NCLEX-PN : Conditions and Treatments

Study concepts, example questions & explanations for NCLEX-PN

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Example Questions

Example Question #2 : Gastrointestinal Conditions

What tissue of the gastrointestinal tract is affected in Celiac disease?

Possible Answers:

Stomach, causing gastritis

Rectum, causing fistulation

Large intestine, causing ulceration

Small intestine, causing villous atrophy

Correct answer:

Small intestine, causing villous atrophy

Explanation:

While individuals with Celiac disease can certainly have gastritis, fistulas, and ulceration due to inflammation, the primary effect of Celiac disease is villous atrophy in the small intestine. Villi become blunted, leading to loss of ability to absorb nutrients, including minerals and fat-soluble vitamins. 

Example Question #2 : Gastrointestinal Conditions

Which of the following refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus?

Possible Answers:

Boerhaave's syndrome

Mallory–Weiss syndrome 

Esophagitis

Barrett's esophagus

Correct answer:

Mallory–Weiss syndrome 

Explanation:

Mallory–Weiss syndrome refers to bleeding from partial-thickness tears in the mucosa at the junction of the stomach and esophagus, often from trauma such as violent retching or coughing. This is compared to Boerhaave's syndrome, which is a full-thickness tear of the esophageal wall. Esophagitis is most commonly caused by gastroesophageal reflux disease (GERD) and does not present with bleeding. Barrett's esophagus refers to a type of metaplasia in the lower esophagus which is thought to be caused by chronic GERD.

Example Question #1161 : Nclex

Full-thickness (transmural) ulceration of the bowel wall occurs in what condition?

Possible Answers:

Ulcerative colitis

Crohn's disease

Irritable bowel syndrome

Celiac disease

Correct answer:

Crohn's disease

Explanation:

Full-thickness (transmural) ulceration of the bowel wall occurs in Crohn's disease. Bowels may also show thickened walls, serosal adhesions, and loss of the regular folds.

In ulcerative colitis, ulceration is restricted to the gut mucosa. Celiac disease results in blunting of intestinal villi, but does not cause ulceration in any form. Irritable bowel syndrome, or IBS, is considered a functional disease as it results in no known pathological tissue changes.

Example Question #1162 : Nclex

Janelle is a 56 year old woman who is three days post total abdominal hysterectomy. She has not passed gas or had a bowel movement since before surgery. The patient starts vomiting dark brown material. The nurse should be sure to do which of the following? 

Possible Answers:

Administer anti-emetics.

Have the patient lay on her left side. 

Auscultate for bowel sounds.

Place a cool washcloth on the patient's forehead.

Report the finding to the next shift.

Correct answer:

Auscultate for bowel sounds.

Explanation:

The patient is displaying symptoms that could indicate a paralytic ileus. A paralytic ileus is a blockage of the intestine that may result after surgery, most commonly abdominal surgery. During an ileus, the intestine cannot move food through the bowel. A patient with this condition will not have bowel sounds. Constipation, nausea, and vomiting are all considered symptoms of an ileus. 

Example Question #1163 : Nclex

The nurse is caring for an 89 year old male who has been admitted for nausea and vomiting. His treatment plan consists of IV fluid replacement of  normal saline at , IV ondansetron PRN, IV prochlorperazine PRN, and an NPO diet. The patient starts to show signs of confusion. The nurse may suspect which of the following? 

Possible Answers:

The patient's anti-emetics.

The NPO order.

The IV fluid replacement rate.

The IV fluid composition.

New onset of Alzheimer's disease.

Correct answer:

The patient's anti-emetics.

Explanation:

Older adults are at high risk for the development of side effects related to medication use. Anti-emetics are commonly administered medications and may cause confusion, especially in older adults.

Example Question #11 : Identifying Gastrointestinal Conditions

The nursing student cares for a patient newly diagnosed with inflammatory bowel disease (IBD). He decides to review the different types of IBD, ulcerative colitis and Crohn’s disease. Which of the following statements is not true about these types of IBD?

Possible Answers:

Complications of Crohn’s disease include fistula formation and intestinal obstruction.

Complications of ulcerative colitis include hemorrhage, abscess formation, and arthritis.

Ulcerative colitis usually manifests with fatty stool (steatorrhea).

Crohn’s disease presents with weight loss, anemia, and dehydration.

Ulcerative colitis and Crohn’s disease may occur in very young children.

Correct answer:

Ulcerative colitis and Crohn’s disease may occur in very young children.

Explanation:

Ulcerative colitis has a usual age of onset from 20-30 and 50-80 years old. Patients with UC have frequent fatty stools with occasional rectal bleeding and abdominal pain after eating. Nurses who care for patients with UC must consider possible intestinal obstruction and fistula formation in these patients. Crohn’s disease has a usual age of onset from young adults to middle aged (30-50 years old). Patients with Crohn’s disease do not have fatty stools but do have common rectal bleeding that may lead to hemorrhage. These patients experience pain before defecating and will have 10-20 liquid (usually bloody) stools per day. Nurses who care for patients with Crohn’s disease should consider possible abscess formation and arthritis. Both UC and Crohn’s disease present with weight loss, anemia, and dehydration due to ineffective nutritional absorption through the intestinal tract.

