NR 509 Final Exam 2025 – Complete Study
Guide and Practice Questions REAL EXAM!!!!
Chapter 19: Abdomen
...
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of
intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek
medical attention. She has a strong family history of gallstones and is concerned about this possibility.
She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10
weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min;
oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam
prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs
are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were
also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase,
alanine aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly
elevated total bilirubin. He presents for a follow-up appointment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most consistent with
hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
,c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents with a
several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise
and denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory
rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her
abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of
the following is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
A 76-year-old retired man with a history of prostate cancer and hypertension has been screened
annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for
follow-up of his hypertension, during which the clinician scans his chart to ensure he is up to date with
his preventive health care. He has a positive FOBT on one occasion at age 66 years and subsequently
went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He
has no first-degree relatives with a history of colorectal cancer or adenomatous polyps. What are the
U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year history of
recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is associated with
onset of constipation. She describes infrequent, small hard stool that she finds very difficult to pass.
She has tried to increase dietary fiber and water intake, but usually this is not sufficient and she
resorts to over-the-counter laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel movements. Which of the following is
the most likely physiological mechanism for her constipation?
,a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis and
bronchiectasis that is associated with a rare congenital condition called Kartagener syndrome. The
preceptor notes that she has situs inversus and asks for a physical exam. Which of the following
descriptions best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper
quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to
chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-day history
of severe abdominal pain. The emergency physician suspects appendicitis and general surgery is
consulted. The resident believes the patient has signs of peritonitis on exam. Which of the following
physical exam findings supports peritonitis?
a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces
pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10
months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain
radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4
months. What is the mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
, c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with
a 3-month course of recurrent severe abdominal pain that usually resolves on its own after a few
hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave
or miss work on three separate occasions. She would like a diagnosis and the problem fixed. Which
symptoms or signs would be most suggestive of a diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain
Chapter 22 Anus, Rectum, and Prostate
A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him
paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a
person without his injuries. Which of the following is true regarding the muscle control of the anal
sphincter?
a. The internal anal sphincter is under voluntary control, whereas the external anal sphincter is under
involuntary control.
b. The internal anal sphincter is under involuntary control, whereas the external anal sphincter is
under voluntary control.
c. Both internal and external anal sphincter are under voluntary control.
d. Both internal and external anal sphincter are under involuntary control.
e. Control of the anal sphincters is variable between individuals
A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a
rectal examination, stating that, "Some trainee once did that and it hurt badly." Which of the
following is true about the innervation of the anus and rectum that may explain this patient's
experience of discomfort?
a. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral
nerves, making the rectum the most likely source of this patient’s discomfort.
b. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral
nerves, making the anus the most likely source of this patient’s discomfort.
Guide and Practice Questions REAL EXAM!!!!
Chapter 19: Abdomen
...
An overweight 26-year-old public servant presents to the Emergency Department with 12 hours of
intense abdominal pain, light-headedness, and a fainting episode that finally prompted her to seek
medical attention. She has a strong family history of gallstones and is concerned about this possibility.
