More Q&A! GI and Endo

1. A patient is suspected with a cholecystitis. He is scheduled for an oral cholecystogram. What would be the most pertinent data that the nurse must obtain during the initial interview with the client?

a. Family history of cholecystitis

b. Recent

c. Iodine/shellfish allergies

d. Educational background

Rationale:

An iodine allergy is an allergy to foods or other substances which contain the element iodine. Allergic reactions to iodine can vary for those affected by this allergy, but the most severe reaction is anaphylactic shock, which is fatal if not quickly treated. Less-severe allergic symptoms such as asthma, dizziness, and fever can also occur as a result of an iodine allergy. Most doctors think iodine allergy is extremely rare, and often confused for allergies to other substances.

Doctors must first test for an iodine allergy before administering contrast dye to a patient, due to the possible severe reaction the dye could cause. Apart from the allergy itself, some people are unable to effectively remove the iodine from their bodies. In these cases, the kidneys, which normally cleanse waste and excess fluid from the body, fail to remove the iodine, resulting in elevated levels throughout the body. Tests are necessary, because a known allergy to something like shellfish is not sufficient reason to forgo the use of iodinated contrast dye.

2. Upon administration of Iodine for her OCG (Oral Cholecystogram); the patient suddenly experienced labored breathing, tachycardia, nausea, and she also reported a swelling sensation in her throat and tongue. The nurse knows very well that these are signs of Iodine reaction. She immediately prepares which of the following drugs?

a. Phentolamine

b. Epinephrine

c. Glucagon

d. Aquamephyton

Rationale:

a. Phentolamine is the antidote for an overdose of ANTIDEPRESSANTS

b. THE GOAL OF THE DRUG TO BE ADMINISTERED IS TO STOP THE HISTAMINE REACTION

c. Glucagon is the antidote of choice for an overdose of B Blockers

d. Aquamephyton or vitamin K is the antidote for an overdose of anticoagulants

3. What are the important interventions in the administration of the “peakless” basal insulin?

a. Do not mix with other insulins, give once a day at bedtime

b. Do not mix with other insulins, once, at the same time each day

c. Administer with rapid acting insulin, twice a day

d. Administer with rapid acting insulin, give once a day in the morning

ANSWER:

b. Do not mix with other insulins, once, at the same time each day

“Peakless” basal insulins are absorbed very slowly over 24 hours and can be only given once per day. Because the insulin is in a suspension with a pH of 4, it cannot be mixed with other insulins because it would cause precipitation. It was originally approved to be given once a day at bedtime; however it has now been approved to be given at the same time each day. It is stressed that the insulin be given at the same time each day to prevent overlapping of the action.

4. Which of the following signs and symptoms must the nurse be alert for in case of complications of insulin therapy?

a. Decreased level of consciousness

b. Agitation and restlessness

c. Dimpling over the site of injection

d. Sudden flaccidity over the area

ANSWER c. Dimpling over the site of injection

Lipodystrophy refers to the localized reaction, in the form of either lipoatrophy or lipohypertrophy, occurring at the site of insulin injections. Lipoatrophy is the loss of subQ fat; it appears as slight dimpling or more serious pitting of SQ fat. Lipohypertrophy, the development of fibrofatty masses at the injection site is caused by the repeated use of an injection site.

5. Mr. Calderon was diagnosed with primary adrenal insufficiency. All but one of the following are expected manifestations of the disease except:

a. Hypernatremia

b. Loss of extracellular fluid

c. Abnormal appetite for salt

d. Decreased cardiac output

ANSWER: A

a. Addison’s disease is caused by mineralocorticoid deficiency which causes increased loss of sodium => Hyponatremia

b. From the said mineralocorticoid deficiency, there would be also an expected increase in urinary loss of water

c. Because of the loss of Na, Cl, and H2O as expected, there will be an abnormal appetite for salts

d. Decreased extracellular fluids will cause a decrease in cardiac output

6. You have assessed that Mr. Calderon has bronzed skin, very dark creases and pressure points and bluish black oral membranes. You are aware that this is caused by:

a. Mineralocorticoid deficiency

b. Glucocorticoid deficiency

c. Increased ACTH levels

d. Loss of sodium and water

ANSWER: C

a. Mineralocorticoid deficiency causes increased urinary losses of Na, Cl and water along with decreased excretion of potassium.

