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NURSING MN551 Chapter 11: Grade A

A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical exam? a. Digital rectal exam c. Sexual history b. Pelvic exam d. All of the above ____ 2. A patient is seen in the office and is complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation? a. Multivitamin c. Pepto-Bismol b. Magnesium hydroxide d. Ibuprofen ____ 3. A patient with complaints of diarrhea is seen. Which of the following should be included on the differential diagnosis list for a patient with diarrhea? a. Gastroenteritis c. Lactase deficiency b. Inflammatory bowel disease d. All of the above ____ 4. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months for which he takes Tums with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain? a. The pain seems better when he smokes to relieve his nerves. b. Coffee and fried foods do not bother him. c. He awakens at night coughing with a bad taste in his mouth. d. All of the above ____ 5. A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly for 2 weeks. He gets temporary relief from Alka Seltzer. The burning pain wakes him at night and radiates up into his chest. Which factor favors a diagnosis of gastric ulcer? a. His gender c. His use of Alka Seltzer b. His age d. His ethnic origin ____ 6. Which of the following is most effective in diagnosing appendicitis? a. History and physical b. Sedimentation rate c. Kidneys, ureter, bladder (KUB) radiograph d. Complete blood cell (CBC) count with differential ____ 7. Which of the following is associated with celiac disease (celiac sprue)? a. Malabsorption c. Rectal bleeding b. Constipation d. Esophageal ulceration ____ 8. A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical exam is remarkable for left lower quadrant (LLQ) tenderness. Which of the following should be considered in the differential diagnosis at this time? a. Endometriosis c. Diverticulitis b. Colon cancer d. All of the above ____ 9. A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient? a. Complete blood cell (CBC) count with differential b. Urine hCG c. Barium enema d. Computed tomography (CT) of the abdomen ____ 10. A 25-year-old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives. Following this, she has diarrhea for a couple of days. She temporarily feels better after a bowel movement. She states she is embarrassed by flatulence and has abdominal distension. She has had no weight loss or blood in her stool. This problem has gone on for about 6 months. What should the next step be? a. Obtain a complete history. b. Order a barium enema. c. Schedule a Bernstein’s test. d. Prescribe a trial of antispasmodics. ____ 11. A 28-year-old patient is seen in the clinic with colicky abdominal pain, particularly with meals. She has frequent constipation, flatulence, and abdominal distension. Which of the data make a diagnosis of diverticulitis unlikely? a. Her age c. Flatulence b. Frequent constipation d. Colicky abdominal pain ____ 12. A 28-year-old patient is seen with complaints of diarrhea. Which of the following questions would help the clinician establish the diagnosis of irritable bowel syndrome? a. Feels relief after a bowel movement b. Sometimes is constipated c. Does not defecate in the middle of the night d. All of the above ____ 13. A patient is diagnosed with gastroesophageal reflux disease (GERD), and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following information should the clinician include in the explanation of the pathology report? a. This is a premalignant tissue. b. This tissue is resistant to gastric acid. c. This tissue supports healing of the esophagus. d. All of the above ____ 14. Which of the following dietary information should be given to a patient with gastroesophageal reflux disease (GERD)? a. Eliminate coffee. b. Drink peppermint tea to relieve stomach distress. c. Recline and rest after meals. d. Limit the amount of antacids. ____ 15. The patient with gastroesophageal reflux disease (GERD) should be instructed to eliminate which of these activities? a. Swimming c. Golfing b. Weight lifting d. Walking ____ 16. A patient is diagnosed with Giardia after a backpacking trip in the mountains. Which of the following would be the appropriate treatment? a. Vancomycin c. Metronidazole b. Penicillin d. Bactrim ____ 17. A 22-year-old is seen complaining of vague belly pain. This type of pain is seen at what point in appendicitis? a. Very early b. 3 to 4 hours after perforation c. Late in inflammation d. Appendicitis never presents with vague pain. ____ 18. The clinician suspects the patient has a peptic ulcer. Which of the following items on the history would lead the clinician to this conclusion? a. Use of NSAIDs c. Alcohol (ETOH) consumption b. Cigarette smoker d. All of the above ____ 19. A patient is seen and a urine sample is taken. The urine dipstick reveals a high level of bilirubin, and the urine is dark colored. Which of the following could be a cause of this problem? a. Increased breakdown of red blood cells b. Inadequate hepatocyte function c. Biliary obstruction d. All of the above ____ 20. A 21-year-old student presents with a chief complaint of fatigue, headache, anorexia, and a runny nose, all of which began about 2 weeks ago. She started taking vitamins and over-the-counter (OTC) cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago, and she wonders if she might have it also. An examination reveals cervical adenopathy and enlarged liver and spleen. Which of the following laboratory tests would be most helpful in the differential diagnosis at this point? a. Stool culture b. Liver enzymes c. Anti-HDV (antibody to hepatitis D virus) d. Thyroid-stimulating hormone (TSH) ____ 21. On further questioning, the 21-year-old patient with the chief complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aide in a day-care center. Which of the following tests would be most helpful in confirming your diagnosis? a. HAV IgM c. Anti-HAcAg b. HAV IgG d. Anti-HAsAg ____ 22. A patient is seen in the clinic with right upper quadrant (RUQ) pain that is radiating to the middle of the back. The clinician suspects acute cholelithiasis. The clinician should expect which of the following laboratory findings? a. Decreased alanine aminotransferase (ALT) and aspartate aminotransferase (AST) b. Elevated alkaline phosphatase c. Elevated indirect bilirubin d. Decreased white blood cell (WBC) count ____ 23. The patient has acute pancreatitis with 7 of the diagnostic criteria from Ranson’s Criteria. In order to plan care, the clinician understands that this criteria score has which of the following meanings? a. A high mortality rate b. An increased chance of recurrence c. A 7% chance of the disease becoming chronic d. All of the above ____ 24. A patient is seen in the office with complaints of six to seven liquid bowel movements per day. Which of the following assessment findings would lead the clinician to a diagnosis of inflammatory bowel disease? a. Intermittent constipation with periods of diarrhea b. Awakens at night with diarrhea c. History of international travel d. All of the above ____ 25. Which of the following is part of the treatment plan for the patient with irritable bowel syndrome? a. High-fiber diet c. Daily laxatives b. Tylenol with codeine d. All of the above

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