She has not had any vomiting or diarrhea. She had a normal bowel movement this morning. Her β-
human chorionic gonadotropin (β-hCG) is positive at triage. She reports that her last period was 10
weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory rate, 20/min;
oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam
prior to her pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
A 63-year-old janitor with a history of adenomatous colonic polyps presents for a well visit. Basic labs
are performed to screen for diabetes mellitus and dyslipidemia. Electrolytes and liver enzymes were
also measured. His labs are all normal expect for moderate elevations of aspartate aminotransferase,
alanine aminotransferase, γ-glutamyl transferase, and alkaline phosphatase as well as a mildly
elevated total bilirubin. He presents for a follow-up appointment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most consistent with
hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
,c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
A 63-year-old underweight administrative clerk with a 50-pack-year smoking history presents with a
several month history of recurrent epigastric abdominal discomfort. She feels fairly well otherwise
and denies any nausea, vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure, 148/92; respiratory
rate, 16; oxygen saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6. On exam, her
abdominal aorta is prominent, which is concerning for an abdominal aortic aneurysm (AAA). Which of
the following is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
A 76-year-old retired man with a history of prostate cancer and hypertension has been screened
annually for colon cancer using high sensitivity fecal occult blood testing (FOBT). He presents for
follow-up of his hypertension, during which the clinician scans his chart to ensure he is up to date with
his preventive health care. He has a positive FOBT on one occasion at age 66 years and subsequently
went for a colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on colonoscopy. He
has no first-degree relatives with a history of colorectal cancer or adenomatous polyps. What are the
U.S. Preventive Services Task Force (USPSTF) screening recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a 3-year history of
recurrent crampy abdominal pain that lasts for about 1-2 weeks each episode and is associated with
onset of constipation. She describes infrequent, small hard stool that she finds very difficult to pass.
She has tried to increase dietary fiber and water intake, but usually this is not sufficient and she
resorts to over-the-counter laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel movements. Which of the following is
the most likely physiological mechanism for her constipation?
,a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
A 23-year-old woman comes to the respirology clinic for follow-up of her chronic sinusitis and
bronchiectasis that is associated with a rare congenital condition called Kartagener syndrome. The
preceptor notes that she has situs inversus and asks for a physical exam. Which of the following
descriptions best fits with findings on the abdominal exam?
a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper
quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to
chronic obstructive pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
An otherwise healthy 28-year-old lawyer presents to the Emergency Department with a 1-day history
of severe abdominal pain. The emergency physician suspects appendicitis and general surgery is
consulted. The resident believes the patient has signs of peritonitis on exam. Which of the following
physical exam findings supports peritonitis?
a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces
pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous
process on a line drawn from the umbilicus
e. Pain with internal rotation of the right hip
A 58-year-old man with a history of diabetes and alcohol addiction has been sober for the last 10
months. He presents with a 4-month history of increasing weakness, recurrent epigastric pain
radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4
months. What is the mechanism of his most likely diagnosis?
a. Helicobacter pylori infection
b. Inflammation of the gallbladder
, c. Inflammation of colonic diverticulum
d. Reduced blood supply to the bowel
e. Fibrosis of the pancreas
A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with
a 3-month course of recurrent severe abdominal pain that usually resolves on its own after a few
hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave
or miss work on three separate occasions. She would like a diagnosis and the problem fixed. Which
symptoms or signs would be most suggestive of a diagnosis of biliary colic?
a. Exacerbating factor includes alcohol intake
b. Positive McBurney point tenderness
c. Poorly localized periumbilical pain
d. Vomiting of bile
e. Associated right shoulder pain
Chapter 22 Anus, Rectum, and Prostate
A 49-year-old male nurse experiences fecal incontinence after a motor vehicle accident that left him
paralyzed below the waist. He asks his rehabilitation physician about the control of this function in a
person without his injuries. Which of the following is true regarding the muscle control of the anal
sphincter?
a. The internal anal sphincter is under voluntary control, whereas the external anal sphincter is under
involuntary control.
b. The internal anal sphincter is under involuntary control, whereas the external anal sphincter is
under voluntary control.
c. Both internal and external anal sphincter are under voluntary control.
d. Both internal and external anal sphincter are under involuntary control.
e. Control of the anal sphincters is variable between individuals
A 62-year-old male who is undergoing evaluation for possible prostate cancer strongly declines a
rectal examination, stating that, "Some trainee once did that and it hurt badly." Which of the
following is true about the innervation of the anus and rectum that may explain this patient's
experience of discomfort?
a. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral
nerves, making the rectum the most likely source of this patient’s discomfort.
b. The rectum contains primarily somatic nerves, whereas the anal canal contains primarily visceral
nerves, making the anus the most likely source of this patient’s discomfort.
