NR 511 Final Exam Questions with Verified Answers (Correct
Update)
Question 1: Marian, age 52, is obese. She complains of a Cholecystitis rapid onset of severe right
upper quadrant abdominal cramping pain, nausea, and vom- A rapid iting. What is your leading
differential diagnosis?
Answer: 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 2: 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 3: 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 4: To differentiate among the different diagnoses of inflammatory bowel diseases, you
look at the patient's histological, culture, and Crohn's 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 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 5: 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.
Page 1
,Question 6: 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 cottee, 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 6to 8-inch blocks; and refrain from eating
for 3 hours before retiring.
Question 7: 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 8: 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,
dysknown lipidemia, and central obesity. How would you diagnose her?
Answer: As having metabolic syndrome Susan has a constellation of symptoms 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 ditterent criteria for
this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
Question 9: 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 10: Matt, age 26, recently returned from a camp- Clostridium ing trip and has
gastroenteritis. He says that he has been eating only canned food. Which of the following
pathogens do you suspect?
Answer: 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 11: Melva, age 63, presents with an acute exacer- Infection bation 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: 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.
Page 2
,Question 12: Which is the most common presenting symp- Weight tom of gastric cancer?
Answer: loss
Question 13: Stacy, a nursing student, is to begin her series "You 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: 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 14: 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 15: What is the most common bacterial cause of traveler's diarrhea?
Answer: Escherichia coli
Question 16: 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.
Question 17: A 7-year-old male presents with his mother to the urgent care clinic complaining of
abdominal pain. He started to complain of pain before going to bed; however, it has gotten
progressively worse and is now preventing him from sleeping. He is nauseous but has not
vomited and did not eat dinner because of the pain. The patient appears pale and is complaining
of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120,
temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right
lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 0.
What is the patient's likely diagnosis?
Answer: Appendicitis
Question 18: All of the following medications are used for the control of nausea and vomiting.
Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper
gastrointestinal motility and increasing lower esophageal sphincter pressure?
Answer: Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan) Metoclopramide
(Reglan) is used for diabetic gastroparesis and postoperative nausea and vomiting. It works by attecting
the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower
esophageal sphincter pressure.
Page 3
, Question 19: Anson tells you he thinks his antacids are causing his diarrhea. How do you
respond?
Answer: Antacids may contain magnesium, which decreases bowel transit time and may contain poorly
absorbed salts that draw fluid into the bowel."
Question 20: Which oral medication might be used to treat Ursodiol a patient with chronic
cholelithiasis who is a poor candidate for surgery?
Answer: (Actigall) Ursodiol (Actigall) is an oral bile acid that dissolves gallstones. For dissolution, 8 to
10 mg/kg per day is given in 2 to 3 divided doses; for prevention, 300 mg twice per day is given. The
safety of its use after 24 months has not been established.
Question 21: You are doing routine teaching with a patient Increase who has a family history of
colorectal cancer. You know she misunderstands the teaching when she tells you she will do
which of the following?
Answer: her fluid intake Increasing fluid intake has not been shown to decrease the risk for colorectal
cancer. Current recommendations to aid in preventing colorectal cancer include decreased fat
consumption, increased fiber consumption, and the daily use of aspirin.
Question 22: What would you expect to see on an abdomi- Air-fluid nal series that would lead
toward a diagnosis of small-bowel obstruction?
Answer: levels hallmark sign of SBO
Question 23: Tina has a chronic hepatitis C infection. She asks you how to prevent its
transmission. How do you respond?
Answer: "Abstain from sex during your period." Because the hepatitis C virus is transmitted in blood,
including menstrual blood, patients should abstain from sex during menstruation. You might also test
Tina to see which genotype her hepatitis C is to see whether she is a candidate for Harvoni or Epclusa.
Question 24: Your patient's 2-month-old daughter is admitted with gastroenteritis and
dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the
child's diarrhea, how do you respond?
Answer: The infectious agent invaded the stomach lining and is attecting the balance of water and
nutrients." In 80% of cases, gastroenteritis is viral in nature. This viral infection causes diarrhea by
stimulating the secretion of electrolytes into the intestine. This is rapidly followed by water along the
osmotic gradient, resulting in watery stools.
Question 25: What is the best diagnostic test to confirm the diagnosis of celiac disease?
Answer: Anti-tTG IgA
Page 4
Update)
Question 1: Marian, age 52, is obese. She complains of a Cholecystitis rapid onset of severe right
upper quadrant abdominal cramping pain, nausea, and vom- A rapid iting. What is your leading
differential diagnosis?
