NR 509 FINAL EXAM QUESTIONS AND
DETAILED CORRECT ANSWERS
10 minute geriatric screener - correct answer-
1.vision a. difficulty driving/watching TV/reading
-->snellen chart with corrective lenses (normal: <20/40)
2. hearing: audioscope at 40dB (1,000 and 2,000) (+= inability to
hear one in both or one ear)
3. leg mobility: Get up and Go test: rise, walk 10 ft, turn, walk
back, sit down (+= greater than 10 seconds)
4. urinary incontinence: Ask: a. lose urine and gotten wet in last
year? b. 6 times? (+= yes to both)
5. nutrition/weight loss: a. lost 10 lbs in 6 mos? b. check weight
(+= <100lbs)
6. memory: three-item recall (+= unable to remember all 3 after
1 min)
7. depression: Ask: do you feel sad/depressed (+= yes)
8. physical disability (6 questions: 1. strenious activity? 2. Heavy
work? 3. Shopping? 4. Go to places out of walking distance? 5.
Bath/shower? 6. Dress?) (+= no to any)
Abdomen palpation - correct answer- gently
palpate over 4 quadrants:
,abnormal: involuntary rigidity=peritoneal inflammation
Deep palpation to feel for masses: physiologic (pregnancy),
inflammatory (diverticulitis), vascular (AAA), neoplastic (colon
cancer), or obstructive (distended bladder or dilated loop of
bowel)
Abdomen percussion - correct answer- --Tympany
dominates d/t gas
--Dull areas: fluid, feces, mass, enlarged organ
--Protuberant abdomen: note where tympany changes to
dullness (solid posterior structures)
--Percuss lower anterior chest above costal margins: normal=
right dullness over liver, left tympany over gastric air bubble and
spelnic flexure of colon.
Abdominal Auscultation - correct answer- 1.
Bowel sounds
2. Bruits: hepatic (Cirrhosis), Arterial with systolic and diastolic
component (occlusion of aorta or large artery (ex. epigastric--
renal artery stenosis/renovascular hypertension)
3. Venous Hum: rare soft humming w/ sys/dias.= increase
collateral circ btwn portal and systemic systems (hepatic
cirrhosis)
,4. Friction Rub over liver or spleen: Rare grating sounds w/
respiratory variation=inflammation (liver cancer,
chlamydial/gonococcal perihepatitis, liver bx, splenic infarct)
Abdominal insepction - correct answer-
Abnormal:
purple striae: cushing syndrome
Dilated veins: portal HTN from cirrhosis or ICV obstruction
Ecchymosis: intraperitoneal or retroperitoneal hemorrhage
Protuberant abdomen: 1. Hernia (umbilica, incisional, epigastric,
2. Diastasis Recti, 3. Lipoma, 4. Fat, 5. Gas, 6. Tumor, 7.
Pregnancy, 8. Ascites
Acrocyanosis - correct answer- Blue cast to hands
and feet when exposed to cold. Common for first few days into
early infancy.
--should disappear within 8 hrs of birth or warming.
Acute Cholecystits - correct answer- RUQ pain
Murphy Sign
, Acute Pancreatitis Aggrevating Factors - correct answer-
Lying supine; dyspnea if pleural effusions from capillary leak syn-
drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Associated Symptoms and Setting -
correct answer- Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Acute Pancreatitis Location - correct answer-
Epigastric, may radiate straight to the back or other areas of the
abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Process - correct answer-
Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of the
pancreas
Acute Pancreatitis Quality - correct answer-
Usually steady
Acute Pancreatitis Relieving factors - correct answer-
Leaning forward with trunk flexed
DETAILED CORRECT ANSWERS
10 minute geriatric screener - correct answer-
1.vision a. difficulty driving/watching TV/reading
-->snellen chart with corrective lenses (normal: <20/40)
2. hearing: audioscope at 40dB (1,000 and 2,000) (+= inability to
hear one in both or one ear)
3. leg mobility: Get up and Go test: rise, walk 10 ft, turn, walk
back, sit down (+= greater than 10 seconds)
4. urinary incontinence: Ask: a. lose urine and gotten wet in last
year? b. 6 times? (+= yes to both)
5. nutrition/weight loss: a. lost 10 lbs in 6 mos? b. check weight
(+= <100lbs)
6. memory: three-item recall (+= unable to remember all 3 after
1 min)
7. depression: Ask: do you feel sad/depressed (+= yes)
8. physical disability (6 questions: 1. strenious activity? 2. Heavy
work? 3. Shopping? 4. Go to places out of walking distance? 5.
Bath/shower? 6. Dress?) (+= no to any)
Abdomen palpation - correct answer- gently
palpate over 4 quadrants:
,abnormal: involuntary rigidity=peritoneal inflammation
Deep palpation to feel for masses: physiologic (pregnancy),
inflammatory (diverticulitis), vascular (AAA), neoplastic (colon
cancer), or obstructive (distended bladder or dilated loop of
bowel)
Abdomen percussion - correct answer- --Tympany
dominates d/t gas
--Dull areas: fluid, feces, mass, enlarged organ
--Protuberant abdomen: note where tympany changes to
dullness (solid posterior structures)
--Percuss lower anterior chest above costal margins: normal=
right dullness over liver, left tympany over gastric air bubble and
spelnic flexure of colon.
Abdominal Auscultation - correct answer- 1.
Bowel sounds
2. Bruits: hepatic (Cirrhosis), Arterial with systolic and diastolic
component (occlusion of aorta or large artery (ex. epigastric--
renal artery stenosis/renovascular hypertension)
3. Venous Hum: rare soft humming w/ sys/dias.= increase
collateral circ btwn portal and systemic systems (hepatic
cirrhosis)
,4. Friction Rub over liver or spleen: Rare grating sounds w/
respiratory variation=inflammation (liver cancer,
chlamydial/gonococcal perihepatitis, liver bx, splenic infarct)
Abdominal insepction - correct answer-
Abnormal:
purple striae: cushing syndrome
Dilated veins: portal HTN from cirrhosis or ICV obstruction
Ecchymosis: intraperitoneal or retroperitoneal hemorrhage
Protuberant abdomen: 1. Hernia (umbilica, incisional, epigastric,
2. Diastasis Recti, 3. Lipoma, 4. Fat, 5. Gas, 6. Tumor, 7.
Pregnancy, 8. Ascites
Acrocyanosis - correct answer- Blue cast to hands
and feet when exposed to cold. Common for first few days into
early infancy.
--should disappear within 8 hrs of birth or warming.
Acute Cholecystits - correct answer- RUQ pain
Murphy Sign
, Acute Pancreatitis Aggrevating Factors - correct answer-
Lying supine; dyspnea if pleural effusions from capillary leak syn-
drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Associated Symptoms and Setting -
correct answer- Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Acute Pancreatitis Location - correct answer-
Epigastric, may radiate straight to the back or other areas of the
abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Process - correct answer-
Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of the
pancreas
Acute Pancreatitis Quality - correct answer-
Usually steady
Acute Pancreatitis Relieving factors - correct answer-
Leaning forward with trunk flexed