b. Glucocorticoid deficiency causes hypoglycemia, poor stress tolerance, lethargy, weakness, and fever.

c. Hyperpigmentation results from elevated levels of ACTH. The skin looks bronzed or suntanned in exposed areas, and the normal creases and pressure points become very dark.

d. Loss of sodium and water is an effect of Mineralocorticoid deficiency

7. Ms. Sanchez was diagnosed with Cushing’s Syndrome caused by a pituitary tumor. Nurse Kyla knows very well that the surgical procedure of choice for this condition is:

a. Temporary replacement with hydrocortisone

b. Transphenoidal hypophysectomy

c. Radiation of the tumor

d. Adrenalectomy

ANSWER: B

Rationale:

a. Temporary replacement with hydrocortisone is a drug management which is administered after the client has undergone the surgery.

b. If Cushing’s syndrome is caused by pituitary tumors rather than tumors of the adrenal cortex, treatment is directed at the pituitary gland. Surgical removal of the tumor by transphenoidal hypophysectomy is done. Success rate: 80%

c. Radiation of the pituitary gland also has been successful, although it may take several months for control of the symptoms.

d. Adrenalectomy is the treatment of choice in patients with adrenal hypertrophy

8. A patient with hyperthyroidism suddenly presented with very high fever, extreme cardiovascular effects (tachycardia, congestive failure and angina), and severe CNS effects (agitation, restlessness, and delirium). Nurse Christle knows that the patient is undergoing a thyroid storm, or thyrotoxicosis. She immediately prepares which of the following:

a. Cold packs

b. Cooling mattress

c. Ice chips

d. None of the above

ANSWER: C

Rationale

a. Peripheral cooling is initiated with cold packs and cooling mattresses.

b. Peripheral cooling is initiated with cold packs and cooling mattresses

c. Ingestion of ice chips will not support peripheral cooling

d. Answer is D

9. John is diagnosed with Grave’s disease. Upon teaching him for his discharge instructions, Nurse Alfred tells him to avoid the following but one?

a. Coca-cola

b. Nestea Iced Tea

c. Dunkin Doughnuts

d. Del Monte Pineapple Tidbits

Answer: C

Rationale:

To reduce diarrhea, highly seasoned foods and stimulants are contraindicated. This includes colas, teas, high-fibred food etc.

a. Cola has methylxanthine, which in turn, increases gastric acid secretions

b. Same as with colas. Teas contain methlxanthine which increases HCl secretions

c. High carbohydrate diet do not trigger this

d. Pineapples are rich in fibre. Our main objective in Hyperthyroidism is to prevent diarrhea.

10. Mrs. De Guzman arrives at your clinic presenting with pain, tenderness, and rigidity of the upper right abdomen. You suspect cholecystitis. You foresee the doctor ordering which diagnostic procedure of choice?

a. Ultrasonography

b. Abdominal x-ray

c. Endoscopic retrograde cholangiopancreatography

d. Cholescintigraphy

Answer: A

a. Ultrasonography is the DPC because it is rapid and accurate and it can be used with patients with liver dysfunction and jaundice. It does not expose the patients to ionizing radiation.

b. Abdominal x-ray is merely used so that other diseases may be ruled out.

c. ERCP is commonly used for diagnostics, visualization, and removal of stones from cholelithiasis

d. Cholescintigraphy is used in the diagnosis of a blockage of bile duct or acute cholelithiasis

11. Mrs. De Guzman arrives with the following signs and symptoms. You know very well that the following are signs and symtoms of cholecystitis but one:

A. tenderness when hand taps the edge of right costal arch.

B. pain when press between edges of sternocleidomastoid

C. Increased sensitivity below the right scapula (also due to phrenic nerve irritation).

D. Rigidity of the left lower abdomen

ANSWER: D

Rationale

A. Ortner's sign, or the tenderness when hand taps the edge of the right costal arch

B. Georgievskiy — Myussi's sign (phrenic nerve sign) — pain when press between edges of sternocleidomastoid

C. Boas' sign — Increased sensitivity below the right scapula (also due to phrenic nerve irritation).

D. Cholecystitis usually presents with rigidity of the RIGHT UPPER ABDOMEN

12. A client with Addison’s would exhibit all but one of the following signs and manifestations?

a. hunger

b. muscle spasm

c. weight gain

d. lethargy

answer:  D

Rationale: lethargy and depression are the early symptoms of Addison’s disease. Most client experience loss of appetite and weight loss. Muscle become weak not spastic.

