?
B. What was his albumin on admission.
D. Is he febrile, tachycardic or healing from a major wound?Explanation
The questions asked are relevant in determining if the patient needs to be fed enterally. The first question assesses the patient's ability to eat in the next 2 days, which helps determine if enteral feeding is necessary. The second question about the patient's albumin levels on admission is important as low albumin levels can indicate malnutrition and the need for enteral feeding. The third question assesses the patient's current condition, specifically if they are febrile, tachycardic, or healing from a major wound, which can impact their ability to eat and require enteral feeding.Rate this question:
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- 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
Correct Answer
D. D10Explanation
D10 is the appropriate IV fluid for a patient with end stage liver disease and cirrhosis because it provides a higher concentration of glucose compared to other options. Patients with liver disease often have impaired glucose metabolism, so providing a higher concentration of glucose can help meet their energy needs. Additionally, D10 provides a balanced solution of glucose and electrolytes, making it suitable for patients with cirrhosis.Rate this question:
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- 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/mm3 and >5% bands
- C.
Increased pain when bending forward.
- D.
Right lower quadrant pain and rebound tenderness.
Correct Answer
B. A WBC count >20,000/mm3 and >5% bandsExplanation
A WBC count >20,000/mm3 and >5% bands suggests a surgical emergency because it indicates a severe infection or inflammation in the body. An elevated WBC count with a high percentage of bands (immature white blood cells) suggests that the body is actively trying to fight off an infection, which is commonly seen in cases of appendicitis. This combination of findings indicates a more severe and urgent condition that may require immediate surgical intervention.Rate this question:
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- 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)
Correct Answer
B. Sodium restriction and Spirolactone (Aldactone), possibly followed by loop diureticsExplanation
Early management of ascites typically involves sodium restriction and the use of spirolactone (Aldactone), which is a potassium-sparing diuretic. This is because ascites is often caused by liver disease, which leads to an imbalance of fluid and electrolytes in the body. Sodium restriction helps to reduce fluid retention, while spirolactone helps to increase urine production and reduce potassium loss. Loop diuretics may be added if there is inadequate response to spirolactone alone. IV administration of Bumex or Lasix and paracentesis are other treatment options for ascites, but they are not typically considered as first-line management strategies.Rate this question:
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- 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
Correct Answer
C. Food soothesExplanation
A duodenal ulcer is a type of peptic ulcer that occurs in the first part of the small intestine called the duodenum. The statement "Food soothes" is true for a duodenal ulcer because eating can temporarily relieve the pain and discomfort caused by the ulcer. This is because food helps to neutralize the stomach acid and provide a protective layer over the ulcer, reducing irritation and inflammation.Rate this question:
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- 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.
Correct Answer
C. Benzodiazapines.Explanation
Benzodiazepines are the most critical medication to administer in order to prevent seizures in a patient with Alcohol Withdrawal Syndrome (AWS). A CIWA score of 19 indicates severe withdrawal symptoms, and seizures are a potential complication of AWS. Benzodiazepines are the first-line treatment for AWS and are effective in reducing the risk of seizures by suppressing excitability in the brain. Opioids, sympathetic nervous system suppressants, and Haldol are not specifically indicated for preventing seizures in AWS.Rate this question:
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- 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
Correct Answer
C. Alterations in BUN (not creatinine), Na+ and Cl- and possibly in BicarbExplanation
In hepatic failure with no renal involvement, the liver is not able to properly metabolize and excrete waste products, leading to an increase in blood urea nitrogen (BUN) levels. Sodium (Na+), chloride (Cl-), and bicarbonate (Bicarb) levels may also be altered due to the liver's role in maintaining electrolyte balance. However, creatinine levels are not typically affected in hepatic failure as creatinine is primarily excreted by the kidneys. Calcium levels may or may not be altered in hepatic failure, so it is not included in the answer.Rate this question:
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- 15.
What is restricted in liver failure?
- A.
Potassium, magnesium and phosphorous.
- B.
Protein and sodium.
- C.
Activity
- D.
Green leafy vegetables
Correct Answer
B. Protein and sodium.Explanation
In liver failure, the liver is unable to properly process and metabolize proteins, leading to a buildup of toxic byproducts in the body. Therefore, it is important to restrict protein intake in order to prevent further damage to the liver. Additionally, sodium restriction is necessary in liver failure as the liver is responsible for maintaining fluid balance in the body, and excessive sodium intake can lead to fluid retention and worsening of symptoms.Rate this question:
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- 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
Correct Answer
D. Low serum glucose levelsExplanation
In liver failure, the liver is unable to produce enough glucose through glycogenolysis and gluconeogenesis. This leads to low serum glucose levels, which is a classic finding in patients with liver failure.Rate this question:
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- 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.
Correct Answer
C. Changes in vital signs (increased HR and narrowed pulse pressure) are often the early indicators -
- 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.
