NURS660 STUDY GUIDE 2025 QUESTIONS AND ANSWERS
RATED A+
✔✔What would you want to educate your patient with gastroenteritis on in regards to
when to be concerned/call for help? - ✔✔vomiting and fever, severe abdominal pain,
headache, neck pain, lethargy, diminished or dark UOP, dizziness, lightheadedness,
vomiting blood or coffee ground emesis, bloody diarrhea
✔✔3 main causes of peptic ulcer disease - ✔✔1. H pylori
2. Nsaids
3. Acid hypersecretion
✔✔Is a physical exam helpful in diagnosing PUD? - ✔✔no
✔✔Name some risk factors for PUD. - ✔✔smoking, aspirin, NSAIDs, H pylori, FH,
COPD, steroids, trauma, caffeine, alcohol, cirrhosis, physiologic stress
✔✔Describe the symptoms patients with PUD will describe. - ✔✔Burning or gnawing
pain
Pain worsened by eating (gastric) or relieved (duodenal)
Episodic pattern, nocturnal pain
✔✔What physical exam findings would require you to send someone to the ED that you
may suspect has PUD? - ✔✔rigid abdomen or rebound tenderness --> perf? peritonitis?
✔✔What is the gold standard for diagnosis of PUD? - ✔✔upper Gi endoscopy
✔✔How do you definitively diagnose H pylori? - ✔✔tissue biopsy
breath test and blood test do not differentiate between past and present infection
✔✔When might a fasting gastrin level be helpful? - ✔✔in trying to figure out why
someone is having recurrent ulcers
indicative of Zollinger-Ellison syndrome (overproduction of gastric acid)
✔✔What is the drug of choice in managing PUD? What is next choice? - ✔✔PPIs
heal 90% of ulcers within 4-8 weeks
next choice: h2 antagonists, slightly lower percent healed but less expensive than PPIs.
Be aware that they can affect metabolism of other cytochrome P-450 drugs (warfarin,
SSRIs)
✔✔What is the treatment for H pylori and who initiates it? - ✔✔PPI + Clarithromycin +
Amox/Flagyl depending on allergies
this is usually managed by GI
,✔✔You start your patient with suspected PUD on PPIs and they follow up in 2 weeks
with no improvement. What is your next step? - ✔✔Referral to GI or endoscopy
✔✔Describe who with a peptic ulcer needs to be seen in the ED. - ✔✔anemia, GI bleed
s/s, rigid abdomen, weight loss, new onset dyspepsia, older than 50 years
✔✔Which type of ulcer requires an endoscopy? Gastric or duodenal? - ✔✔Gastric
increased incidence of gastric cancer
✔✔RFs for colorectal cancer - ✔✔FH
diet of red meats, fat, low in fiber, refined carbs
✔✔Summarize colorectal screening guidelines in regards to age. - ✔✔Start between
ages 45-50 (patient preference) until 75, then stop 10 years prior to expected death
✔✔Describe the options patients have for colorectal cancer screening. - ✔✔High
sensitivity guaiac fecal occult blood test or fecal immunochemical test (FIT) every year
(only $20)
Stool DNA-FIT every 1-3 years (cologuard-$600)
Note: DNA-FIT and FIT are not synonyms
Colonography every 5
Flex sig every 5 or every 10 if annual FIT is completed
Colonoscopy every 10 (gold standard, performed whenever another screening test is
abnormal)
Capsule colonscopies are not recommended
✔✔Who is a high risk patient that should only screen for colon cancer via colonoscopy?