13. Which intervention is the highest priority for a client with Addisonian crisis?

a. preventing irreversible shock

b. preventing infection

c. relieving anxiety

d. lowering blood pressure

answer: A.

Rationale: in Addisonian crisis, there’s an uncontrolled loss of sodium in the urine and impaired mineralcorticoid function resulting in loss of extracellular fluid and low blood volume and possible irreversible shock. Preventing infection is not an appropriate goal in a life-threatening situation. Relieving anxiety is appropriate after the patient is stabilized. The client in Addisonian crisis is hypotensive, so blood pressure should be increased not decreased.

14.  A client presents with a  “buffalo hump” at the shoulder area and an obese truncal area with thin extremities. What is the best test for the nurse to anticipate?

a. fluid deprivation test

b. glucose tolerance test

c. low-dose dexamethasone suppression test

d. Thallium stress test

answer: C.

Rationale: a low-dose dexamethasone suppression test is used to detect changes in plasma cortisol levels and to diagnose Cushing’s syndrome. A fluid deprivation test is used to diagnose diabetes insipidus. The glucose tolerance test is used to determine gestational diabetes in pregnant women. A Thallium stress test is used to monitor heart function under stress.

15.  Treatment for Cushing’s syndrome may involve removal of one of the adrenal glands, which could cause a temporary state of which condition?

a. hyperkalemia

b. adrenal insufficiency

c. excessive adrenal hormone

d. syndrome of  inappropriate antidiuretic hormone (SIADH)

answer: B.

Rationale: removing a major source of adrenal hormones may cause a temporary adrenal insufficiency, requiring short-term replacement therapy. When both adrenal glands are removed, the client requires lifelong hormone replacement. A client with Cushing’s syndrome would have a loe-not high- potassium level. The client wouldn’t have excessive adrenal hormone if all or part of the adrenal glands are removed. SIADH doesn’t involve the adrenal; it involves the pituitary gland.

16. A client presents with weight gain, intolerance to cold, constipation, and lethargy. Which test should the nurse expect to be ordered?

a. liver function test

b. hemoglobin A1C

c. T4 and thyroid-stimulating hormone

d. 24-hour urine free cortisol measurement

answer: C.

Rationale: the client’s symptoms suggest hypothyroidism. Levels of thyroid-stimulating hormone and T4 should be measured if hypothyroidism is suspected. Liver function test is used to determine liver disease. Hemoglobin A1c measurement is used to assess hyperglycemia. As part of the screening process for Cushing’s syndrome, 24-hour urine free cortisol measurement is completed.

17. when assessing a client who is being treated for hypothyroidism, which of these findings would indicate a potentially serious complication?

a. chills, fever, hypotension

b. Palpitations and chest pain

c. Decreased visual acuity

d. Low platelet counts

Answer: B.

Rationale: Palpitations and chest pain are cardiac symptoms, which can be precipitated with thyroid replacement therapy, especially in clients with pre-existing heart disease. Chills, fever and hypotension could indicate several complications, such as sepsis to infection, or transfusion reactions, which are not related to hypothyroid therapy. Decreased visual acuity and low platelet count are not related to hypothyroidism.

18. Which group of symptoms of hyperthyroidism is most commonly found in elderly clients?

a. depression, apathy and weight loss

b. palpitations, irritability, and heat intolerance

c. cold intolerance, weight gain, and thinning hair

d. numbness, tingling, and cramping of extremities

answer: A.

Rationale: most elderly clients present with depression, apathy and weight loss, which are typical signs and symptoms of hyperthyroidism. palpitations, irritability, and heat intolerance can be present with hyperthyroidism, but these aren’t typical in elderly clients. cold intolerance, weight gain, and thinning hair are some signs of hypothyroidism. numbness, tingling, and cramping of extremities are symptoms of hypocalcaemia, which may be a symptom of hypoparathyroidism.

19. if pancreatitis attack has been brought on by gallstones or gallbladder disease, a client may require reinforcement about the need to follow which type of diet?

a. high calorie, high protein diet

b. high fiber diet, encouraging fluid intake

c. low-fat diet, avoiding heavy meals

d. diet high in protein, calcium, and vitamin D.

answer: C.

