NCLEX-PN : Gastrointestinal Conditions

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

Example Question #1178 : Nclex

You are the nurse taking care of a 22-year old female who complains of increased frequency of loose non-bloody, non-mucoid stools for three days. She notes that her eating habits have not changed recently, she has not traveled outside of the United States recently, she has no known sick contacts, no family history of colon cancer, and does not take any medications on a daily basis. She notes that her job has become increasingly stressful over the last five days, and that in the past, when her job or relationships have become stressful, this has triggered abdominal cramps, and diarrhea that is temporarily relieved with bowel movements. She currently is afebrile, with a normal white blood cell count, and vital signs within normal limits. Which of the following is the most likely diagnosis?

Possible Answers:

Ulcerative colitis

Gluten intolerance

Irritable bowel syndrome (IBS)

Colon cancer

Lactose intolerance

Correct answer:

Irritable bowel syndrome (IBS)

Explanation:

The most likely diagnosis in this patient is "Irritable bowel syndrome (IBS)." 

IBS is a gastrointestinal condition characterized by abdominal pain or cramps, as well as acute episodes of diarrhea and/or constipation that is often triggered by psychological stressors such as depression or anxiety, or a preceding gastrointestinal infection. IBS is more common in young females than other demographics, and often can be co-morbid with clinical depression or anxiety disorders. Its pathophysiology has not yet been fully characterized. There is no definitive diagnostic test to confirm a diagnosis of IBS, but the lack of blood or mucus in the stool, as well as the lack of a fever or elevated white blood cell count all are consistent with a diagnosis of IBS. Further, in this patient, given that she is a young female whose symptoms for this episode and prior episodes coincided with psychological stressors and resolved with bowel movements and resolution of her stressors, and who also had no fever, elevated white blood cell count, vital sign abnormalities, or concerning historical details (foreign travel, dietary changes, sick contacts), IBS is the most likely diagnosis.

Ulcerative colitis would be more likely to present with recurrent episodes of bloody and/or mucoid diarrhea, as opposed to non-bloody, non-mucoid diarrhea. Further, given this patient's relationship of symptoms to immediate psychological stressors, her symptoms are more consistent with IBS than ulcerative colitis. 

Colon cancer would be an unlikely diagnosis in a young, otherwise healthy patient with no family history of colon cancer. The fact that she is experiencing non-bloody, non-mucoid diarrhea does not in and of itself provide evidence for colon cancer. Colon cancer may present with occult blood in the stool, melanotic stools, or blood streaked stools, but would be highly, highly unlikely in a healthy young patient.

Gluten intolerance and lactose intolerance are reasonable thoughts when evaluating a young, otherwise healthy patient with non-bloody, non-mucoid diarrhea. Lactose intolerance would likely present at a younger age though, and the patient's diet reportedly has not changed prior to her diarrhea episodes, which would argue against a dietary etiology of her diarrhea. Further, given the close relationship of her symptoms to acute psychological stressors, IBS is the most fitting diagnosis.

Example Question #1179 : Nclex

You are the nurse taking care of a patient who underwent a total abdominal hysterectomy 36 hours ago. The patient states that they have not passed flatus or had a bowel movement since the surgery. You reassure the patient that this is common following surgery, for which of the following reasons?

Possible Answers:

Bacterial infection

Viral infection

Fungal infection

Post-operative amphetamines

Post-operative ileus

Correct answer:

Post-operative ileus

Explanation:

The correct answer choice is "post-operative ileus." This answer is correct because in the presented scenario, the patient is just 36 hours removed from a total abdominal hysterectomy, which is an invasive abdominal surgery. During a hysterectomy, the patient typically receives inhaled anesthesia, as well as opioid pain medications, which each individually can result in a post-operative ileus. Furthermore, given that there is manipulation of abdominal organs in accessing the uterus, simple mechanical manipulation of the bowels during surgery can be enough to result in a post-operative ileus. For each of these reasons, post-operative ileus is a common occurrence, and is the most likely cause of this patient's lack of passing of flatus or feces.

