AHN 447 Test Questions with Correct Answers Latest Update

AHN 447 Test Questions with Correct Answers Latest Update GERD - Answers Backwards flow (reflex esophagitis), Most common GI disorder Symptoms of GERD (12) - Answers Dyspepsia, regurgitation, coughing, hoarseness, water brash, dysphagia, epigastric pain, belching, nausea, pyrosis (heartburn), pharyngitis, dental caries Main goal of GERD - Answers symptom relief Interventions for GERD - Answers Diet therapy (Avoid coffee, chocolate, alcohol), Do not lay down after meals (1-2hrs), sleep on your left side..never sleep flat(6-12ins), lose weight, no constrictive clothing, aviod heavy lifting or working in a bent over position, drug therapy..histamine blockers( famotidine (Pepcid), ranitidine(Zantac)) PPIs..(Protonix, esomeprazole(Nexium))...Antacids(Maalox, Mylanta) ..Prokinetic (Bethanechol..(Urecholine), Metoclopramide (Reglan) Surgical procedures for GERD - Answers Nissen fundoplication, radiofrequency ablation of vagus nerve, enteryx procedure Interventions for Esophageal Cancer - Answers Radiation to shrink tumor, and surgical removal (stomach is brought up above diaphragm, NG tube surgically placed, Totally NPO for 8 weeks) Complications of Esophageal Cancer surgery - Answers Multiple complications (p. 1121), esophagus can be disconnected from stomach Causes of gastric ulcers - Answers H. Pylori, abnormal function of pyloric sphincter, delayed gastric emptying, lesser curvature Causes of duodenal ulcer - Answers increased gastric acid secretions When an ulcers goes through all layers of the stomach - Answers perforation (surgical emergency!!) Pepcid ulcer consideration in the elderly - Answers Common after 60, melena is usually the first sign, altered mental status due to low hgb/hct, co-morbid meds may worsen symptoms, increased use of OTC meds Complications of PUD - Answers GI Bleed (Melena, hematemesis), Perforation, Pyloric obstruction caused by scarring and edema(severe vomiting), Intractable (2/3 re-occurrence) Causes of PUD - Answers NSAIDS, H. Pylori PUD Assessment - Answers HX, Pain pattern..Gastric pain-30 mins post meal upper, duodenal pain 1 to 1.5 hrs post meal lower, Dyspepsia, low H/H, N/V PUD diagnostic test - Answers Barium swallow, EGD (most commonly used) PUD Interventions - Answers PPI and 2 ABX (Flagyl/Clarithromycin, Amoxil), diet therapy (BLAND), surgical managment..(dumping syndrome, NG tube) Interventions for GI Bleed - Answers NPO, NG tube, Saline lavage, transfusions, volume replacement Zollinger/Ellison Syndrome - Answers upper GI ulceration due to increased acid secretions, Gastrinoma (tumor of the prancreas) cause increased acid secretions, mimic PUD but does not respond to treatment Gastric Carcinoma - Answers few early S/S, usually adenocarcinoma, 2nd leading cause of death Assessment of Gastric Carcinoma - Answers Weight loss, Abd discomfort Diagnostic of Gastric Carcinoma - Answers UGI series, EGD Interventions of Gastric carcinoma - Answers Chemo, Radiation, surgical management sub total (Bilroth 1) or total (Bilroth 2) gastrectomy Post surgical complications of GI surgery - Answers Pneumonia (hurts to breath), hemorrhage, reflux aspiration, sepsis, gastritis, ileus, bowel obstruction, dumping syndrome, wound dehisence IBS - Answers 2-3x morel likely in women, associated with analgesic use, remission/flareups IBS symptoms - Answers abd pain relieved by BM, abd distention, incomplete evacuation of stool, presence of mucus in stool, pain in LLQ after eating, no weight loss Diagnostic IBS - Answers normal labs, barium swallow may show colon spasm Interventions for IBS - Answers Diet therapy ( fiber and bulk..30-40g a day, eat regular meals, drink 8-10 cups of water a day) Metamucil (bulk forming laxative) Trycyclics (Elvail) Zelnorm Assessment of peritonitis - Answers rigid board like abd abd pain distention N/V Decreased BS rebound tenderness Elevated HR, temp dehydration Diagnostic Peritonitis - Answers Lab (extremely elevated WBC), U/S/ CT Scan Interventions for Peritonitis - Answers NPO/ IV fluid, abx, laporotomy (find the cause), fix the problem symptoms of U/C - Answers Pain and distention, bloody diarrhea, tenesmus (Hyperactive BS), may have temp Complications of U/C - Answers perforation, hemorrhage, malabsorption, bowel obstruction, increased risk for colon cancer Interventions for U/C - Answers Azulfidine, steriods, immunosuppressive