Rationale: a client who survives an acute pancreatitis attack caused by gallstones or gallbladder disease requires reinforcement to maintain a low-fat diet and to avoid heavy meals. A high calorie, high protein diet is appropriate for clients with hyperthyroidism. A diet high in fiber, encouraging fluid intake, is recommended for constipation. A client with Cushing’s syndrome should follow a diet high in protein, calcium and Vitamin D.

20. A client is diagnosed with acute Pancreatitis. The nurse is teaching the client about the causes. Which of the following client’s response is most correct?

a. Gallstones

b. Crohn’s disease

c. High gastric Acid levels

d. Low thyroid hormone

Answer: A.

Rationale: Gallstones may cause obstruction and swelling at the ampulla of Vater, preventing flow of pancreatic juices into the duodenum and leading to pancreatitis. Gallbladder obstruction and alcoholism are the major causes of acute pancreatitis. Crohn’s disease usually involves the terminal ileum and wouldn’t affect the pancreas. High gastric acid levels and low thyroid hormone levels aren’t related to an acute pancreatitis attack.

21.          What disorder is characterized by having hyper secretion of glucocorticoids and/or steroid medications?

A.     Addison’s Disease

B.      Cushing’s syndrome

C.      Myxedema

D.     SIADH

Answer: B

a)      Addison’s disease is characterized by severe decrease in adrenal cortex hormones.

b)      It is caused by hyper secretion of adrenal cortex hormones (glucocorticoids, mineralocorticoids and sex hormone).

c)       It is the hyposecretion of thyroid hormones in adulthood.

d)      It is Syndrome if Inappropriate Diuretic Hormone.

22.            Which of the following findings would be a typical of Cushing’s syndrome?

A.     Hirsutism

B.      Eternal tan

C.      Loss of libido

D.     Dehydration

Answer: A

a)      Hirsutism is the masculine characteristics in females which is one of the manifestations of Cushing’s syndrome.

b)      B and C are manifestations of Addison’s disease.

c)       D is a manifestation of Diabetes Insipidus

22.  Which of the following findings would be a typical of Addison’s disease?

A.     Hypokalemia

B.      Hypernatremia

C.      Hypoglycemia

D.     Decreased blood urea nitrogen (BUN) level

Answer: C

a)      Hypokalemia is a included in the manifestations of Cushing’s syndrome

b)      Hypernatremia is one of the manifestations in Diabetes Insipidus

c)       Hypoglycemia is a typical manifestation. Hyperkalemia and hyponatremia also occur. These are due to hyposecretion of aldosterone. In Addison’s disease everything is low except for Potassium.

d)      This is not included in any of the manifestations.

23. All are manifestations of Addisonian Crisis except:

A.     Severe headache

B.      Generalized weakness

C.      Severe hypotension

D.     Easy bruising

Answer: D

Easy bruising is one of the clinical manifestations of Cushing’s syndrome while a, b, and c are all clinical manifestations of Addisonian Crisis which is life threatening.

24. Which of the following manifestations is experienced by the patient having hyperthyroidism?

A.     Cold intolerance

B.      Lethargy

C.      Increased metabolic rate

D.     Constipation

Answer: C

In hyperthyroidism everything is high, fast, and wet. E.g. high and wet: HPN, tachycardia, hyperthermia; wet: diaphoresis, diarrhea.

23.          Increased metabolism in hyperthyroidism causes all of the following except:

A.     Increased appetite to eat

B.      Weight loss

C.      Heat intolerance

D.     Menorrhagia

Answer: D

A, B and C are all manifestations of increased metabolism in hyperthyroidism except D because is included in the manifestations in hypothyroidism.

25. Which manifestation is not included in hypothyroidism?

A.     Heat intolerance

B.      Amenorrhea

C.      Exophthalmos

D.     Lethargy

Answer: D

In hypothyroidism, everything is low, slow and dry.  Low and slow: slowed physical and mental reactions, lethargy, low body temperature, bradycardia, and slow metabolism. Dry: dry hair and skin, and constipation.

26.                        What foods should be avoided by the patient who has hypothyroidism?

A.     Cabbage, cauliflower and radish

B.      Hotdog and ham

C.      Chicken

D.     Pasta

Answer: A

These foods can inhibit thyroid secretion.