There is no reason to think that this patient received post-operative amphetamines. Furthermore, if the patient did receive amphetamines, that would likely stimulate the digestive tract, rather than inhibit its activity. 

Neither bacterial, viral, nor fungal infections would be likely causes of lack of flatus or feces passage following a surgery. These infections would be more likely to cause loose stools/diarrhea, rather than an ileus. 

Example Question #1180 : Nclex

You are the nurse taking care of a two-week-old firstborn male child. His parents brought him to the emergency department because he has been projectile vomiting for the last five days. On physical exam, you note a "palpable olive" within the upper abdomen, and lab work shows a hypokalemic, hypochloremic metabolic alkalosis. Which of the following is the most likely diagnosis?

Possible Answers:

Pyloric stenosis

Esophageal tumor

Achalasia

Toxic megacolon

Type two diabetes mellitus

Correct answer:

Pyloric stenosis

Explanation:

The correct answer is "pyloric stenosis," as this is a congenital condition that most commonly affects firstborn male infants. Pyloric stenosis is a congenital narrowing and excessive tightness of the pyloric sphincter, resulting in difficulty passing food from the stomach to the duodenum in the infant. As a result, the child frequently forcefully vomits until a surgical intervention reduces the tone of the pyloric sphincter. On physical exam, a "palpable olive" can sometimes be felt within the upper abdomen, representing the pyloric sphincter. On lab work, due to the potassium and chloride lost in the vomited material, a hypokalemic, hypochloremic metabolic alkalosis can be observed. On occasion, there is a history of the mother having taken erythromycin antibiotics during gestation.

Esophageal tumor is highly, highly unlikely in a newborn, as both of the most common types of esophageal tumors typically occur in patients 50 and older.

Achalasia would present as difficulty swallowing, rather than as frequent vomiting of stomach contents. In achalasia, the food cannot pass beyond the esophagus, whereas in pyloric stenosis it cannot pass beyond the stomach. A "palpable olive" would not be felt in achalasia.

Type two diabetes is extremely unlikely in an infant, and would not likely present with gastroparesis as its first symptom.

 

Example Question #371 : Conditions And Treatments

Cirrhosis is a chronic disease that affects which organ?

Possible Answers:

Heart

Small intestine

Liver

Kidney

Correct answer:

Liver

Explanation:

Cirrhosis is a chronic liver disease, usually caused by alcoholism. It is characterized by fibrosis and destruction of the normal liver tissue. Patient's who have cirrhosis may have hepatomegaly on physical exam, which is enlargement of the liver (e.g., it may be felt on the abdomen).

Example Question #1 : Causes And Treatments Of Gastrointestinal Conditions

Which of the following describes a calcium carbonate preparation?
Possible Answers:
Rapid-acting; Is also a saline laxative
Slow-acting; Contains significant amounts of sodium
Rapid onset and liberates carbon dioxide; Increases intra-abdominal pressure and promotes flatulence
Rapid-acting; releases carbon dioxide in the stomach, causing belching and flatulence
Correct answer: Rapid-acting; releases carbon dioxide in the stomach, causing belching and flatulence
Explanation: Calcium carbonate preparation is rapid-acting, releasing carbon dioxide in the stomach, causing belching and flatulence. Calcium carbonate is an antacid which reacts quicly with HCl to form CaCL2 and carbon dioxide.

Example Question #2 : Causes And Treatments Of Gastrointestinal Conditions

Which of the following does the nurse not recognize as a medication regimen for treating Helicobacter Pylori infections?
Possible Answers:
Quadruple Therapy-Colloidal bismuth subnitrate, tetracycline, metronidazole plus omeprazole
Single therapy-Colestipol
Triple Therapy-Metronidazole, omeprazole plus clarithromycin
Dual Therapy-Ranitidine bismuth citrate plus clarithromycin Omeprazole plus clarithromycin
Correct answer: Single therapy-Colestipol
Explanation: Multiple therapies are required to treat Helicobacter Pylori infections. Colestipol is a bile acid sequestrant used to lower blood cholesterol, which is not used to treat Helicobacter Pylori infections ( a bacterium that colonizes the human stomach).