Example Question #12 : Identifying Gastrointestinal Conditions

Nurse is discussing with a 56-year-old male client causative factors that have lead to his development of peptic ulcer disease. The nurse realizes that there is need for further teaching when the patient makes which of the incorrect statements?

Possible Answers:

"I am aware that I should in engage in relaxation techniques to minimize stress, to help reduce the amount of acid my stomach produces. "

"I will quit smoking, as I understand nicotine contributes to the development of gastric ulcers."

"I will take my prescribed triple therapy with antibiotics and proton pump inhibitor to eliminate the the H. pylori infection for two months as instructed by my physician." 

"I will avoid certain medications such as aspirin, NSAIDs, and corticosteroids - they are capable of disrupting the stomach lining."

"I will eat several small bland meals daily, and avoid irritating foods such as raw fruits, and vegetables."

Correct answer:

"I will take my prescribed triple therapy with antibiotics and proton pump inhibitor to eliminate the the H. pylori infection for two months as instructed by my physician." 

Explanation:

The treatment for peptic ulcer disease when the bacterium H. pylori is found to be present has several treatment strategies. These strategies include a triple drug therapy consisting of a proton pump inhibitor, amoxicillin and clarithromycin. This combination of drugs should be continued for 7-14 days, 2 months is not the course of treatment. All other statements are consistent with proper teaching of causative factors associated with peptic ulcer disease. 

Example Question #11 : Identifying Gastrointestinal Conditions

A nurse is retrieving a report from a hepatic biopsy in a patient with an acute hepatitis B infection. The report describes swollen hepatocytes with irregularly clumped cytoplasmic organelles and large clear spaces. This is known as which of the following? 

Possible Answers:

Ascites

Fibrotic changes

Ballooning degeneration

Necrosis

Correct answer:

Ballooning degeneration

Explanation:

Ballooning degeneration is a form of hepatocellular apoptosis (rather than necrosis) in which hepatocytes swell and begin to show irregularly clumped cytoplasmic organelles and large clear spaces. It is a severe condition often seen with viral hepatitis or steatohepatitis. It is distinct from fibrotic changes, in which depositions of collagen fibers are seen on histology. Ascites is a collection of fluid in the peritoneal cavity, rather than a histological feature.

Example Question #1172 : Nclex

Which of the following is not a response normally seen in liver disease?

Possible Answers:

All of these are commonly seen in liver disease

Inflammation

Necrosis

Intracellular accumulation

Correct answer:

All of these are commonly seen in liver disease

Explanation:

The liver generally responds to injury in the following ways: inflammation, necrosis or apoptosis, degeneration leading to accumulation of intracellular deposits, fibrosis, and regeneration. Some of these, such as inflammation and mild degeneration, are reversible. Other changes, such as severe degeneration and fibrosis, may be permanent.

Example Question #1171 : Nclex

You are assessing a patient complaining of three days of fever, crampy abdominal pain and profuse, watery, mucoid, non-bloody diarrhea. The patient recently completed a course of clindamycin after having her wisdom teeth removed. The patient has not eaten any raw foods, red meats, shellfish, seafood, or greasy foods recently, and has not had any recent travel. What is the most likely cause of her diarrhea?

Possible Answers:

Clostridium difficile

Escherichia coli

Shigella dysenteriae

Salmonella typhi

Cryptosporidium parvum

Correct answer:

Clostridium difficile

Explanation:

The most likely cause of this patient's diarrhea is Clostridium difficile, also known as "C. diff." 

Clostridium difficile typically causes watery, non-bloody, mucoid diarrhea, associated with fever and abdominal pain, most commonly in patients who have completed a recent course of antibiotics. In the past, it was thought that clindamycin was the most frequent antibiotic-related cause of C. difficile, but recent studies have shown that other classes of antiobiotics, including cephalosporins, are associated with comparable rates of C. difficile diarrhea. In this patient, the characteristics of her diarrhea, associated sypmtoms, and recent antibiotic exposure are most consistent with C. difficile as the cause of her diarrhea.

Escherichia coli exists in multiple subtypes, but often is associated with bloody diarrhea after eating undercooked red meats (EHEC diarrhea), or watery diarrhea after traveling to a foreign, undeveloped country (ETEC diarrhea). This patient's history is not consistent with E. coli infection.

Salmonella and Shigella diarrhea are each typically bloody. This patient's diarrhea is non-bloody. 

Cryptosporidium parvum diarrhea is often watery, as is the case in this patient, but it frequently occurs in immunosuppressed patients, is typically not mucoid, and does not have a known temporal association with taking antibiotics, as does C. difficile

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