NR 667 VISE CEA FNP CAPSTONE
COMPREHENSIVE EXAM STUDY
GUIDE | LATEST 2025 GUIDE |
CHAMBERLAIN
Etiology: GERD - Correct Answer - -Facilitated by decreased lower
esophageal sphincter (LES) tone
-Some cases are physiologic
-GERD is present when gastric contents flow upward into the esophagus
or oropharynx, producing symptoms
Risk factors: GERD - Correct Answer - -Factors that reduce LES tone:
alcohol, anticholinergics, CCBs, caffeine, chocolate, peppermint,
fatty/spicy/citrus foods, hormones, meperidine, nicotine, overweight,
pregnancy
-Aging
-DM, gastroparesis
-Delayed gastric emptying
-Increased gastric acid secretion
-Irritation of esophageal mucosa: NSAIDs, tetracycline, quinidine,
caffeine, SSRIs, hydrocodone
-Zollinger-Ellison syndrome (too much acid)
,-Childhood GERD
Assessment findings: GERD - Correct Answer - -Chest pain (requires
cardiac workup)
-Chronic sore throat/hoarseness
-Dysphagia
-Erosion of tooth enamel
-Esophageal pain referred to neck, midback, upper abdomen
-Extra-esophageal presentation: asthma, chronic cough, laryngitis
-Post-nasal drip, throat clearing
-Pyrosis (heartburn)
-Regurgitation
-Sensation of lump in throat
-Ulceration: hematemesis, fatigue, anemia
Differential diagnosis: GERD - Correct Answer - -Asthma
-Cardiac disease
-Cholelithiasis
-Esophageal spasm, infection, cancer
-H. pylori
-Hiatal hernia
-IBS
,-Intestinal motility disorders
-Lower resp. infection: bronchitis, pneumonia
-PUD (often coexists)
Final diagnosis: GERD - Correct Answer - -Presumptive DX can be
made based on sx of heartburn and regurgitation
-Empiric PPI therapy for 8 weeks should be initiated
-Endoscopy is recommended for patients with GERD that do not
respond to empiric PPI treatment
Prevention: GERD - Correct Answer - -Lifestyle modification
-Maintain a healthy weight (BMI < 25)
-Eat smaller meals
-Avoid trigger foods (fatty, spicy, acidic, mint, chocolate, garlic/onion,
caffeine, carbonation)
-Don't lie down for 2-3 hours after eating
-Elevate head 6-8 inches
-Quit smoking
-Limit alcohol consumption
Non-pharm treatment: GERD - Correct Answer - -Education of physical
causes, aggravating factors, and lifestyle changes to control it
, Pharmacological management: GERD - Correct Answer - -8 week
course of PPI therapy
-PPIs should be dosed once daily and before the first meal of the day
-If partial response to PPI, increase to BID dosing
-If symptoms persist after 8 weeks, refer to gastro
Follow-up: GERD - Correct Answer - -Consider maintenance therapy to
manage symptoms and prevent long-term complications
-CBC
-Screen for B12 deficiency and increased risk of osteopenia after long-
term PPI use
Expected course: GERD - Correct Answer - -Most patients respond well
to combined therapies
-Symptoms may return once mediation is withdrawn
Possible complications: GERD - Correct Answer - -Erosion/ulceration
-Stricture
-Barrett's esophagitis
-High-grade dysplasia
-Esophageal adenocarcinoma
-Aspiration pneumonia
