APEA 3P Exam Prep- GI Questions with Correct Answers and Explanations, Exams of Nursing

Download APEA 3P Exam Prep- GI Questions with Correct Answers and Explanations and more Exams Nursing in PDF only on Docsity! APEA 3P Exam Prep- GI Questions with Correct Answers and Explanations The relationship between colon polyps and colon cancer is those polyps: eventually, all become malignant. have a slow progression to colon cancer. have a rapid progression to colon cancer. have no relationship to colon cancer. B. Colon polyps are usually slow-growing and take a long time to progress to cancer. This is the reason that a colonoscopy does not need to be repeated annually. While not all polyps grow slowly, this is the usual progression. A 5-year-old has been diagnosed with pinworms. He lives with his mother. There are no other members of the household. How should his mother be managed? Reassure the mother that if she develops symptoms, she will need to be treated. Visually assess the mother’s rectum for redness or presence of worms. Have the mother collect a stool specimen and send it to the laboratory. Perform the “scotch tape” test and look at the collection under the microscope. D. The diagnosis of pinworms (Enterobiasis) is made by using a piece of scotch tape on a tongue depressor. It is touched against the patient’s rectum. The greatest yield of eggs will occur during the nighttime or early AM. Eggs will be found here if they are present. Worms and eggs are rarely found in stool specimens, so this is not a good plan. When the scotch tape is examined under a low power microscope, the eggs will be easily visualized since they are large and bean shaped. The finding of an adult worm would confirm the diagnosis. These are large enough to be seen with the naked eye. If the mother is symptomatic, she should be treated with or without a rectal exam. It is very likely she is infected. A patient has been diagnosed with hepatitis B. The most commonly reported risk factor is: drinking contaminated water. eating contaminated food. exposure to blood. sexual exposure. D. Hepatitis B is transmitted by blood and body fluids. While exposure to infected blood or blood products would significantly increase the risk of infection in unvaccinated people, this is much less likely than becoming infected via sexual exposure or IV drug use. Hepatitis A is transmitted via fecal-oral routes. Drinking contaminated water and eating contaminated food implicate hepatitis A as the etiologic agent. The three most common causes of bacterial diarrhea in the US are Salmonella, Campylobacter, and: E. coli. Enterovirus. Yersinia. Shigella. D. Shigella will be shed continuously in the stool and should be easily identified on stool culture. When bacterial gastroenteritis is suspected, a stool specimen could be ordered for confirmation. Generally, these three pathogens are easily identified if they are present. Enterovirus produces a viral form of diarrhea. Yersinia produces the deadly disease called bubonic plague. E. coli is a typical colonic pathogen. An 83-year-old patient is diagnosed with diverticulitis. The most common complaint is: rectal bleeding. bloating and cramping. left lower quadrant pain. frequent belching and flatulence. with patient squatting. B. The patient should be examined while he is standing. He should be asked to bear down, cough, or strain during the exam. Though hernias are far more common in males, they can be found in females too. In males, the patient should be asked to stand. The examiner should put his 2nd or 3rd finger through the scrotum and into the external ring. When the patient is asked to cough, a “silky” feel will butt up against the examiner’s finger, and the hernia can be easily felt. A 15-year-old is about 10% below her ideal body weight. Laboratory studies were performed. Which complaint might be common in this patient (Labs in image)? Headaches Dizziness with standing Muscle cramps Hair loss B. This patient does not meet the strict criteria for an eating disorder, but it should be suspected. The other laboratory values are not the cause of her dizziness with standing. This is likely due to a low hemoglobin. She needs treatment for a probable iron deficiency anemia and elicitation of history to help identify the cause of her low hemoglobin. A 45-year-old patient has the following laboratory values. How should they be interpreted (Labs in image)? The patient has hepatitis. The patient had hepatitis. The patient should consider immunization. The results are indeterminate A. This patient has a positive hepatitis B surface antigen (HBsAg). Therefore, he has hepatitis B. A positive anti-HBc is found in patients who either have hepatitis now or who have had it. The surface antibody (anti-HBs) would be expected to be negative in a patient with a positive surface antigen (HBsAg) because these two markers will not be positive at the same time. A 37-year-old has routine blood work performed during an annual exam. On exam, he has a tender, enlarged liver. How should the nurse practitioner proceed (Labs in image)? Repeat the liver enzymes today. Order a hepatitis panel. Have patient return in one week for recheck. Order a CBC. B. The differential for a patient with elevated liver enzymes can reflect many different etiologies. Since the liver is tender and liver enzymes are elevated, a likely etiology is hepatitis. The size and consistency of the liver should be ascertained. The spleen should be assessed. If it is palpable, it is enlarged also. Hepatitis panel should be performed and strong consideration given to referral to gastroenterology. Repeating liver enzymes might be considered if the rest of the exam was normal and the lab values were the only abnormal values. The results of a CBC will not change the differential. The patient’s abnormal labs and exam make this urgent, and waiting a week will delay diagnosis and possible treatment. Many older adults have cachexia. What characterizes this? Anorexia and weight loss Weakness and fatigue Illness and loss of muscle mass Starvation and weight loss C. Cachexia is common in older adults and is associated with increased mortality. It is described as a syndrome of underlying illness that is accompanied by loss of muscle mass. Illnesses associated with cachexia are malignancies, renal disease, COPD, and chronic heart failure. Other matters are associated with cachexia and may contribute to loss of muscle mass. These include loss of appetite, insulin resistance, and increased catabolism of bodily proteins. A 70-year-old patient states that he had some bright red blood on the toilet tissue this morning after a bowel movement. He denies pain. What is the LEAST likely cause in this patient? Hemorrhoids Diverticulitis Colon cancer Anal fissure D. Nearly 1 in 3 patients in this age group with acute lower gastrointestinal bleeding have bleeding secondary to diverticulitis. Nearly 1 in 5 have colorectal cancer or polyps, though, polyps usually do not bleed. Patients who have anal fissures often complain of a tearing pain during bowel movements. Regardless of the etiology, this patient needs referral for a colonoscopy to identify the cause of bleeding. He is at high risk for colon cancer because of his age. The appropriate recommendation is referral to gastroenterology for colonoscopy. A patient has received a prescription for metronidazole for treatment of C. difficile. What should be avoided in this patient? Excess fluids Vitamin B12 Grapefruit juice Alcohol D. D. Irritable bowel syndrome (IBS) is common in adults and lasts into older adulthood, but symptoms start before age 50 years. Typical symptoms of IBS are diarrhea and constipation intermittently, abdominal pain (one of the criteria for diagnosis), and bloating. Other symptoms that are inconsistent with IBS are associated weight loss, blood in the stool, rectal bleeding, and nocturnal diarrhea. These are more indicative of inflammatory disease or carcinoma of the bowel. A 70-year-old presents to the nurse practitioner’s office for a well exam today. What medication probably has no effect on screening for occult blood in the stool? Aspirin Clopidogrel Acetaminophen Ibuprofen C. The exam for occult blood is a screen for colorectal cancer. Aspirin, clopidogrel, NSAIDs, warfarin all decrease the positive predictive value of the test because they all can exacerbate bleeding if it is occurring in the colon secondary to a polyp or tumor. Ideally, the medications mentioned (except acetaminophen) would be stopped prior to the exam to increase the likelihood of test sensitivity, but this is not always possible. Most patients who have acute hepatitis B infection: are females. are acutely ill. have varied clinical presentations. develop subsequent cirrhosis. C. Most patients with hepatitis B (70%) have subclinical hepatitis. Development of cirrhosis is rare following hepatitis B infection unless other systemic factors are present, such as ethanol abuse, HIV infection, hepatitis C infection, etc. There is no predilection for this disease by gender. When patients are symptomatic, they typically develop nausea, jaundice, and flu-like symptoms with fever, body aches, and fatigue. An