NR 511 FInal Exam | Chamberlain University-Illinois | Questions with 100%
Verified Answers | Latest Update
Question: Marian, age 52, is obese. She complains of a rapid onset of
severe right upper quadrant abdominal cramping pain, nausea, and
vomiting. What is your leading differential diagnosis?
Answer:
Cholecystitis
A rapid onset of severe right upper quadrant (RUQ) abdominal cramping pain with nausea and
vomiting is a classic presentation of acute cholecystitis; 90% to 95% of patients with acute
cholecystitis also have gallstones. Other symptoms include low-grade fever, epigastric
tenderness, guarding, and pain on inspiration during palpation of the RUQ (Murphy sign). The
7 Fs of cholecystitis are fair, fat, 40, female, fertile, fat intolerant, and flatulent.
Question: You suspect that Nikki has a gastroduodenal ulcer caused by
Helicobacter pylori and plan to treat her empirically. What medications
should you order?
Answer:
A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl)
All of the drugs listed are used in the eradication of H pylori. Traditional 14-day "triple
therapy" with a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and
metronidazole (Flagyl) has consistently produced eradication rates of approximately 95% and
is the least expensive therapy.
Question: You elicit costovertebral angle tenderness in Gordon, age 29.
Which condition do you suspect?
Answer:
Inflammation of the kidney
Costovertebral angle tenderness is tenderness or sharp pain that is elicited when one hand is
"thumped" with the ulnar edge of the other fist over the 12th rib at the costovertebral angle on
the back. It indicates inflammation of the kidney (and possible associated renal calculi, renal
artery or vein occlusion, and perirenal abscess).
,Question: To differentiate among the different diagnoses of
inflammatory bowel diseases, you look at the patient's histological,
culture, and radiological features. Mary has transmural inflammation,
granulomas, focal involvement of the colon with some skipped areas,
and sparing of the rectal mucosa. What do you suspect?
Answer:
Crohn's disease
Crohn's disease would show transmural inflammation, granulomas, focal involvement of the
colon with some skipped areas, and sparing of the rectal mucosa. The key words are "skipped
areas of mucosal involvement."
Question: Margie, age 52, has an extremely stressful job and was just
given a diagnosis of gastric ulcer. She tells you she is sure it is going to
be malignant. How do you respond?
Answer:
About 95% of gastric ulcers are benign."
About 3% to 5% of gastric ulcers of benign-appearing ulcers prove to be cancer.
Question: Rose has gastroesophageal reflux disease (GERD). Which
statement by the patient indicates that she misunderstands your
teaching?
Answer:
"I will have a snack before retiring so that the esophagus and stomach are not empty at
bedtime."
Rose should not have a snack before retiring. Patients with GERD should be instructed to
avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop
smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6- to 8-inch
blocks; and refrain from eating for 3 hours before retiring.
Question: Which is the most important diagnostic test for celiac
disease?
Answer:
An IgA-tTG test, followed by a biopsy of the small intestine
There are several serologic tests available that screen for celiac disease antibodies, but the
most important diagnostic test is called an IgA-tTG test. Although it may be falsely negative, if
the test results suggest celiac disease, it is recommended that a biopsy of the small intestine be
done to confirm the diagnosis.
,Question: Susan, age 59, has no specific complaints when she comes in
for her annual examination. She does, however, have type 2 diabetes
mellitus (DM), slight hypertension, dyslipidemia, and central obesity.
How would you diagnose her?
Answer:
As having metabolic syndrome
Susan has a constellation of symptoms known as metabolic syndrome. The World Health
Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III
(NCEP ATP III), and International Diabetes Federation (IDF) have slightly different criteria
for this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
Question: Which gastrointestinal disease below could theoretically be
completely eradicated with a total colectomy?
Answer:
Ulcerative colitis
Ulcerative colitis is a disease only of the colon. Although it is not the first treatment choice,
total colectomy is a treatment option that can completely resolve this problem.
