As you prepare for the NCLEX, remember to focus on gastrointestinal disorders. Mastery of GI conditions empowers you to deliver exceptional health care.
A 40-year-old male is admitted to the emergency department with sudden and severe abdominal pain. He reports a history of chronic epigastric pain that has worsened over the past 24 hours. On examination, the patient is diaphoretic and appears in significant distress. His blood pressure is 100/60 mm Hg, heart rate is 120 bpm, and respiratory rate is 22 bpm. Abdominal examination reveals marked tenderness with guarding and rebound tenderness in the epigastric region. Bowel sounds are absent. Laboratory results show an elevated white blood cell count (WBC) and an elevated serum lipase level. An abdominal X-ray reveals the presence of free air under the diaphragm. Which of the following is the most likely diagnosis based on the clinical presentation and diagnostic findings?
A) Acute cholecystitis
B) Gastroesophageal reflux disease (GERD)
C) Perforated peptic ulcer
D) Acute pancreatitis
E) Diverticulitis
Explanation: The clinical presentation and diagnostic findings in this patient are highly suggestive of a perforated peptic ulcer. Key indicators include sudden, severe abdominal pain with a history of chronic epigastric pain, diaphoresis, vital sign changes (tachycardia and hypotension), marked tenderness with guarding and rebound tenderness on abdominal examination, absence of bowel sounds, and elevated white blood cell count (WBC).
@qbankproacademy 4000+ Free NCLEX QUESTIONS. Go to QBankProAcademy.com FREE Qbank questions for NCLEX RN, PN, HESI Exit, Med Surg, AANP, ANCC, and HesiA2. Practice questions, quizzes, and listen to the Free Podcast. In this video, we review a question on INFECTION CONTROL in Nursing Care. Free nursing NCLEX 60-DAY CHALLENGE https://qbankpro.thinkific.com/courses/qbankpro-academy At QbankproAcademy.com our mission is to provide free QBanks, videos, and the most up to date test prep information for nurses. If you find our website helpful, please tell other aspiring nurses, nursing students, and professors. Please link to our site from your blogs, videos, and college websites, or share us on your favorite social media sites. Thank you for your support! nclex Nurses Nursing aanp qbank ancc hesi medsurg qbank
The elevated serum lipase level may be a result of irritation of adjacent structures due to perforation. Additionally, the abdominal X-ray showing free air under the diaphragm is a classic radiological sign of perforation, which is highly specific for this diagnosis. Perforated peptic ulcer is a surgical emergency requiring prompt intervention. Acute cholecystitis, GERD, acute pancreatitis, and diverticulitis may present with abdominal pain but do not typically exhibit the combination of findings seen in this patient, making perforated peptic ulcer the most likely diagnosis in this case.
A 45-year-old female presents to the emergency department after sustaining a gunshot wound to the chest. On examination, there is a visible bullet entry wound in the left anterior chest wall. She is hypotensive with distant heart sounds on auscultation. A chest X-ray shows an enlarged cardiac silhouette. What is the most likely diagnosis?
A) Flail chest
B) Cardiac tamponade
C) Tension pneumothorax
D) Hemothorax
Explanation: The clinical presentation with gunshot wound to the chest, hypotension, distant heart sounds, and an enlarged cardiac silhouette on chest X-ray is indicative of cardiac tamponade. In this condition, there is an accumulation of fluid (usually blood) in the pericardial sac, which compresses the heart and impairs its ability to pump effectively.
A 32-year-old male is involved in a fall from a significant height. He presents with chest pain, paradoxical chest wall movement, and a visible deformity of the chest wall during breathing. Chest X-ray shows multiple rib fractures on the left side. What is the most likely diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Flail chest
D) Hemothorax
Explanation: The clinical presentation with chest pain, paradoxical chest wall movement (inward during inspiration and outward during expiration), visible deformity of the chest wall during breathing, and multiple rib fractures on imaging is indicative of flail chest. Flail chest occurs when multiple adjacent ribs are fractured in two or more places, leading to instability of the chest wall.