- ✔✔a patient with a history of familial polyposis
✔✔What are some causes of hemorrhoids (suspected)? - ✔✔fiber deficiency, straining,
constipation, prolonged sitting, pregnancy, anal infection, heredity, history of diarrhea,
IBD
✔✔A thrombosed hemorrhoid will present as - ✔✔a VERY painful perianal lump
✔✔What is required for definitive diagnosis of internal hemorrhoids? - ✔✔Scope
may as well just do a colonoscopy and r/o cancer if you already have to scope them
✔✔treatment of hemorrhoids - ✔✔Hydration, oral analgesia w/ tylenol/ibuprofen, sistz
baths, bulk-forming laxative, increased fiber + water, topical hydrocortisone for itching,
surgical excision prn etc
✔✔Define constipation. - ✔✔2 of the following for >3 months:
, <3 BMs/week
Straining 25%
Hard lumpy stool
Incomplete evacuation
Manual manuevers to remove stool
Pain with defecation
✔✔Why would you recommend Miralax over Ex lax? - ✔✔ex lax is habit forming, as are
the stimulant laxatives
miralax is osmotic, not known to be habit forming
✔✔Is diagnostic imaging required for constipation? - ✔✔no unless concerned for
something serious like a bowel obstruction (patient has constipation + n/v + rectal
bleeding, for example)
✔✔How much fiber is recommended to prevent/treat constipation? - ✔✔25-30g/day
✔✔Which patients would you avoid recommending Miralax to? - ✔✔CHF or CKD
patients
✔✔Briefly describe the major types of IBD - ✔✔Ulcerative colitis: involves mucosal
surface of the colon leading to friability, erosions, and bleeding (starts at rectum,
continuous)
Crohn's: can involve all or any layer of the bowel wall as well as any portio of the GI
tract from mouth to anus (skip lesions)
✔✔Clinical presentation of UC - ✔✔Bloody diarrhea 4-10x/day, tenesmus, abdominal
pain/tenderness, impaired nutrition, anemia, hypovolemia (severe disease)
✔✔Clinical presentation of Crohn's - ✔✔Diarrhea (bloody stool intermittently,
steatorrhea), insidious gradual onset, abdominal cramping, pain, tenderness, fever,
anorexia, weight loss
✔✔What needs to be ruled out when you suspect IBD? - ✔✔colon cancer
colonoscopy should be performed
✔✔Why are IBD patients at risk for anemia? - ✔✔malabsorption of folate, vitamin d,
calcium
✔✔What surgical options are available for ulcerative colitis? - ✔✔colectomy OR newer
surgery: ileoanal pouch (should be able to avoid ostomy)
✔✔What nutrition counseling is required for UC and Crohn's patients? - ✔✔no caffeine,
raw fruits, vegetables, bland diet high in calories and protein
RATED A+
✔✔What would you want to educate your patient with gastroenteritis on in regards to
when to be concerned/call for help? - ✔✔vomiting and fever, severe abdominal pain,
headache, neck pain, lethargy, diminished or dark UOP, dizziness, lightheadedness,
vomiting blood or coffee ground emesis, bloody diarrhea
✔✔3 main causes of peptic ulcer disease - ✔✔1. H pylori
2. Nsaids
3. Acid hypersecretion
✔✔Is a physical exam helpful in diagnosing PUD? - ✔✔no
✔✔Name some risk factors for PUD. - ✔✔smoking, aspirin, NSAIDs, H pylori, FH,
COPD, steroids, trauma, caffeine, alcohol, cirrhosis, physiologic stress
✔✔Describe the symptoms patients with PUD will describe. - ✔✔Burning or gnawing
pain
Pain worsened by eating (gastric) or relieved (duodenal)
Episodic pattern, nocturnal pain
✔✔What physical exam findings would require you to send someone to the ED that you
may suspect has PUD? - ✔✔rigid abdomen or rebound tenderness --> perf? peritonitis?
✔✔What is the gold standard for diagnosis of PUD? - ✔✔upper Gi endoscopy
✔✔How do you definitively diagnose H pylori? - ✔✔tissue biopsy
breath test and blood test do not differentiate between past and present infection
✔✔When might a fasting gastrin level be helpful? - ✔✔in trying to figure out why
someone is having recurrent ulcers
indicative of Zollinger-Ellison syndrome (overproduction of gastric acid)
✔✔What is the drug of choice in managing PUD? What is next choice? - ✔✔PPIs
heal 90% of ulcers within 4-8 weeks
next choice: h2 antagonists, slightly lower percent healed but less expensive than PPIs.