Question: Matt, age 26, recently returned from a camping trip and has
gastroenteritis. He says that he has been eating only canned food. Which
of the following pathogens do you suspect?
Answer:
Clostridium botulinum
C botulinum is an anaerobic, gram-positive bacillus that produces toxins. It is widely
distributed in the soil and vegetation. Improperly processed home-canned low-acid vegetables
and contaminated meats are the usual cause of food-borne botulism.
Question: Melva, age 63, presents with an acute exacerbation of
pancreatitis, and you are going to admit her to the hospital. Which is the
most important factor in determining a negative long-term outcome for
her?
Answer:
Infection
The most important factor in determining long-term negative outcomes for pancreatitis is the
presence of infection. Despite best practices, mortality associated with severe acute
pancreatitis remains approximately 20% to 25% because of systemic complications.
, Question: Which is the most common presenting symptom of gastric
cancer?
Answer:
Weight loss
Question: Stacy, a nursing student, is to begin her series of hepatitis B
vaccinations. You test her for a serological marker, and the results show
hepatitis B surface antibodies (HBsAb). What do you tell Stacy?
Answer:
"You need to be tested again because one reading is not indicative of immunity."
The presence of hepatitis B surface antibodies indicates that Stacy is permanently immune to
hepatitis B.
Question: Shelby has recently been diagnosed with pancreatitis. Of the
following objective findings that can result from the pancreatic
inflammatory process, which is known as Grey Turner sign?
Answer:
Bluish discoloration over the flanks
Question: What is the most common bacterial cause of traveler's
diarrhea?
Answer:
Escherichia coli
Question: Olive has an acute exacerbation of Crohn's disease. Which
laboratory test value(s) would you expect to be decreased?
Answer:
Vitamin A, B complex, and C levels
Folic acid and serum levels of most vitamins, including A, B complex, C, and the fat-soluble
vitamins, are decreased in Crohn's disease as a result of malabsorption.
Verified Answers | Latest Update
Question: Marian, age 52, is obese. She complains of a rapid onset of
severe right upper quadrant abdominal cramping pain, nausea, and
vomiting. What is your leading differential diagnosis?
Answer:
Cholecystitis
A rapid onset of severe right upper quadrant (RUQ) abdominal cramping pain with nausea and
vomiting is a classic presentation of acute cholecystitis; 90% to 95% of patients with acute
cholecystitis also have gallstones. Other symptoms include low-grade fever, epigastric
tenderness, guarding, and pain on inspiration during palpation of the RUQ (Murphy sign). The
7 Fs of cholecystitis are fair, fat, 40, female, fertile, fat intolerant, and flatulent.
Question: You suspect that Nikki has a gastroduodenal ulcer caused by
Helicobacter pylori and plan to treat her empirically. What medications
should you order?
Answer:
A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl)
All of the drugs listed are used in the eradication of H pylori. Traditional 14-day "triple
therapy" with a proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and
metronidazole (Flagyl) has consistently produced eradication rates of approximately 95% and
is the least expensive therapy.
Question: You elicit costovertebral angle tenderness in Gordon, age 29.
Which condition do you suspect?
Answer:
Inflammation of the kidney
Costovertebral angle tenderness is tenderness or sharp pain that is elicited when one hand is
"thumped" with the ulnar edge of the other fist over the 12th rib at the costovertebral angle on
the back. It indicates inflammation of the kidney (and possible associated renal calculi, renal
artery or vein occlusion, and perirenal abscess).
,Question: To differentiate among the different diagnoses of
inflammatory bowel diseases, you look at the patient's histological,
culture, and radiological features. Mary has transmural inflammation,
granulomas, focal involvement of the colon with some skipped areas,
and sparing of the rectal mucosa. What do you suspect?
Answer:
Crohn's disease
Crohn's disease would show transmural inflammation, granulomas, focal involvement of the
colon with some skipped areas, and sparing of the rectal mucosa. The key words are "skipped
areas of mucosal involvement."