older adult has suspected vitamin B12 deficiency. Which of the following lab indices is more indicative of a vitamin B12 deficiency? Microcytosis Macrocytosis Leukocytosis Thrombocytosis B. A vitamin B12 deficiency can produce anemia called pernicious anemia. This is most commonly found in older adults and is characterized by macrocytosis. In other words, the red cells are larger than expected. Microcytosis may be seen in iron deficiency anemia or thalassemia. Leukocytosis refers to large numbers of white cells in the bloodstream. Thrombocytosis refers to an increased number of platelets in the bloodstream. A 48-year-old patient has the following laboratory values. How should they be interpreted (Labs in image)? The patient has hepatitis C. The patient does not have hepatitis C. The patient should consider immunization. The results are indeterminate. A. This patient has hepatitis C. He has a reactive HCV antibody (anti-HCV). This is a positive screen for hepatitis C. The HCV RNA level is detectable, which confirms infection. When both the anti-HCV and HCV RNA are positive, the patient can be diagnosed with hepatitis C. At this time, there is no immunization for hepatitis C. A patient presents with complaints of bright red stools over the past week. This symptom could be consistent with: cancer of the ascending colon. cancer of the sigmoid colon. gastric ulcers. small bowel obstruction. B. Bright red blood in the stools is more characteristic of left-sided colon cancer (descending and sigmoid colon) or rectal hemorrhoids. If blood occurs in the stool in right-sided colon cancers (ascending colon) or gastric ulcers, the stool will be black and tarry. A healthcare provider was stuck with a needle from a patient suspected to be infected with HIV. A rapid HIV test was performed on the patient and found to be positive. This means that: HIV prophylaxis should be initiated. the patient is infected with HIV. the HIV status of the patient requires further testing. the HIV status of the healthcare provider requires further testing. C. A rapid HIV is always performed on the source patient. It is known as an ELISA (enzyme-linked immunosorbent assay). In the patient suspected of being HIV positive, it is performed to establish whether or not he was positive at the time of the needle stick. In this case, it was found to be positive, but, this is a screening test, and false positives can occur. Therefore, a confirmatory test, the western blot, is routinely performed on the patient’s specimen to confirm the findings of the ELISA. The healthcare provider will usually be tested with a rapid HIV but it is done to establish HIV status at the time of the needlestick. The results of a rapid test can be performed in less than 20 minutes. The relationship between duodenal ulcer disease and H. pylori infection is: distant. very unlikely possible. very likely. D. Patients with viral gastroenteritis should be treated symptomatically. The goal of therapy is to prevent dehydration and replace electrolyte losses. Antidiarrheals, antispasmodics, and antiemetics can decrease nausea, vomiting, abdominal cramping and symptoms of diarrhea, but should be used with extreme caution when given to older adults or children younger than 5 years of age. Clinical judgment should dictate when it is prudent to initiate these agents. Which of the following would be usual in a patient with biliary colic? Presence of gallstones in imaging studies Presence of gallstones and unpredictable abdominal pain Positive Murphy’s sign only Pain in the upper abdomen in response to eating fatty foods D. Biliary colic refers to discomfort produced by contraction of the gallbladder. This occurs in response to eating. Typically, pain occurs in the upper right quadrant or chest, peaks an hour after eating, and then remains constant and finally subsides over the next several hours. Biliary colic usually lasts at least 30 min, but less than 6 hours. An episode of acute cholecystitis usually lasts greater than 6 hours. A positive Murphy’s sign is elicited when the gallbladder wall is inflamed. It can be elicited by palpating the gallbladder just beneath the liver as the patient takes a deep breath. A 31-year-old patient is suspected of having hepatitis C. He reports possible exposure about a month ago. How should the nurse practitioner interpret these laboratory results? The patient does not have hepatitis C The patient has hepatitis C The results are inconclusive Further testing is indicated A. This patient does not have hepatitis C (HCV) infection. An HCV antibody test (anti- HCV) is