Example Question #3 : Causes And Treatments Of Gastrointestinal Conditions

What foods must be avoided in Celiac disease?

Possible Answers:

Foods containing dairy

Foods containing wheat

Foods containing oat

Foods containing gluten

Foots containing red meat

Correct answer:

Foods containing gluten

Explanation:

Celiac disease is an autoimmune condition that is triggered by ingestion of gluten, a protein found in wheat, barley, and rye. A wheat-free diet is not sufficient for a patient with Celiac disease, as many other products contain elements of barley or rye and thus also contain gluten.

Oat, while often avoided by individuals with Celiac disease due to cross-contamination during processing, does not contain gluten. Whole dairy products are also generally gluten-free and considered safe for patients with Celiac disease.

Example Question #4 : Causes And Treatments Of Gastrointestinal Conditions

Samantha is a registered nurse working in the intensive care unit with a patient recently diagnosed with Clostridium difficile. She violates Clostridium difficile contact precautions by __________

Possible Answers:

placing the client in a semi-private room with another patient diagnosed with Clostridium difficile

cleaning surfaces with hypochlorite-based disinfectants

cleansing her hands with only alcohol-based gel before leaving the room

donning only gloves and a gown before entering the room

placing the patient in a private room

Correct answer:

cleansing her hands with only alcohol-based gel before leaving the room

Explanation:

Clostridium difficile (C. diff) is an infection caused by Clostridium difficile bacteria and requires contact precautions. Contact precautions state that nurses must wear gloves and a gown while caring for the patient. Nurses must also preform adequate hand hygiene before and after the use of gloves. Additionally, because C. diff infections are caused by spores, alcohol gel alone may not be sufficient to eliminate the bacteria. Current practice is the use of soap and water to cleanse hands. Afterwards, nurses may utilize alcohol-based hand gel. It is acceptable to place a C. diff patient in a semi-private room with another C. diff patient if private rooms are unavailable.

Example Question #5 : Causes And Treatments Of Gastrointestinal Conditions

Carrie is caring for an 85-year-old woman in a long-term care facility. Her patient has been taking antibiotics for the past two weeks to treat a severe case of cellulitis. Carrie notices that her patient has developed a fever, has refused her last two meal trays, and is complaining of abdominal pain. Which of the following samples should Carrie seek permission to obtain? 

Possible Answers:

A gastric fluid sample

A urine sample

A sputum sample

A stool sample

A blood sample

Correct answer:

A stool sample

Explanation:

It is possible that this patient is suffering from a Clostridium difficile infection caused by bacteria. The presence of an underlying condition, increasing age, and antibiotic use are all risk factors for contracting Clostridium difficile. A stool sample is commonly used to test for the bacteria. Until the results are available, Carrie should place the patient under proper C. difficile contact precautions.

Example Question #6 : Causes And Treatments Of Gastrointestinal Conditions

A female client with advanced cirrhosis of the liver has noticed that her abdomen has become greatly distended and she is concerned about her body image. The client asks the nurse "What is causing my stomach to look so big?"

The nurse responds based on her knowledge of liver disease and possible signs and symptoms. She tells the client which of the following explanations for her distended abdomen?

Possible Answers:

An accumulation of nitrogen waste in the bloodstream due to the liver's inability to transform the waste to non toxic substances causes ascites

The liver is producing excess cholesterol and it has accumulated in the interstitial spaces of the abdomen

The liver's inability to make clotting factors due to vitamin K deficiency causes internal bleeding into the abdominal cavity

Cirrhosis is highly associated with severe constipation and the accumulation of gas in the peritoneal cavity causing distention

Elevated blood pressure in the liver and the liver's inability to synthesize albumin causes fluid shifts in the abdomen

Correct answer:

Elevated blood pressure in the liver and the liver's inability to synthesize albumin causes fluid shifts in the abdomen

Explanation:

Portal hypertension causes proteins to move from the bloodstream into the lymphatics which cannot handle the excess and they leak into to abdominal cavity. The proteins causes an osmotic pressure pulling fluid into the space leading to ascites. Hypoalbuminemia will lead to decreased colloid oncotic pressure as well, also contributing to ascites.  

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