NR 509 ADVANCED HEALTH ASSESSMENT
FINAL EXAM QUESTIONS REVIEW WITH
ANSWERS LATEST
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 periterm-12od 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?
Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension,
positive β-hCG, and findings suggestive of peritoneal inflammation/irritation strongly
suggest a ruptured ectopic pregnancy with significant intra-abdominal bleeding leading
to peritoneal signs. This case is emergent and requires immediate treatment of her
hypotension and presumed blood loss as well as gynecological consult for emergent
surgery. Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding. Although acute cholecystitis, ruptured appendix, bowel wall perforation, and
ruptured ovarian cyst are all possibilities, the positive β-hCG testing and her unstable
vital signs make ruptured ectopic pregnancy more likely.
CHAPTER 19: Abdomen
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?
Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin, midclavicular
line, would be considered normal on inspiration when the liver is pushed down into the
abdominal cavity on inspiration, but is abnormal on expiration. Findings to support
hepatomegaly would be more convincing if, by percussion, the liver span was >12 cm at
the midclavicular line. For patients with obstructive lung disease, air trapping in the
lungs may displace the liver downwards into the abdominal cavity. The liver span and
dullness to percussion refer to the same measurement. Measurements of 6-12 cm at
the mid-clavicular line and 4-8 cm at the midsternal line are considered normal.
CHAPTER 19: Abdomen
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?
History of smoking
Rationale: History of smoking is her most significant risk factor for an AAA. Male gender,
not female gender, is considered as risk factor. Underweight is not a risk factor for AAA.
Family history of ruptured aneurysm is vague and could be a cerebral aneurysm.
Further, her family history is in a first-degree cousin not a first-degree relative (biologic
parents, siblings, and children). Hypertension could contribute to atherosclerosis, which
is a risk factor. Further, a diagnosis of hypertension is not based on one elevated blood
pressure reading.
CHAPTER 19: Abdomen
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
FINAL EXAM QUESTIONS REVIEW WITH
ANSWERS LATEST
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 periterm-12od 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?
Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension,
positive β-hCG, and findings suggestive of peritoneal inflammation/irritation strongly
suggest a ruptured ectopic pregnancy with significant intra-abdominal bleeding leading
to peritoneal signs. This case is emergent and requires immediate treatment of her
hypotension and presumed blood loss as well as gynecological consult for emergent
surgery. Ruptured ectopic pregnancies can lead to life-threatening intra-abdominal
bleeding. Although acute cholecystitis, ruptured appendix, bowel wall perforation, and
ruptured ovarian cyst are all possibilities, the positive β-hCG testing and her unstable
vital signs make ruptured ectopic pregnancy more likely.
CHAPTER 19: Abdomen
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?
Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin, midclavicular
line, would be considered normal on inspiration when the liver is pushed down into the
abdominal cavity on inspiration, but is abnormal on expiration. Findings to support
hepatomegaly would be more convincing if, by percussion, the liver span was >12 cm at
the midclavicular line. For patients with obstructive lung disease, air trapping in the
lungs may displace the liver downwards into the abdominal cavity. The liver span and
dullness to percussion refer to the same measurement. Measurements of 6-12 cm at
the mid-clavicular line and 4-8 cm at the midsternal line are considered normal.
CHAPTER 19: Abdomen
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?
History of smoking
Rationale: History of smoking is her most significant risk factor for an AAA. Male gender,
not female gender, is considered as risk factor. Underweight is not a risk factor for AAA.
Family history of ruptured aneurysm is vague and could be a cerebral aneurysm.
Further, her family history is in a first-degree cousin not a first-degree relative (biologic
parents, siblings, and children). Hypertension could contribute to atherosclerosis, which
is a risk factor. Further, a diagnosis of hypertension is not based on one elevated blood
pressure reading.
CHAPTER 19: Abdomen
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