recommended as the initial screen for infection. Development of detectable antibodies (anti-HCV) usually occurs between 2-6 months following exposure. The patient's HCV antibody test (anti-HCV) is nonreactive. Typically, subsequent evaluation to detect the presence of HCV RNA is not necessary following a nonreactive anti-HCV result. Because exposure occurred less than 6 months ago, he may lack detectible levels of anti-HCV antibodies, which warrants testing for HCV RNA. HCV RNA levels become detectible before reactive antibodies. HCV RNA was not detected in this patient. This confirms that this patient has a true negative screen for infection with HCV. A 63-year-old male has been your patient for several years. He is a former smoker who takes simvastatin, ramipril, and aspirin daily. His blood pressure and lipids are well controlled. He presents to your clinic with complaints of fatigue and “just not feeling well” for the last few days. His vital signs and exam are normal, but his liver enzymes are elevated. His hepatitis panel is negative for infectious hepatitis. What is the most likely cause of his elevated liver enzymes? He has received a generic version of simvastatin He is an alcoholic in denial Daily grapefruit consumption for the past 10 days Rare liver toxicity from a usual dose of simvastatin C. Grapefruit is a potent inhibitor of the cytochrome P450 enzyme system. Statins and calcium channel blockers are two infamous drug interactions that occur with grapefruit and grapefruit juice. Because they inhibit metabolism of the statin, the patient continues to have statin in circulation because he cannot significantly metabolize the medication. When the next day’s dose is taken, its effect is coupled with the effect of the previous day’s dose. The effect is cumulative. Hepatoxicity can quickly develop. The simvastatin must be stopped immediately! The liver enzymes must be followed until they return to normal; which could take weeks, months or even longer. The most common reason that older adults develop peptic ulcer disease is: chronic NSAID use. H. pylori infection. acetaminophen abuse. polypharmacy. B. The most common reason that older adults have peptic ulcer disease is infection with H. pylori. There are many regimens approved to treat H. pylori and most are well tolerated. NSAID use is the second most common reason older patients have peptic ulcer disease. A patient with diarrhea is tested for C. difficile. How soon should the enzyme immunoassay (EIA) yield results? Within 20 minutes About 24 hours About 3 days Less than one week B. The enzyme immunoassay allows detection of Clostridium difficile toxin, not the organism. It is the most commonly used assay in the US because it is easy to perform, and yields results in less than 24 hours. The assay has good specificity, but moderate sensitivity. More sensitive tests can be performed, but they are more expensive and take longer to yield results. An 82-year-old adult has constipation. A supplement known to cause constipation is: vitamin A. calcium. magnesium. vitamin B12. B. Calcium does produce constipation in many patients. If this is taken as a supplement for osteoporosis or osteopenia, the patient should be encouraged to increase fluids and fiber. The most common cause of diarrhea in adults is: E. coli. salmonella. C. difficile. A 24-year-old female presents with pain and tenderness in the right lower abdominal quadrant. Her pelvic exam and urinalysis are within normal limits. Her WBC is elevated and her urine pregnancy test is negative. What is part of the differential diagnosis? Pelvic inflammatory disease Appendicitis Ectopic pregnancy UTI B. A CBC with a mild elevation in white cell count indicates that infection is likely. This finding is present in most patients who have acute appendicitis. Right lower quadrant abdominal pain, anorexia, and nausea/vomiting are considered classic symptoms of acute appendicitis. Pelvic inflammatory disease is characterized by cervical motion and adnexal tenderness on bimanual examination. Purulent endocervical discharge may be present. This is unlikely in the presence of a normal pelvic exam. Acute pelvic pain and a positive pregnancy test in women of childbearing age may suggest ectopic pregnancy. The patient’s pregnancy test is negative. Symptoms of a urinary tract infection (UTI) can mimic appendicitis, but this can be ruled out with the patient’s normal urinalysis report. A 50-year-old with a history of consumption of 3-4 alcoholic drinks daily and weekend binges has elevated liver enzymes. Which set of enzymes is most