NCA 623 Module 6 Exam Study
Guide
A patient presents to the ED with severe abdominal pain. Which of the following is the
most important first step in your treatment plan? - Answer Obtain a thorough history
Which of the following is an example of referred pain? - Answer A patient with right
suprascapular pain and suspected cholecystitis.
A ruptured appendix would be considered which type of peritonitis? - Answer
Secondary
During your physical exam on a patient with abdominal pain, you hear high pitched
bowel sounds. This could support which of the following diagnoses? - Answer Small
bowel obstruction
Your patient has pain when you release pressure on her abdomen. This finding is called
- Answer Rebound Tendernes
After taking a thorough history and completing a physical exam, you suspect your
patient has appendicitis. Which of the following is the FIRST diagnostic test you should
order? - Answer Abdominal US
After taking a thorough history and completing a physical exam, you suspect your
patient has diverticulitis. Which of the following is the diagnostic test that will help
confirm that diagnosis? - Answer CT Scan
Your 75 year old patient has LLQ pain, positive peritoneal signs, and a fever of 102.
Which of the following treatment plans is most appropriate? - Answer Admit, order CT
scan, order empiric IV abx, make NPO.
A 42-year old woman presents to the ED with complaints of upper abdominal pain,
nausea, and vomiting for 24 hours. She has a history of drinking a pint of vodka daily.
Physical exam is positive for upper abdominal tenderness and flank bruising. Which of
the following is the most likely the cause of his pain? - Answer Acute Pancreatitis
When choosing an antibiotic regimen to treat spontaneous bacterial peritonitis, you
would want to ensure coverage for which of the following? - Answer E-Coli and
Klebsiella
A 30 y/o female presents to the ED with complaints of anorexia and constipation. Had
emesis one time with pain mostly to the right lower quadrant of her abdomen. As the NP,
you would expect all of the following to be positive signs on physical exam EXCEPT: -
Answer positive murphys sign
, A 18 y/o male presents to the ED with c/o with umbilical pain that is colicky in nature and
that has now moved to the RLQ over the past eight hours. Describes the pain as a
steady ache that is worse with coughing or walking and radiates to his chest. On exam
he has rebound tenderness and guarding with a positive McBurney's point. As an
advanced provider you know that your patient most likely has which of the following
diseases: - Answer acute appendicitis
Classic s/s associated with acute appendicitis include: - Answer pain that migrates from
periumbilical to the RL, low grade fever, and positive psoas and obturators sign
True or False: an abdominal u/s and CT of Abd/Pelvis are both useful tools in the
diagnosis of acute appendicitis. - Answer true, both can be used, however, more often
then not, a provider but not only order abs us but also ct abd/pelvis
All of the following are differentials in those with appendicitis EXCEPT: - Answer GERD
True or False: All of those with appendicitis will eventually require appendix removal -
Answer true
Treatment for a perforated appendix with peritoneal s/s should be: - Answer emergent
appendectomy with IV abx
True or False: All females who present with acute abodominal pain should have a
urinalysis, pregnancy test, and exam to r/o ectopic preganancy and other GYN
complications. - Answer true
A 60 y/o female presents to the ED with a temp of 101.8F, LLQ localizing abdominal pain,
and mild rebound tenderness. The BEST diagnostic imaging tool for this patient would
be: - Answer ct abd/pelvis
All of the following are true regarding the pressentations of acute appendicitis in the
elderly EXEPT: - Answer often misdiagnosed as constipation
All of the following condition are indications for emergency surgery in a patient with
severe acute diverticulitis EXCEPT: - Answer chronic disease process with a new fistula
A 70 y/o male presents with acute abdominal pain to the LLQ. CT of Abd/Pelvis with large
abscess. IV antimicrobials were started, but there is no improvement after three days
and continues to run high fevers with severe pain. The BEST next setp is to : - Answer
consult the GI surgeon for an emergent colectomy
Two acute abdominal disease diagnoses where reported pain is out of proportion to
physical exam would include: - Answer acute pancreatitis and mesenteric ischemia
Peritonitis caused by acute appendicitis is classified as what type of peritonitis:
Secondary or Primary ? - Answer secondary
True or False: Those with SBP always have abdominal pain at time of presentation. -
Answer false
Guide
A patient presents to the ED with severe abdominal pain. Which of the following is the
most important first step in your treatment plan? - Answer Obtain a thorough history
Which of the following is an example of referred pain? - Answer A patient with right
suprascapular pain and suspected cholecystitis.