A 40-year-old male undergoes a total gastrectomy for refractory peptic ulcers. He presents with symptoms of frequent diarrhea, dehydration, and electrolyte imbalances. Stool studies show steatorrhea. What is the most likely diagnosis, and what treatment should be considered?
A) Dumping syndrome; dietary modification
B) Gastroesophageal reflux disease (GERD); proton pump inhibitor (PPI)
C) Short bowel syndrome; nutritional support
D) Inflammatory bowel disease (IBD); corticosteroids
Explanation: The patient’s symptoms of diarrhea, dehydration, electrolyte imbalances, and steatorrhea are indicative of short bowel syndrome, which can occur after a total gastrectomy. Treatment typically involves nutritional support, which may include parenteral nutrition or dietary adjustments to compensate for malabsorption.
A 55-year-old female presents with progressive joint pain, stiffness, and swelling in her hands, particularly in the small joints of the fingers. She also complains of morning stiffness that improves with activity. Laboratory tests reveal an elevated erythrocyte sedimentation rate (ESR) and positive rheumatoid factor (RF). What is the most likely diagnosis?
A) Osteoarthritis
B) Gout
C) Ankylosing spondylitis
D) Rheumatoid arthritis (RA)
Explanation: The clinical presentation of progressive joint pain, stiffness, swelling in small joints, morning stiffness, elevated ESR, and positive RF is characteristic of rheumatoid arthritis (RA). These findings are part of the diagnostic criteria for RA.
A 65-year-old male presents with severe hip pain, limited range of motion, and a history of gradual onset of discomfort in the hip and groin area. Physical examination reveals restricted hip abduction and internal rotation. X-ray shows joint space narrowing, subchondral sclerosis, and osteophyte formation in the hip joint. What is the most likely diagnosis?
A) Osteoarthritis
B) Gout
C) Ankylosing spondylitis
D) Rheumatoid arthritis (RA)
Explanation: The clinical presentation of hip pain, limited range of motion, joint space narrowing, subchondral sclerosis, and osteophyte formation on X-ray is indicative of osteoarthritis. Osteoarthritis is a common degenerative joint disease that often affects weight-bearing joints like the hips.
A 30-year-old female presents with diarrhea, nausea, and abdominal pain following antibiotic use for a respiratory infection. Stool samples reveal the presence of pseudomembranes on microscopy. What is the most likely diagnosis?
A) Salmonella enterica
B) Vibrio cholerae
C) Giardia lamblia
D) Clostridium difficile
Explanation: The clinical presentation of diarrhea following antibiotic use, along with the presence of pseudomembranes in stool samples, is indicative of Clostridium difficile infection. Antibiotic-associated diarrhea is a common complication, and C. difficile is a leading causative organism.
A 55-year-old male presents with bloody diarrhea, abdominal pain, and tenesmus. Stool samples show the presence of blood and leukocytes. What is the most likely diagnosis?
A) Salmonella enterica
B) Vibrio cholerae
C) Giardia lamblia
D) Shigella species
Explanation: The clinical presentation of bloody diarrhea, abdominal pain, tenesmus, and the presence of blood and leukocytes in stool samples is characteristic of Shigella infection. Shigella species are known to cause bacillary dysentery, which is characterized by these symptoms and is highly contagious.
A 70-year-old female resident of a long-term care facility presents with severe diarrhea, abdominal cramps, and fever. Stool samples reveal the presence of Clostridium difficile toxins A and B. What is the initial treatment of choice for this patient?
A) Broad-spectrum antibiotics
B) Antispasmodic agents
C) Loperamide (Imodium)
D) Oral vancomycin or fidaxomicin
Explanation: The initial treatment of choice for Clostridium difficile infection with the presence of toxins A and B is oral vancomycin or fidaxomicin. These antibiotics are effective in targeting C. difficile and reducing symptoms.