representative of this patient? AST= 200, ALT= 75 AST= 100, ALT = 90 AST=100, ALT=200 AST= 30, ALT= 300 A. The normal AST/ALT ratio in healthy subjects is 0.8. In patients with alcoholic hepatitis, the usual ratio (AST:ALT) is 2:1. When the ALT is very elevated, infectious hepatitis must be considered. Normally, both AST and ALT are less than 40 IU/L. The level of elevation does not correlate with the degree of damage in the liver and has no prognostic value in patients with nonacute liver disease. A fecal occult blood test (FOBT) obtained during a rectal examination: should be adequate for screening of colorectal cancer. will usually detect the presence of polyps. is adequate to screen for rectal cancer only. is inadequate to screen for colorectal cancer. D. This is not adequate to screen for colorectal cancer. Fecal occult blood tests have a much higher sensitivity if three consecutive stool specimens are used (applying two samples per card for each specimen). A single specimen is inadequate for screening purposes. Since polyps do not usually bleed, the fecal occult blood test is not a good screen for polyp identification. An inguinal hernia is palpated on a male patient by an examiner. Which word below best describes what the hernia feels like when touched by the examiner? Nodular Silky Firm Bumpy B. Patients should be in the standing position when examined for a hernia. They are asked to strain, cough, or bear down after the examiner has inserted his fingertip within the external ring. The word used to describe the impulse of the hernia bumping into the finger is “silky.” Nodular might be the word used to describe a prostate gland. Bumpy implies an irregular surface on some object. This is not the case with a hernia. The two tests that can indicate current infection with hepatitis B are: presence of hepatitis B surface antigen and hepatitis B surface antibody. presence of hepatitis B surface antigen and IgM. presence of hepatitis B surface antibody and core antibody. absence of IgM and presence of core antibody. B. The earliest serologic marker that indicates acute hepatitis B infection is the presence of hepatitis B surface antigen. It becomes positive about 1-10 weeks after infection, but usually before symptom onset. A positive IgM indicates current infection. The presence of hepatitis B core antibody identifies hepatitis B infection (present or past) with certainty. It does not indicate the timing of infection. Which of the following symptoms is typical of GERD? Chest pain Cough Sore throat Pyrosis D. Typical symptoms of GERD include pyrosis (heartburn). The other symptoms listed are considered atypical symptoms of GERD. Patients who present with atypical symptoms of GERD, especially if older than 50 years, should be considered for endoscopy. Which of the following is NOT a risk factor for developing hepatitis B? Homosexual activity Injecting drug use Heterosexual activity Consuming contaminated water D. Hepatitis B can be contracted by any of the choices listed except drinking contaminated water. Drinking contaminated water increases the risk of hepatitis A. A 26-year-old female presents with concerns about possible hepatitis C (HCV) infection. She admits to IV drug use 2 months ago and sharing needles with several other people. Initial laboratory studies have been completed. How should this be managed? Order HCV RNA Repeat anti-HCV Prescription-strength ranitidine Cimetidine Pantoprazole D. If a patient has been diagnosed with GERD and he is symptomatic on an H2 blocker like ranitidine, a proton pump inhibitor (PPI) should be considered. An example of a proton pump inhibitor is pantoprazole. Relief of symptoms after using a PPI does not indicate a benign condition. This patient could have esophageal erosions, Barrett’s esophagitis, or esophageal cancer. He should be screened for risk factors for these conditions and then a decision to refer this patient to gastroenterology can be made. The most common symptoms associated with gastroesophageal reflux disease (GERD) are heartburn and: cough. regurgitation and dysphagia. cough and hoarseness. belching and sore throat. B. The three most common symptoms of GERD are heartburn (especially postprandial), regurgitation, and dysphagia (especially after longstanding heartburn). Other common symptoms are chest pain, nausea, and odynophagia (painful swallowing). What choice below is most commonly associated with pancreatitis? Gallstones and alcohol abuse Hypertriglyceridemia and cholecystitis Appendicitis and renal stones Viral infection and cholecystitis A. In adults, the most common