Be aware that they can affect metabolism of other cytochrome P-450 drugs (warfarin,
SSRIs)
✔✔What is the treatment for H pylori and who initiates it? - ✔✔PPI + Clarithromycin +
Amox/Flagyl depending on allergies
this is usually managed by GI
,✔✔You start your patient with suspected PUD on PPIs and they follow up in 2 weeks
with no improvement. What is your next step? - ✔✔Referral to GI or endoscopy
✔✔Describe who with a peptic ulcer needs to be seen in the ED. - ✔✔anemia, GI bleed
s/s, rigid abdomen, weight loss, new onset dyspepsia, older than 50 years
✔✔Which type of ulcer requires an endoscopy? Gastric or duodenal? - ✔✔Gastric
increased incidence of gastric cancer
✔✔RFs for colorectal cancer - ✔✔FH
diet of red meats, fat, low in fiber, refined carbs
✔✔Summarize colorectal screening guidelines in regards to age. - ✔✔Start between
ages 45-50 (patient preference) until 75, then stop 10 years prior to expected death
✔✔Describe the options patients have for colorectal cancer screening. - ✔✔High
sensitivity guaiac fecal occult blood test or fecal immunochemical test (FIT) every year
(only $20)
Stool DNA-FIT every 1-3 years (cologuard-$600)
Note: DNA-FIT and FIT are not synonyms
Colonography every 5
Flex sig every 5 or every 10 if annual FIT is completed
Colonoscopy every 10 (gold standard, performed whenever another screening test is
abnormal)
Capsule colonscopies are not recommended
✔✔Who is a high risk patient that should only screen for colon cancer via colonoscopy?
- ✔✔a patient with a history of familial polyposis
✔✔What are some causes of hemorrhoids (suspected)? - ✔✔fiber deficiency, straining,
constipation, prolonged sitting, pregnancy, anal infection, heredity, history of diarrhea,
IBD
✔✔A thrombosed hemorrhoid will present as - ✔✔a VERY painful perianal lump
✔✔What is required for definitive diagnosis of internal hemorrhoids? - ✔✔Scope
may as well just do a colonoscopy and r/o cancer if you already have to scope them
✔✔treatment of hemorrhoids - ✔✔Hydration, oral analgesia w/ tylenol/ibuprofen, sistz
baths, bulk-forming laxative, increased fiber + water, topical hydrocortisone for itching,
surgical excision prn etc
✔✔Define constipation. - ✔✔2 of the following for >3 months:
, <3 BMs/week
Straining 25%
Hard lumpy stool
Incomplete evacuation
Manual manuevers to remove stool
Pain with defecation
✔✔Why would you recommend Miralax over Ex lax? - ✔✔ex lax is habit forming, as are
the stimulant laxatives
miralax is osmotic, not known to be habit forming
✔✔Is diagnostic imaging required for constipation? - ✔✔no unless concerned for
something serious like a bowel obstruction (patient has constipation + n/v + rectal
bleeding, for example)
✔✔How much fiber is recommended to prevent/treat constipation? - ✔✔25-30g/day
✔✔Which patients would you avoid recommending Miralax to? - ✔✔CHF or CKD
patients
✔✔Briefly describe the major types of IBD - ✔✔Ulcerative colitis: involves mucosal
surface of the colon leading to friability, erosions, and bleeding (starts at rectum,
continuous)
Crohn's: can involve all or any layer of the bowel wall as well as any portio of the GI
tract from mouth to anus (skip lesions)
✔✔Clinical presentation of UC - ✔✔Bloody diarrhea 4-10x/day, tenesmus, abdominal
pain/tenderness, impaired nutrition, anemia, hypovolemia (severe disease)
✔✔Clinical presentation of Crohn's - ✔✔Diarrhea (bloody stool intermittently,
steatorrhea), insidious gradual onset, abdominal cramping, pain, tenderness, fever,
anorexia, weight loss
✔✔What needs to be ruled out when you suspect IBD? - ✔✔colon cancer
colonoscopy should be performed
✔✔Why are IBD patients at risk for anemia? - ✔✔malabsorption of folate, vitamin d,
calcium
✔✔What surgical options are available for ulcerative colitis? - ✔✔colectomy OR newer
surgery: ileoanal pouch (should be able to avoid ostomy)
✔✔What nutrition counseling is required for UC and Crohn's patients? - ✔✔no caffeine,
raw fruits, vegetables, bland diet high in calories and protein