Answer: 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 2: 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 3: 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 4: To differentiate among the different diagnoses of inflammatory bowel diseases, you
look at the patient's histological, culture, and Crohn's 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 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 5: 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.
Page 1
,Question 6: 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 cottee, 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 6to 8-inch blocks; and refrain from eating
for 3 hours before retiring.
Question 7: 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 8: 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,
dysknown lipidemia, and central obesity. How would you diagnose her?
Answer: As having metabolic syndrome Susan has a constellation of symptoms 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 ditterent criteria for
this diagnosis. They all, however, include hypertension, dyslipidemia, and central obesity.
Question 9: 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 10: Matt, age 26, recently returned from a camp- Clostridium ing trip and has
gastroenteritis. He says that he has been eating only canned food. Which of the following
pathogens do you suspect?
Answer: 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 11: Melva, age 63, presents with an acute exacer- Infection bation 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: 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.
Page 2
,Question 12: Which is the most common presenting symp- Weight tom of gastric cancer?
Answer: loss
Question 13: Stacy, a nursing student, is to begin her series "You 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: 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 14: 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 15: What is the most common bacterial cause of traveler's diarrhea?
Answer: Escherichia coli
Question 16: 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.
Question 17: A 7-year-old male presents with his mother to the urgent care clinic complaining of
abdominal pain. He started to complain of pain before going to bed; however, it has gotten
progressively worse and is now preventing him from sleeping. He is nauseous but has not
vomited and did not eat dinner because of the pain. The patient appears pale and is complaining
of right-sided abdominal pain. His vitals are as follows: blood pressure 130/85, pulse 120,
temperature 100.5°F, pulse oximetry 98% on room air. On physical exam he is tender in the right
lower quadrant. His complete blood count (CBC) shows a white blood cell count (WBC) of 0.
What is the patient's likely diagnosis?
Answer: Appendicitis
Question 18: All of the following medications are used for the control of nausea and vomiting.
Which medication works by affecting the chemoreceptor trigger zone, thereby stimulating upper
gastrointestinal motility and increasing lower esophageal sphincter pressure?
Answer: Antidopaminergic and cholinergic agents, such as metoclopramide (Reglan) Metoclopramide
(Reglan) is used for diabetic gastroparesis and postoperative nausea and vomiting. It works by attecting
the chemoreceptor trigger zone, thereby stimulating upper gastrointestinal motility and increasing lower
esophageal sphincter pressure.
Page 3
, Question 19: Anson tells you he thinks his antacids are causing his diarrhea. How do you
respond?
Answer: Antacids may contain magnesium, which decreases bowel transit time and may contain poorly
absorbed salts that draw fluid into the bowel."
Question 20: Which oral medication might be used to treat Ursodiol a patient with chronic
cholelithiasis who is a poor candidate for surgery?
Answer: (Actigall) Ursodiol (Actigall) is an oral bile acid that dissolves gallstones. For dissolution, 8 to
10 mg/kg per day is given in 2 to 3 divided doses; for prevention, 300 mg twice per day is given. The
safety of its use after 24 months has not been established.
Question 21: You are doing routine teaching with a patient Increase who has a family history of
colorectal cancer. You know she misunderstands the teaching when she tells you she will do
which of the following?
Answer: her fluid intake Increasing fluid intake has not been shown to decrease the risk for colorectal
cancer. Current recommendations to aid in preventing colorectal cancer include decreased fat
consumption, increased fiber consumption, and the daily use of aspirin.
Question 22: What would you expect to see on an abdomi- Air-fluid nal series that would lead
toward a diagnosis of small-bowel obstruction?
Answer: levels hallmark sign of SBO
Question 23: Tina has a chronic hepatitis C infection. She asks you how to prevent its
transmission. How do you respond?
Answer: "Abstain from sex during your period." Because the hepatitis C virus is transmitted in blood,
including menstrual blood, patients should abstain from sex during menstruation. You might also test
Tina to see which genotype her hepatitis C is to see whether she is a candidate for Harvoni or Epclusa.
Question 24: Your patient's 2-month-old daughter is admitted with gastroenteritis and
dehydration after 2 days of vomiting and diarrhea. When the father asks you what is causing the
child's diarrhea, how do you respond?
Answer: The infectious agent invaded the stomach lining and is attecting the balance of water and
nutrients." In 80% of cases, gastroenteritis is viral in nature. This viral infection causes diarrhea by
stimulating the secretion of electrolytes into the intestine. This is rapidly followed by water along the
osmotic gradient, resulting in watery stools.
Question 25: What is the best diagnostic test to confirm the diagnosis of celiac disease?
Answer: Anti-tTG IgA
Page 4