A ruptured appendix would be considered which type of peritonitis? - Answer
Secondary
During your physical exam on a patient with abdominal pain, you hear high pitched
bowel sounds. This could support which of the following diagnoses? - Answer Small
bowel obstruction
Your patient has pain when you release pressure on her abdomen. This finding is called
- Answer Rebound Tendernes
After taking a thorough history and completing a physical exam, you suspect your
patient has appendicitis. Which of the following is the FIRST diagnostic test you should
order? - Answer Abdominal US
After taking a thorough history and completing a physical exam, you suspect your
patient has diverticulitis. Which of the following is the diagnostic test that will help
confirm that diagnosis? - Answer CT Scan
Your 75 year old patient has LLQ pain, positive peritoneal signs, and a fever of 102.
Which of the following treatment plans is most appropriate? - Answer Admit, order CT
scan, order empiric IV abx, make NPO.
A 42-year old woman presents to the ED with complaints of upper abdominal pain,
nausea, and vomiting for 24 hours. She has a history of drinking a pint of vodka daily.
Physical exam is positive for upper abdominal tenderness and flank bruising. Which of
the following is the most likely the cause of his pain? - Answer Acute Pancreatitis
When choosing an antibiotic regimen to treat spontaneous bacterial peritonitis, you
would want to ensure coverage for which of the following? - Answer E-Coli and
Klebsiella
A 30 y/o female presents to the ED with complaints of anorexia and constipation. Had
emesis one time with pain mostly to the right lower quadrant of her abdomen. As the NP,
you would expect all of the following to be positive signs on physical exam EXCEPT: -
Answer positive murphys sign
, A 18 y/o male presents to the ED with c/o with umbilical pain that is colicky in nature and
that has now moved to the RLQ over the past eight hours. Describes the pain as a
steady ache that is worse with coughing or walking and radiates to his chest. On exam
he has rebound tenderness and guarding with a positive McBurney's point. As an
advanced provider you know that your patient most likely has which of the following
diseases: - Answer acute appendicitis
Classic s/s associated with acute appendicitis include: - Answer pain that migrates from
periumbilical to the RL, low grade fever, and positive psoas and obturators sign
True or False: an abdominal u/s and CT of Abd/Pelvis are both useful tools in the
diagnosis of acute appendicitis. - Answer true, both can be used, however, more often
then not, a provider but not only order abs us but also ct abd/pelvis
All of the following are differentials in those with appendicitis EXCEPT: - Answer GERD
True or False: All of those with appendicitis will eventually require appendix removal -
Answer true
Treatment for a perforated appendix with peritoneal s/s should be: - Answer emergent
appendectomy with IV abx
True or False: All females who present with acute abodominal pain should have a
urinalysis, pregnancy test, and exam to r/o ectopic preganancy and other GYN
complications. - Answer true
A 60 y/o female presents to the ED with a temp of 101.8F, LLQ localizing abdominal pain,
and mild rebound tenderness. The BEST diagnostic imaging tool for this patient would
be: - Answer ct abd/pelvis
All of the following are true regarding the pressentations of acute appendicitis in the
elderly EXEPT: - Answer often misdiagnosed as constipation
All of the following condition are indications for emergency surgery in a patient with
severe acute diverticulitis EXCEPT: - Answer chronic disease process with a new fistula
A 70 y/o male presents with acute abdominal pain to the LLQ. CT of Abd/Pelvis with large
abscess. IV antimicrobials were started, but there is no improvement after three days
and continues to run high fevers with severe pain. The BEST next setp is to : - Answer
consult the GI surgeon for an emergent colectomy
Two acute abdominal disease diagnoses where reported pain is out of proportion to
physical exam would include: - Answer acute pancreatitis and mesenteric ischemia
Peritonitis caused by acute appendicitis is classified as what type of peritonitis:
Secondary or Primary ? - Answer secondary
True or False: Those with SBP always have abdominal pain at time of presentation. -
Answer false
