Question 1.                       

 

Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?

 

Inhibition of the actions of Brunner glands

 

Overstimulation of the oxyntic glands

 

 Suppression of cholecystokinin

 

 Inflammation of the parotid glands

 

Question 2.                       

 

Which of the following patients is most clearly displaying the signs and symptoms of IBD?

 

A 32-year-old mother who complains of intermittent abdominal pain that persists even after defecation.

 

A 51-year-old male who states that his stomach pain is in his lower abdomen, “comes and goes,” and “feels more like a cramp than a dull ache.”

 

A 44-year-old man who is under great financial stress and who states that his lower abdominal pain is much worse at night than during the day.

 

  A 24-year-old man who has a stressful job but whose diarrhea and cramping do not worsen during periods of high stress.

 

 

 

Question 3.                       

 

A 24-year-old woman undergoing a premarital screening test is found to have elevated levels of AST, ALT, and IgG, but no antibody-specific markers for viral hepatitis. A liver biopsy reveals inflammation and cellular damage. Which of the following treatments is most likely to be effective for her?

 

Lamivudine

 

Peginterferon and ribavirin

 

Interferon-alfa-2b

 

Corticosteroids and immunosuppressant drugs

 

 

 

Question 4.                       

 

Which of the following statements best captures an aspect of the process of fat digestion and absorption?

 

Ingested triglycerides are broken down into absorbable form by gastric lipase.

 

Simple forms of fats are absorbed in the upper jejunum.

 

Long-chain fatty acids are absorbed more readily than medium-chain triglycerides.

 

 Stool is not excreted until all fat is absorbed.

 

Question 5.                       

 

A 40-year-old female has been categorized as being obese, with a BMI of 33.2. Which of the following health problems is the patient at a significantly increased risk for compared with individuals with a BMI below 25?

 

Cardiac arrhythmias

 

 Osteoarthritis

 

 Multiple sclerosis

 

 Atelectasis

 

Gallbladder disease

 

Insulin resistance

 

Question 6.                       

 

David has an acute exacerbation of Crohn’s disease. Which of the following lab tests  would you expect to be decreased?

 

Sedimenatation rate

 

Liver enzyme levels

 

 Vitamins A, B complex and C levels

 

 Bilirubin level

 

Question 7.                       

 

A 51-year-old male professional is in the habit of consuming six to eight rum and cokes each evening after work. He assures the nurse practitioner, who is performing his regular physical exam, that his drinking is under control and does not have negative implications for his work or family life. How could the nurse best respond to the patient’s statement?

 

“You are more than likely inflicting damage on your liver, but this damage would cease as soon as you quit drinking.

 

 “That may be the case, but you are still creating a high risk of hepatitis A or B or liver cancer.”

 

 “In spite of that, the amount of alcohol you are drinking is likely to result first in cirrhosis and, if you continue, in hepatitis or fatty liver changes.”

 

 “When your body has to regularly break down that much alcohol, your blood and the functional cells in your liver accumulate a lot of potentially damaging toxic byproducts.”

 

 

 

Question 8.                       

 

A nurse practitioner is providing care for a male patient with a long-standing hiatal hernia. Which of the following statements most accurately captures an aspect of the pathophysiology of hiatal hernias?

 

Paraesophageal hiatal hernias are common and are normally not treated if the patient is asymptomatic.

 

 The root causes of hiatal hernias are normally treatable with medication.

 

 If esophageal acid clearance is impaired, esophagitis can result.

 

An incompetent pyloric sphincter and high fat diet are commonly implicated in the development of hiatal hernias.

 

 

 

Question 9.                       

 

As a result of oral ingestion of the microorganisms, an individual has contracted H. pylori. Which of the following health problems is the individual now at increased risk for?

 

Inflammatory bowel disease (IBD)

 

 Gastric adenocarcinoma

 

 Gastric atrophy

 

 Peptic ulcer

 

 Esophagitis

 

 Diverticular disease

 

Question 10.                    

 

A 43-year-old male who is 5 feet 10 inches tall and weighs 216 pounds has been informed by his nurse practitioner that his body mass index (BMI) is 31. Which of the following clinical conclusions based on these data would his nurse be most justified in rejecting?

 

Further investigation of his nutritional status is needed to supplement the BMI value.

 

 The patient faces an increased risk of type 2 diabetes and hyperlipidemia.

 

 He is classified as being obese, likely as the result of the interplay of genetic and lifestyle factors.

 

 The patient is borderline obese but is not yet at the point of significantly increased risks to health.

 

 

 

Question 11.                    

 

A 20-year-old male who is addicted to crystal methamphetamine has been admitted to the hospital with a diagnosis of protein-calorie malnutrition after many months of inadequate food intake. Which of the following treatment plans would the care team most likely favor?

 

Intravenous infusion of albumin coupled with vitamin supplementation

 

Total parenteral nutrition

 

Incremental feeding combined with vitamin and mineral supplementation

 

 Rapid administration of normal saline and carbohydrates

 

 

 

Question 12.                    

 

As part of the intake protocol at an eating disorders clinic, an interview precedes a physical examination. Which of the following questions would a clinician be justified in excluding from an intake interview for a 16-year-old female referred by her pediatrician for the treatment of anorexia nervosa?

 

“Do you remember when your last menstrual period was?

 

“Have you noticed any new hair growth on your body in the last several months?”

 

“Have you had any episodes of shortness of breath in the recent past?”

 

“Can you tell me about some of the habits that you have related to food in your daily routine?”