Correct Answer
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.Explanation
The CIWA scale is a tool used to assess and monitor alcohol withdrawal symptoms in patients. A score of >10 on the CIWA scale indicates a need for a symptom-triggered response, such as the administration of benzodiazepines, to manage the withdrawal symptoms. The assessment of the CIWA score should be continued to evaluate the effectiveness of the treatment.Rate this question:
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- 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
Correct Answer
B. Treatment of ammonia levels.Explanation
In a patient with hepatic encephalopathy, the most critical aspect to assess and treat is the levels of ammonia in the body. Hepatic encephalopathy is caused by liver dysfunction, which leads to the accumulation of ammonia in the blood. High levels of ammonia can cause neurological symptoms and can be life-threatening. Therefore, the primary focus should be on reducing ammonia levels through interventions such as medications, dietary changes, and potentially dialysis. Treating other factors such as jaundice, nutritional deficiencies, and electrolyte abnormalities may also be necessary, but addressing ammonia levels is the most critical aspect.Rate this question:
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- 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.
Correct Answer
A. PT and INR.Explanation
The best indication of hepatic function in a patient with hepatic cirrhosis is the PT (prothrombin time) and INR (international normalized ratio). These laboratory values assess the liver's ability to produce clotting factors, with prolonged PT and increased INR indicating impaired hepatic function. This is because the liver is responsible for synthesizing clotting factors, and in hepatic cirrhosis, liver function is compromised. Monitoring PT and INR levels helps in assessing the severity of liver disease and guiding treatment decisions.Rate this question:
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- 21.
Which of the following is DECREASED in hepatic failure?
- A.
Glucose levels
- B.
Conjugated Bilirubin levels
- C.
BUN
- D.
Calcium levels
Correct Answer
A. Glucose levelsExplanation
In hepatic failure, the liver is unable to properly metabolize glucose, leading to a decrease in glucose levels. The liver plays a crucial role in maintaining glucose homeostasis by storing excess glucose as glycogen and releasing it when needed. However, in hepatic failure, this process is disrupted, resulting in decreased glucose production and increased glucose utilization by other organs. As a result, the overall glucose levels in the blood decrease.Rate this question:
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- 22.
Which of the following is ELEVATED in chronic hepatic failure
- A.
Conjugated bilirubin
- B.
Unconjugated bilirubin
- C.
Amylase
- D.
Lipase
Correct Answer
B. Unconjugated bilirubinExplanation
In chronic hepatic failure, the liver is unable to properly metabolize bilirubin, resulting in an increase in unconjugated bilirubin levels. Unconjugated bilirubin is the form of bilirubin that is produced by the breakdown of heme in red blood cells and is normally processed by the liver to become conjugated bilirubin. However, in chronic hepatic failure, the liver's ability to conjugate bilirubin is impaired, leading to an accumulation of unconjugated bilirubin in the blood. This can result in jaundice, a common symptom of liver disease.Rate this question:
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- 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
Correct Answer
C. Hematocrit and HemoglobinExplanation
Hematocrit and hemoglobin are the best laboratory indicators of a gastrointestinal (GI) bleed. Hematocrit measures the percentage of red blood cells in the blood, while hemoglobin measures the amount of oxygen-carrying protein in the red blood cells. In a GI bleed, there is a loss of blood, leading to a decrease in both hematocrit and hemoglobin levels. Therefore, monitoring these levels can help in diagnosing and assessing the severity of a GI bleed. BUN (blood urea nitrogen) and albumin levels may also be affected in a GI bleed, but they are not as specific or sensitive indicators as hematocrit and hemoglobin. PT/INR (prothrombin time/international normalized ratio) is a test used to assess blood clotting and is not directly related to GI bleeding.Rate this question:
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- 24.
Which of the following lab values is associated with encephalopathy
- A.
Hypoglycemia
- B.
Hypo-albunemia
- C.
Elevated unconjugated bilirubin
- D.
Ammonia levels
Correct Answer
D. Ammonia levelsExplanation
Elevated ammonia levels are associated with encephalopathy. Encephalopathy is a condition characterized by brain dysfunction that can result from various causes, including liver disease. In liver disease, the liver is unable to effectively process ammonia, leading to its accumulation in the blood. Elevated ammonia levels can then lead to neurological symptoms, such as confusion, disorientation, and impaired cognitive function, which are characteristic of encephalopathy. Therefore, monitoring ammonia levels is important in the diagnosis and management of encephalopathy.Rate this question:
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- 25.
Which of the following is the BEST marker of chronic hepatic failure?
- A.
AST
- B.
ALT
- C.
Albumin
- D.
PT/INR
Correct Answer
D. PT/INRExplanation
PT/INR (prothrombin time/international normalized ratio) is the best marker of chronic hepatic failure because it measures the liver's ability to produce clotting factors. In chronic hepatic failure, the liver is unable to produce these factors effectively, leading to prolonged clotting times and an increased PT/INR value. AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are markers of liver cell damage, but they do not specifically indicate chronic hepatic failure. Albumin is a protein synthesized by the liver, but its levels can be affected by factors other than liver function.Rate this question:
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Mar 20, 2023Quiz Edited by
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Apr 04, 2020Quiz Created by
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