causes of acute pancreatitis are gallstones and alcohol abuse. Pancreatitis in women is more often due to gallstones; in men, due to alcohol abuse. Hypertriglyceridemia can precipitate pancreatitis, but a serum amylase measurement may be normal. This can be a difficult diagnosis to make. The other conditions listed are not associated with pancreatitis. However, viral infections of the pancreas can produce pancreatitis. A 42-year-old patient was diagnosed with ulcerative colitis many years ago. What part of his routine health screenings should be stressed by the nurse practitioner? He should be screened at age 50 with a colonoscopy. Tetanus immunization should be given every 5 years. Pneumococcal vaccine should be administered by age 50. He should have a colonoscopy every 1-5 years. D. A history of ulcerative colitis or Crohn’s disease is associated with an increased risk of colorectal cancer. Recommendations vary according to organization, but generally, screening with annual colonoscopy should take place 8-10 years after diagnosis in patients with pancolitis. Colonoscopy should be repeated every 1-5 years, depending on his level of risk. A patient has had right upper quadrant pain that has lasted for the past 3 days, but the pain has become acute in the past 12 hours. He has low-grade fever. Which lab test(s) will be elevated if he has pancreatitis? CBC Serum amylase ALT and AST CRP B. Serum amylase levels begin to rise 6-12 hours after pancreatic insult and remain elevated for 3-5 days. The other tests described may be abnormal but are not specific for pancreatitis. A 19-year-old female presents with lower abdominal pain that began about 12 hours ago. She denies vaginal discharge. Which choice below is the least likely cause of her symptoms? Appendicitis Urinary tract infection Renal stone Ruptured ovarian cyst C. A renal stone can produce lower abdominal pain, but it is unlikely to produce fever. Low-grade fever might accompany appendicitis, UTI, or a ruptured ovarian cyst. Another diagnosis that must be considered because of her age is pelvic inflammatory disease. In this case, a pelvic exam should be performed. Which choice contains three medications that should have liver function tests measured prior to initiation? Terbinafine, atorvastatin, simvastatin Naproxen, metformin, aspirin Cimetidine, pravastatin, and propanolol Ketoconazole, simvastatin, iron A. Patients who take terbinafine and statins should have liver enzymes measured prior to initiation. Periodic monitoring of liver enzymes with the statins is no longer required. However, baseline values are prudent. There is no need to do this routinely with aspirin, cimetidine, propanolol, or iron in patients without risk factors. More than 600 commonly prescribed drugs can produce liver enzyme elevations. Care with prescribing is always warranted. Which is NOT an effective strategy for helping older adults gain weight? Increase carbohydrate intake Increase the calories at each meal Increase the frequency of meals Consider liquid supplements A. When treating patients with weight loss, the goal is to increase the number of calories at each meal. Fats are more heavily laden with calories than carbohydrates. Carbohydrates (and proteins) provide only 4 calories per gram; fats provide 9 Ultrasound CT scan MRI X-ray D. X-rays are usually not helpful in diagnosing appendicitis, however, some findings on radiograph can be associated with appendicitis: ileus, free air, right lower quadrant appendicolith or soft tissue density, or a deformity of the cecal outline. A CT scan is considered more accurate than an ultrasound, but ultrasound and CT are the most commonly used tests. The sensitivity and specificity with CT scan are 94 and 95%, respectively. With an ultrasound, the sensitivity and specificity are 86 and 81%, respectively, but it is the preferred diagnostic test in children because of an absence of radiation. MRI is generally not used because it is more expensive, takes more time to complete, and is not as readily available. Most patients who have acute hepatitis A infection: develop fulminant disease. become acutely ill. have a self-limited illness. develop subsequent cirrhosis. C. Clinical presentation of patients infected with hepatitis A virus (HAV) is variable. However, most adult patients have a self-limited, uncomplicated course. There may be mild, flu-like symptoms or there may be a more acute and severe clinical manifestation. Rarely does HAV result in hepatic failure unless other complicating illnesses, like HIV or hepatitis B or C, are present. In children, most