Question: Margie, age 52, has an extremely stressful job and was just
given a diagnosis of gastric ulcer. She tells you she is sure it is going to
be malignant. How do you respond?
Answer:
About 95% of gastric ulcers are benign."
About 3% to 5% of gastric ulcers of benign-appearing ulcers prove to be cancer.
Question: Rose has gastroesophageal reflux disease (GERD). Which
statement by the patient indicates that she misunderstands your
teaching?
Answer:
"I will have a snack before retiring so that the esophagus and stomach are not empty at
bedtime."
Rose should not have a snack before retiring. Patients with GERD should be instructed to
avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop
smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6- to 8-inch
blocks; and refrain from eating for 3 hours before retiring.
Question: Which is the most important diagnostic test for celiac
disease?
Answer:
An IgA-tTG test, followed by a biopsy of the small intestine
There are several serologic tests available that screen for celiac disease antibodies, but the
most important diagnostic test is called an IgA-tTG test. Although it may be falsely negative, if
the test results suggest celiac disease, it is recommended that a biopsy of the small intestine be
done to confirm the diagnosis.
,Question: Susan, age 59, has no specific complaints when she comes in
for her annual examination. She does, however, have type 2 diabetes
mellitus (DM), slight hypertension, dyslipidemia, and central obesity.
How would you diagnose her?
Answer:
As having metabolic syndrome
Susan has a constellation of symptoms known as metabolic syndrome. The World Health
Organization (WHO), National Cholesterol Education Program Adult Treatment Panel III
(NCEP ATP III), and International Diabetes Federation (IDF) have slightly different criteria
for this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
Question: Which gastrointestinal disease below could theoretically be
completely eradicated with a total colectomy?
Answer:
Ulcerative colitis
Ulcerative colitis is a disease only of the colon. Although it is not the first treatment choice,
total colectomy is a treatment option that can completely resolve this problem.
Question: Matt, age 26, recently returned from a camping trip and has
gastroenteritis. He says that he has been eating only canned food. Which
of the following pathogens do you suspect?
Answer:
Clostridium botulinum
C botulinum is an anaerobic, gram-positive bacillus that produces toxins. It is widely
distributed in the soil and vegetation. Improperly processed home-canned low-acid vegetables
and contaminated meats are the usual cause of food-borne botulism.
Question: Melva, age 63, presents with an acute exacerbation of
pancreatitis, and you are going to admit her to the hospital. Which is the
most important factor in determining a negative long-term outcome for
her?
Answer:
Infection
The most important factor in determining long-term negative outcomes for pancreatitis is the
presence of infection. Despite best practices, mortality associated with severe acute
pancreatitis remains approximately 20% to 25% because of systemic complications.
, Question: Which is the most common presenting symptom of gastric
cancer?
Answer:
Weight loss
Question: Stacy, a nursing student, is to begin her series of hepatitis B
vaccinations. You test her for a serological marker, and the results show
hepatitis B surface antibodies (HBsAb). What do you tell Stacy?
Answer:
"You need to be tested again because one reading is not indicative of immunity."
The presence of hepatitis B surface antibodies indicates that Stacy is permanently immune to
hepatitis B.
Question: Shelby has recently been diagnosed with pancreatitis. Of the
following objective findings that can result from the pancreatic
inflammatory process, which is known as Grey Turner sign?
Answer:
Bluish discoloration over the flanks
Question: What is the most common bacterial cause of traveler's
diarrhea?
Answer:
Escherichia coli
Question: Olive has an acute exacerbation of Crohn's disease. Which
laboratory test value(s) would you expect to be decreased?
Answer:
Vitamin A, B complex, and C levels
Folic acid and serum levels of most vitamins, including A, B complex, C, and the fat-soluble
vitamins, are decreased in Crohn's disease as a result of malabsorption.
