NURS 6501 Advanced Pathophysiology Module 3
Week 5 Knowledge Check with Answer Key 100%
Correct
QUESTION 1
1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that
has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after
meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and
frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2
homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of
smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use,
vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
The main cause of PUD is Helicobacter pylori (H. pylori) infection in the stomach which this
patient was positive for in the breath urea test. Another main factor is the use of NSAIDs
(Ibuprofen). Smoking and alcohol consumption does not directly cause the disease, but it
increases susceptibility. Stress and excessive coffee consumption also do not cause the disease,
but these factors can prolong the disease (Lanas & Chan, 2017, pp. 614-615).
Reference
Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.
http://dx.doi.org/10.1016/%20S0140-6736(16)32404-7
Stress secondary to divorce and financial situation, cigarette smoking, alcohol consumption, use of
NSAIDS, excess coffee consumption, +H Pylori test
QUESTION 2
2 of 2 Questions:
How do these factors contribute to the formation of peptic ulcers?
, H. Pylori produces urease which breaks down urea into ammonia and carbon dioxide. Ammonia
neutralizes acid in the stomach and breaks the mucosal barrier. NSAIDs are cytotoxic to epithelial
cells, causing damage to the mucosal barrier. They also reduce the production of prostaglandin
which has the epithelial repair mechanism. Smoking increases acid production and inhibits the
cell renewal process. Alcohol also causes the stomach to produce more gastric acid, causing
inflammation to the stomach lining. All of these factors eventually cause the stomach lining to
become ulcer (Lanas & Chan, 2017, pp. 614-615).
Reference
Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.
http://dx.doi.org/10.1016/%20S0140-6736(16)32404-7
Correct
Answer: Chronic use of NSAIDS causes suppresses of mucosal prostaglandin and direct irritative
topical effect. High gastrin level and excessive gastric acid production © 2020 Walden
University 2 often seen in Zollinger-Ellison syndrome which can caused by gastrinoma.
Smoking impairs healing by vasoconstriction. H Pylori causes gastritis and interferes
with mucosa.
QUESTION 3
1. A 36-year-old morbidly obese female comes to the office with a chief complaint of ―burning in my
chest and a funny taste in my mouth‖. The symptoms have been present for years but patient
states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5
weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night
when she is lying down and has had to sleep with 2 pillows. She says she has started coughing
at night which has been interfering with her sleep. She denies palpitations, shortness
of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid
2
obesity (BMI 48 kg/m )
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
GERD is caused by frequent acid reflux. The lower esophageal sphincter (LES), which is a band
of muscle at the end of the esophagus, gets weak, and the stomach content goes up in the
esophagus. High BMI and smoking are the risk factors causing GERD (Clarrett & Hachem, 2018,
pp. 214-215).
Reference
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri
medicine, 115(3), 214-218.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/pdf/ms115_p0214.pdf
, Correct
Answer: GERD manifestations result directly from gastric acid reflux into the esophagus. Pyrosis,
the classic symptom, is a substernal burning sensation typically described as heartburn.
It may be accompanied by regurgitation, particularly in someone who has recently eaten.
The lower esophageal sphincter (LES) relaxes due to certain medications (calcium
channel blockers), hiatal hernia, and obesity allows stomach contents to enter the lower
esophagus causing inflammation and possibly erosion of the esophagus.
QUESTION 4
1. A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief
complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred
last week, but it was only a small amount after he had eaten a dinner of beets and beef. The
episode today was accompanied by nausea, sweating, and weakness. He states he has had
some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely
diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are
performed.
Question:
What factors can contribute to an upper GI bleed?
Most upper GI bleeds are caused by inflammatory diseases like stomach ulcers, esophagitis, or
gastritis, which this patient may have due to his symptom described (Epigastric pain) (Seetlani et
al., 2019, pp. 1916-1917). Some of the OTC antacids contain aspirin, and it could cause GI to
bleed as well (Zhao et al., 2019, p. 2).
References
Seetlani, N. K., Imran, K., Deepak, P., Tariq, F., Mirza, D., Abbasi, A., ... & Akhtar, T. (2019).
Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital
of Karachi. The Professional Medical Journal, 26(11), 1916-1924.
https://doi.org/10.29309/TPMJ/2019.26.11.3224
Zhao, J., Fan, Y., Ye, W., Feng, W., Hu, Y., Cai, L., & Lu, B. (2019). The protective effect of
teprenone on aspirin-related gastric mucosal injuries. Gastroenterology research and
practice, 2019. 1-7. https://doi.org/10.1155/2019/6532876
Correct Answer:
UGI bleeds can be caused by Peptic ulcer disease (PUD) which remains the most common cause of
UGIB. Esophageal bleeding from a Mallory-Weiss tea
QUESTION 5
1. A 64-year-old steel worker presents to his Primary Care Provider (PCP) with a chief complaint of
passing bright red blood when he had a bowel movement that morning. He stated the first
Week 5 Knowledge Check with Answer Key 100%
Correct
QUESTION 1
1. A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that
has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after
meals. He denies nausea, vomiting, weight loss or obvious bleeding. He admits to bloating and
frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2
homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of
smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use,
vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
The main cause of PUD is Helicobacter pylori (H. pylori) infection in the stomach which this
patient was positive for in the breath urea test. Another main factor is the use of NSAIDs
(Ibuprofen). Smoking and alcohol consumption does not directly cause the disease, but it
increases susceptibility. Stress and excessive coffee consumption also do not cause the disease,
but these factors can prolong the disease (Lanas & Chan, 2017, pp. 614-615).
