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NR 509 Final Exam Study Guide Questions and Answers
with Verified Solutions 2025 | 2026
Chapter 19: Abdomen
...
An overweight 26-year-old public servant presents to the
Emergency Department with 12 hours of intense abdominal
pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family
history of gallstones and is concerned about this possibility. She
has not had any vomiting or diarrhea. She had a normal bowel
movement this morning. Her β-human chorionic gonadotropin
(β-hCG) is positive at triage. She reports that her last period was
10 weeks ago. Her vital signs at triage are pulse, 118; blood
pressure, 86/68; respiratory rate, 20/min; oxygen saturation,
99%; and temperature, 37.3ºC orally. The clinician performs an
abdominal exam prior to her pelvic exam and, on palpation of
her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
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c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
A 63-year-old janitor with a history of adenomatous colonic
polyps presents for a well visit. Basic labs are performed to
screen for diabetes mellitus and dyslipidemia. Electrolytes and
liver enzymes were also measured. His labs are all normal
expect for moderate elevations of aspartate aminotransferase,
alanine aminotransferase, γ-glutamyl transferase, and alkaline
phosphatase as well as a mildly elevated total bilirubin. He
presents for a follow-up appointment and the clinician performs
an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the
midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal
line
e. Liver palpable 3 cm below the right costal margin, mid
clavicular line, on expiration
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A 63-year-old underweight administrative clerk with a 50-pack-
year smoking history presents with a several month history of
recurrent epigastric abdominal discomfort. She feels fairly well
otherwise and denies any nausea, vomiting, diarrhea, or
constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86;
blood pressure, 148/92; respiratory rate, 16; oxygen saturation,
95%; and temperature, 36.2ºC. Her body mass index is 17.6. On
exam, her abdominal aorta is prominent, which is concerning
for an abdominal aortic aneurysm (AAA). Which of the following
is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using
high sensitivity fecal occult blood testing (FOBT). He presents
for follow-up of his hypertension, during which the clinician
scans his chart to ensure he is up to date with his preventive
health care. He has a positive FOBT on one occasion at age 66
years and subsequently went for a colonoscopy. Internal
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hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of
colorectal cancer or adenomatous polyps. What are the U.S.
Preventive Services Task Force (USPSTF) screening
recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
An otherwise healthy 31-year-old accountant presents to an
outpatient clinic with a 3-year history of recurrent crampy
abdominal pain that lasts for about 1-2 weeks each episode and
is associated with onset of constipation. She describes
infrequent, small hard stool that she finds very difficult to pass.
She has tried to increase dietary fiber and water intake, but
usually this is not sufficient and she resorts to over-the-counter
laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel
movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
NR 509 Final Exam Study Guide Questions and Answers
with Verified Solutions 2025 | 2026
Chapter 19: Abdomen
...
An overweight 26-year-old public servant presents to the
Emergency Department with 12 hours of intense abdominal
pain, light-headedness, and a fainting episode that finally
prompted her to seek medical attention. She has a strong family
history of gallstones and is concerned about this possibility. She
has not had any vomiting or diarrhea. She had a normal bowel
movement this morning. Her β-human chorionic gonadotropin
(β-hCG) is positive at triage. She reports that her last period was
10 weeks ago. Her vital signs at triage are pulse, 118; blood
pressure, 86/68; respiratory rate, 20/min; oxygen saturation,
99%; and temperature, 37.3ºC orally. The clinician performs an
abdominal exam prior to her pelvic exam and, on palpation of
her abdomen, finds involuntary rigidity and rebound
tenderness. What is the most likely diagnosis?
a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
,2|Page
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
A 63-year-old janitor with a history of adenomatous colonic
polyps presents for a well visit. Basic labs are performed to
screen for diabetes mellitus and dyslipidemia. Electrolytes and
liver enzymes were also measured. His labs are all normal
expect for moderate elevations of aspartate aminotransferase,
alanine aminotransferase, γ-glutamyl transferase, and alkaline
phosphatase as well as a mildly elevated total bilirubin. He
presents for a follow-up appointment and the clinician performs
an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?
a. Liver span of 11 cm at the midclavicular line
b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the
midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal
line
e. Liver palpable 3 cm below the right costal margin, mid
clavicular line, on expiration
,3|Page
A 63-year-old underweight administrative clerk with a 50-pack-
year smoking history presents with a several month history of
recurrent epigastric abdominal discomfort. She feels fairly well
otherwise and denies any nausea, vomiting, diarrhea, or
constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86;
blood pressure, 148/92; respiratory rate, 16; oxygen saturation,
95%; and temperature, 36.2ºC. Her body mass index is 17.6. On
exam, her abdominal aorta is prominent, which is concerning
for an abdominal aortic aneurysm (AAA). Which of the following
is her most significant risk factor for an AAA?
a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using
high sensitivity fecal occult blood testing (FOBT). He presents
for follow-up of his hypertension, during which the clinician
scans his chart to ensure he is up to date with his preventive
health care. He has a positive FOBT on one occasion at age 66
years and subsequently went for a colonoscopy. Internal
, 4|Page
hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of
colorectal cancer or adenomatous polyps. What are the U.S.
Preventive Services Task Force (USPSTF) screening
recommendations for this patient?
a. Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
An otherwise healthy 31-year-old accountant presents to an
outpatient clinic with a 3-year history of recurrent crampy
abdominal pain that lasts for about 1-2 weeks each episode and
is associated with onset of constipation. She describes
infrequent, small hard stool that she finds very difficult to pass.
She has tried to increase dietary fiber and water intake, but
usually this is not sufficient and she resorts to over-the-counter
laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel
movements. Which of the following is the most likely
physiological mechanism for her constipation?
a. A large, firm fecal mass in the rectum
