Week 5 Exam Q A - Week 5 Exam Q & A A 37-year -old female complai...

NR-507 Advanced Pathophysiology

Week 5 Exam Q & A

A 37-year -old female complains of a 7-month history of intermittent heart burn that occurs after eating tomatoes. She denies any weight loss. On exam, the NP identifies epigastric tenderness. As first line therapy for this

patient, the NP should advise the patient to:

• Avoid trigger foods.
• Drink addition fluids with food intake.
• Take an antacid prior to eating.
• Use a prokinetic agent.

Correct Answer:

Prior to starting medications, avoiding trigger foods can be tried since a specific food, tomatoes were identified, and the patient reports no alarm symptoms.

Which of the following is an "alarm" finding in a person with GERD symptoms?

• Abdominal pain.
• Hypotension.
• Iron-deficiency anemia
• Weight gain.

Correct Answer:

Iron-deficiency anemia is an alarm system that can indicate bleeding.

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The NP provides education to a patient with a new diagnosis of GERD. Which statement below would indicate that the patient needs further teaching?

• "I will eat small meals throughout day instead of 3 large ones."
• "I will not eat just before bedtime."
• "After I eat, I will recline to help decrease the pressure on the lower

esophageal sphincter (LES)."

• "I will drink ginger tea instead of mint tea."

Correct Answer:

Reclining will exacerbate GERD symptoms.

A volvulus is the twisting of the bowel.

• True
• False

Correct Answer:

Volvulus occurs when a loop of intestine twists around itself and the mesentery that supplies it, causing a bowel obstruction. Symptoms include abdominal distension, pain, vomiting, constipation, and bloody stools. The onset of symptoms may be insidious or sudden.

Hiatal Hernia Which of the following is true?

• A hiatal hernia protrudes through the inguinal canal.
• Hiatal hernia symptoms usually develop early in the disease.
• Patients with a hiatal hernia can be asymptomatic.
• Hiatal hernias are strongly associated with colon cancer.

Correct Answer:

The patient with a hiatal hernia can be asymptomatic. The remaining choices are not true of hernias.

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Intussusception occurs when a part of the small bowel herniates through the diaphragm.

• True
• False

Correct Answer:

Intussusception refers to part of the bowel that invaginates itself.(telescopes)

Pseudo Bowel Obstruction A pseudo bowel obstruction is due to a myopathy or neuropathy.

• True
• False

Correct Answer:

A pseudo obstruction does not involve actual matter that causes an obstruction. Rather, it is related to myopathy (bowel does not function) or neuropathy (innervation of the nerves is altered).

Bowel Obstruction Complications Which of the following are complications of bowel obstruction?

• Ischemic bowel.
• Perforation.
• Peritonitis.
• All of the above.

Correct Answer:

All are complications of a bowel obstruction.

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Hiatal hernia definition

Correct Answer:

A hiatal hernia is a diaphragmatic hernia that protrudes (herniates) through the upper part of the stomach through the diaphragm and into the thorax due to dilation of the gastroesophageal junction (GJ).

There are four types of hiatal hernias:

Correct Answer:

Type 1 Sliding hiatal hernia. This is where the junction of the esophagus slides up past the GE junction.Type 2 Paraesophageal hernia. In a paraesophageal hernia, the contents of the abdomen slide up around the esophagus and into the chest. The GE junction in the type 2 hernia does not go up into the chest.Type 3 Mixed hiatal hernia. This is a combination of both Type 1 and Type 2 hernias. The GE junction slides up into the chest and the fundus of the stomach slides up and around.The type 4 hernia is an aggravated Type 3 where other organs other than the stomach slide up into the chest including the colon and small bowel and spleen.

Bowel Obstruction symptoms

Correct Answer:

nausea, vomiting, cramping abdominal pain, constipation, diarrhea, distended abdomen, fever, tachycardia. Can occur in small bowel or large bowel.

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