Reference
Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.
http://dx.doi.org/10.1016/%20S0140-6736(16)32404-7
Stress secondary to divorce and financial situation, cigarette smoking, alcohol consumption, use of
NSAIDS, excess coffee consumption, +H Pylori test
QUESTION 2
2 of 2 Questions:
How do these factors contribute to the formation of peptic ulcers?
, H. Pylori produces urease which breaks down urea into ammonia and carbon dioxide. Ammonia
neutralizes acid in the stomach and breaks the mucosal barrier. NSAIDs are cytotoxic to epithelial
cells, causing damage to the mucosal barrier. They also reduce the production of prostaglandin
which has the epithelial repair mechanism. Smoking increases acid production and inhibits the
cell renewal process. Alcohol also causes the stomach to produce more gastric acid, causing
inflammation to the stomach lining. All of these factors eventually cause the stomach lining to
become ulcer (Lanas & Chan, 2017, pp. 614-615).
Reference
Lanas, A., & Chan, F. K. (2017). Peptic ulcer disease. The Lancet, 390(10094), 613-624.
http://dx.doi.org/10.1016/%20S0140-6736(16)32404-7
Correct
Answer: Chronic use of NSAIDS causes suppresses of mucosal prostaglandin and direct irritative
topical effect. High gastrin level and excessive gastric acid production © 2020 Walden
University 2 often seen in Zollinger-Ellison syndrome which can caused by gastrinoma.
Smoking impairs healing by vasoconstriction. H Pylori causes gastritis and interferes
with mucosa.
QUESTION 3
1. A 36-year-old morbidly obese female comes to the office with a chief complaint of ―burning in my
chest and a funny taste in my mouth‖. The symptoms have been present for years but patient
states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5
weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night
when she is lying down and has had to sleep with 2 pillows. She says she has started coughing
at night which has been interfering with her sleep. She denies palpitations, shortness
of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid
2
obesity (BMI 48 kg/m )
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
GERD is caused by frequent acid reflux. The lower esophageal sphincter (LES), which is a band
of muscle at the end of the esophagus, gets weak, and the stomach content goes up in the
esophagus. High BMI and smoking are the risk factors causing GERD (Clarrett & Hachem, 2018,
pp. 214-215).
Reference
Clarrett, D. M., & Hachem, C. (2018). Gastroesophageal reflux disease (GERD). Missouri
medicine, 115(3), 214-218.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140167/pdf/ms115_p0214.pdf
, Correct
Answer: GERD manifestations result directly from gastric acid reflux into the esophagus. Pyrosis,
the classic symptom, is a substernal burning sensation typically described as heartburn.
It may be accompanied by regurgitation, particularly in someone who has recently eaten.
The lower esophageal sphincter (LES) relaxes due to certain medications (calcium
channel blockers), hiatal hernia, and obesity allows stomach contents to enter the lower
esophagus causing inflammation and possibly erosion of the esophagus.
QUESTION 4
1. A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief
complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred
last week, but it was only a small amount after he had eaten a dinner of beets and beef. The
episode today was accompanied by nausea, sweating, and weakness. He states he has had
some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely
diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are
performed.
Question:
What factors can contribute to an upper GI bleed?
Most upper GI bleeds are caused by inflammatory diseases like stomach ulcers, esophagitis, or
gastritis, which this patient may have due to his symptom described (Epigastric pain) (Seetlani et
al., 2019, pp. 1916-1917). Some of the OTC antacids contain aspirin, and it could cause GI to
bleed as well (Zhao et al., 2019, p. 2).
References
Seetlani, N. K., Imran, K., Deepak, P., Tariq, F., Mirza, D., Abbasi, A., ... & Akhtar, T. (2019).
Upper GI bleeding: Causes, morbidity and mortality in admitted patients at Tertiary Care Hospital
of Karachi. The Professional Medical Journal, 26(11), 1916-1924.
https://doi.org/10.29309/TPMJ/2019.26.11.3224
Zhao, J., Fan, Y., Ye, W., Feng, W., Hu, Y., Cai, L., & Lu, B. (2019). The protective effect of
teprenone on aspirin-related gastric mucosal injuries. Gastroenterology research and
practice, 2019. 1-7. https://doi.org/10.1155/2019/6532876
Correct Answer:
UGI bleeds can be caused by Peptic ulcer disease (PUD) which remains the most common cause of
UGIB. Esophageal bleeding from a Mallory-Weiss tea
QUESTION 5
1. A 64-year-old steel worker presents to his Primary Care Provider (PCP) with a chief complaint of
passing bright red blood when he had a bowel movement that morning. He stated the first