are asymptomatic. The early signs and symptoms of appendicitis in an adult: are subtle. produce marked pain in the lower right abdominal quadrant. produce symptoms in the periumbilical region only. include fever, nausea and vomiting. A. The most consistent findings in adults with early presentation of acute appendicitis are subtle and difficult to identify. Symptoms may be as vague as indigestion, flatulence, and a feeling of ill-being. Initially, pain can be in the general abdomen, then become periumbilical, and finally localize to the lower right quadrant. Early symptoms are difficult to identify, especially in older adults A patient has hepatitis B. He probably has a predominance of: leukocytes. lymphocytes. neutrophils. eosinophils. B. Lymphocytes tend to be the predominant white cell present during viral infections. Hepatitis B is a viral infection. The total white count will likely be decreased. This often happens in the presence of viral infections. A bacterial infection is frequently evidenced by an elevated leukocyte count, an increased neutrophil count, and a decreased lymphocyte count. A patient has the following laboratory value. What is the clinical interpretation? He has hepatitis A. He has immunity to hepatitis A. He has no immunity to hepatitis A. More data is needed to interpret this. B. This patient is immune to hepatitis because he has a positive immunoglobulin G (IgG). This signifies immunity secondary to (1) past infection, or (2) immunization. A negative IgG signifies an absence of an immunity to hepatitis A and susceptibility if exposed. What medication listed below could be used to increase appetite in an anorexic patient? Megestrol Loratadine Fexofenadine Serum ferritin A. Megestrol acetate has a positive effect on weight in patients who are trying to gain weight. It increases appetite and may improve quality of life. Weight gain may take up to 3 months before it is measurable. Megestrol has the potential to cause edema and so should be used cautiously (or not at all) in patients with chronic heart failure. A patient has suspected peptic ulcer disease. Her symptoms occur a few hours after eating. She probably has a(n): gastric ulcer. duodenal ulcer. gastric or duodenal ulcer. infection with H. pylori. B. Symptoms have a poor correlation with disease found during endoscopy. However, duodenal symptoms tend to occur within 2-5 hours of eating. These patients derive relief from eating or taking antacids. This is in contrast to a patient with a gastric ulcer who has symptoms within minutes of eating. He tends to derive less relief from antacids. An older patient presents with left lower quadrant pain. If diverticulitis is suspected, how should the NP proceed? Order a chest and abdominal x-ray CT scan of abdomen Barium enema Ultrasound of the abdomen B. generalized abdominal pain. initial WBC elevation. UTI symptoms. low-grade fever. B. Very young children and elderly adults are not likely to have initial WBC elevations. Consequently, appendicitis can be easily missed in these populations. Generalized abdominal pain is typical initially. UTI symptoms in older adults can manifest as lower abdominal pain and are a common presentation in this age group. Low-grade fever is common too. A patient presents with right upper quadrant and upper abdominal pain. Acute cholecystitis is suspected because the pain radiates to the: left scapula area. lower abdomen. back. right scapula area. D. Acute cholecystitis presents with right upper quadrant and/or upper abdominal pain radiating to the right scapular area. The pain is usually steady and aching. Pain in the epigastric area could be associated with a peptic ulcer or dyspepsia. Cancer of the stomach presents with epigastric pain. Acute mechanical colon obstruction presents with pain in the lower abdomen. Symptoms of uncomplicated reflux disease in older adults should be treated: by referring for upper GI testing. with empiric treatment. ambulatory pH testing. referral to gastroenterology. B. In older patients without signs of complicated GERD (choking, cough, shortness of breath, pain with swallowing or in the chest), empiric treatment is appropriate. Empiric treatment can take place using proton pump inhibitors or H2 blockers. If H2 blockers are used, famotidine and nizatidine are preferred because of their efficacy and low risk of drug-drug interactions. If symptoms of GERD persist despite initial treatment, or if symptoms are severe, patients should have testing to rule out esophageal cancer, Barrett’s esophagitis, or other conditions of the esophagus and throat.