A 55-year-old male with a history of recent hospitalization and antibiotic use develops diarrhea with abdominal discomfort. Stool samples are positive for Clostridium difficile toxins. What is the appropriate initial step in managing this patient’s diarrhea? A) Initiate intravenous (IV) hydration
B) Discontinue all antibiotics
C) Administer proton pump inhibitors (PPIs)
D) Begin empiric antibiotic therapy
Explanation: The initial step in managing Clostridium difficile infection is to discontinue all antibiotics that may have contributed to the development of the infection. This helps remove the inciting cause and may lead to symptom improvement in some cases.
A 65-year-old female presents with recurrent Clostridium difficile infection (CDI) despite multiple courses of antibiotics. She is seeking alternative treatment options. What adjunctive therapy may be considered to prevent CDI recurrence?
A) Intravenous (IV) fluids
B) Probiotics
C) High-dose corticosteroids
D) Antidiarreals
Explanation: Probiotics may be considered as adjunctive therapy to prevent recurrence of Clostridium difficile infection (CDI). Certain probiotic strains can help restore the balance of the gut microbiota, potentially reducing the risk of CDI recurrence.
A 30-year-old female presents with muscle weakness, hypertension, and a buffalo hump on her upper back. Laboratory tests show elevated cortisol levels, low potassium levels, and metabolic alkalosis. What is the most likely diagnosis, and what test should be performed to confirm it?
A) Addison’s disease; low-dose dexamethasone suppression test
B) Cushing’s disease; high-dose dexamethasone suppression test
C) Hyperthyroidism; thyroid function tests
D) Conn’s syndrome; 24-hour urine aldosterone
Explanation: The clinical presentation of muscle weakness, hypertension, a buffalo hump, elevated cortisol levels, low potassium levels, and metabolic alkalosis is suggestive of Cushing’s disease. The diagnosis should be confirmed with a high-dose dexamethasone suppression test.
A 45-year-old male presents with hypotension, fatigue, and weight loss. Laboratory tests show low cortisol levels and elevated adrenocorticotropic hormone (ACTH). Imaging studies reveal adrenal gland atrophy. What is the most likely diagnosis, and what additional test may be helpful?
A) Cushing’s disease; low-dose dexamethasone suppression test
B) Hypothyroidism; thyroid function tests
C) Addison’s disease; 21-hydroxylase antibody test
D) Pheochromocytoma; 24-hour urine metanephrines
Explanation: The clinical presentation of hypotension, fatigue, weight loss, low cortisol levels, elevated ACTH, and adrenal gland atrophy suggests Addison’s disease. An additional test that may be helpful in confirming the diagnosis is the 21-hydroxylase antibody test, which can detect autoimmune adrenal gland destruction.
A 50-year-old female presents with weight gain, hypertension, and truncal obesity. Laboratory tests show elevated cortisol levels and a lack of diurnal variation. Imaging studies reveal a pituitary adenoma. What is the most likely diagnosis, and what is the recommended treatment?
A) Addison’s disease; glucocorticoid and mineralocorticoid replacement
B) Conn’s syndrome; surgical resection of the adrenal adenoma
C) Cushing’s disease; surgical resection of the pituitary adenoma
D) Hyperthyroidism; radioactive iodine therapy
Explanation: The clinical presentation of weight gain, hypertension, truncal obesity, elevated cortisol levels, and a pituitary adenoma is indicative of Cushing’s disease. The recommended treatment is surgical resection of the pituitary adenoma to normalize cortisol levels.
A 65-year-old male undergoes elective abdominal surgery. On postoperative day 2, he develops a fever, tachycardia, and abdominal pain. Laboratory tests reveal an elevated white blood cell count and a localized collection of pus within the abdominal cavity on imaging. What is the likely diagnosis, and what intervention is required?
A) Surgical site infection; wound debridement
B) Atelectasis; incentive spirometry
C) Deep vein thrombosis; anticoagulation therapy
D) Urinary tract infection; antibiotic therapy
Explanation: The clinical presentation of fever, tachycardia, abdominal pain, elevated white blood cell count, and evidence of pus collection on imaging is suggestive of a surgical site infection. The primary intervention is wound debridement to remove infected tissue and control the infection.
