NR 511 final exam Questions and Answers
mesenteric infarction - ANS-Patient presents with mid epigastric pain, LUQ radiating to
back, mild to very severe pain. Also has associated nausea and vomiting diaphoresis,
pain is worse with lying supine. Physical assessment shows diminished bowel sounds
and abdominal arteriogram.
Urinary stones/kidney stones - ANS-Patient presents with a colicky flank pain
progressing to constant and severe radiating to the groin in both lower quadrant, patient
has associated nausea vomiting fever chills and abdominal distention. Costovertebral
angle tenderness hematuria; do urinalysis IVP and US
intestinal perforation - ANS-Patient presents with severe, parietal, diffuse pain; has
associated guarding, rebound tenderness, pain is relieved while lying still. Physical
exam shows decreased bowel sounds, guarding, rebound tenderness; get abdominal
x-ray
intestinal obstruction - ANS-Patient presents with colicky right lower quadrant and left
lower quadrant pain; has associated nausea vomiting, Anorexia, obstipation; physical
exam shows hyperactive high-pitched bowel sounds are hypo active bowel sounds, get
an abdominal x-ray
Pancreatitis - ANS-Patient presents with severe, visceral, diffuse pain. Has associated
hypotension tachycardia; pain is relieved by leaning forward. Physical exam shows
abdominal distention, diminished bowel sounds, diffuse rebound tenderness; will have
elevated amylase levels
ectopic pregnancy - ANS-Patient will present with persistent right lower quadrant pain or
left lower quadrant pain. May have vaginal bleeding. Physical exam will show tender
adnexal mass and will have a positive hCG test.
Dissection or Rupture of Aortic Aneurysm - ANS-Patient will present with ripping,
tearing, intense pain in chest, abdomen, lower back. Will have associated hypotension,
feelings of doom, shock. Physical exam will show shock, diminished femoral pulses; get
x-ray and CT scan
Peptic Ulcer Disease (PUD) - ANS-Patient presents with annoying pain in epigastric
region radiating to the back, right shoulder, or side. Associated nausea, hunger; worse
with empty stomach, alcohol, NSAIDs, ASA; relieved with food and antacids. Will have
, epigastric tenderness to palpation. Studies done is endoscopy and barium swallow
gastroesophageal reflux disease (GERD) - ANS-Patient will present with epigastric,
retrosternal pain. This pain will be intermittent. Patient may have sour taste, low-grade
bleeding, hoarseness, pharyngitis; worse with bending at the waist, NSAIDs, ASA,
alcohol, caffeine, recumbency; relieved with antacids. Test are barium swallow, upper
G.I., esophageal endoscopy with biopsy
gastritis - ANS-Patient will present with epigastric pain that is constant. May have
associated nausea, vomiting, diarrhea, fever, hemorrhage; worse with alcohol, NSAIDs,
aspirin; is rarely worse with food
salpingitis - ANS-Patient will present with right lower quadrant and or left lower quadrant
pain. Pain will be worse around menstruation and when ascending stairs. There will be
cervical motion and adnexal tenderness
irritable bowel syndrome (IBS) - ANS-Patient will present with left lower quadrant pain
right lower quadrant pain the pain will be intermittent and recurrent. Will have
associated diarrhea, mucus in store; worse with stress and eating; often relieved by
defecation. There will be: tender to palpation; small bowel follow through to rule out
other causes
Inflammatory bowel disease (Crohn's disease, ulcerative colitis) - ANS-Patient will
present with pain in the right lower quadrant and left lower quadrant; may have diarrhea,
weight loss, rectal bleeding, tenesmus, fever; worse with stress. Physical exam will
show tenderness in the right lower quadrant left lower quadrant; order CBC with
differential small bowel follow through (crohns) and a colonoscopy (UC)
gastroenteritis - ANS-This pain will be diffuse. May have associated nausea, vomiting,
diarrhea, fever, chills; worse with food; relieved with vomiting or defecation. Physical
exam will show hyperactive bowel sounds; stool ova and parasites, stool culture
Diverticulitis - ANS-Patient will present with left lower quadrant intermittent pain. May
have associated constipation, diarrhea, fever. Physical assessment Michelle left lower
quadrant mass, mild tenderness in the left iliac fossa; laparoscopy will diagnose; other
labs are normal
Cholecystitis/Cholelithiasis - ANS-Patient will present with right upper quadrant pain
radiating to the infrascapular region, also mid at the gastric pain; starts as visceral
progressing to parietal. May have associated nausea, vomiting, jaundice, dark urine,
mesenteric infarction - ANS-Patient presents with mid epigastric pain, LUQ radiating to
back, mild to very severe pain. Also has associated nausea and vomiting diaphoresis,
pain is worse with lying supine. Physical assessment shows diminished bowel sounds
and abdominal arteriogram.
Urinary stones/kidney stones - ANS-Patient presents with a colicky flank pain
progressing to constant and severe radiating to the groin in both lower quadrant, patient
has associated nausea vomiting fever chills and abdominal distention. Costovertebral
angle tenderness hematuria; do urinalysis IVP and US
intestinal perforation - ANS-Patient presents with severe, parietal, diffuse pain; has
associated guarding, rebound tenderness, pain is relieved while lying still. Physical
exam shows decreased bowel sounds, guarding, rebound tenderness; get abdominal
x-ray
intestinal obstruction - ANS-Patient presents with colicky right lower quadrant and left
lower quadrant pain; has associated nausea vomiting, Anorexia, obstipation; physical
exam shows hyperactive high-pitched bowel sounds are hypo active bowel sounds, get
an abdominal x-ray
Pancreatitis - ANS-Patient presents with severe, visceral, diffuse pain. Has associated
hypotension tachycardia; pain is relieved by leaning forward. Physical exam shows
abdominal distention, diminished bowel sounds, diffuse rebound tenderness; will have
elevated amylase levels
ectopic pregnancy - ANS-Patient will present with persistent right lower quadrant pain or
left lower quadrant pain. May have vaginal bleeding. Physical exam will show tender
adnexal mass and will have a positive hCG test.
Dissection or Rupture of Aortic Aneurysm - ANS-Patient will present with ripping,
tearing, intense pain in chest, abdomen, lower back. Will have associated hypotension,
feelings of doom, shock. Physical exam will show shock, diminished femoral pulses; get
x-ray and CT scan
Peptic Ulcer Disease (PUD) - ANS-Patient presents with annoying pain in epigastric
region radiating to the back, right shoulder, or side. Associated nausea, hunger; worse
with empty stomach, alcohol, NSAIDs, ASA; relieved with food and antacids. Will have
, epigastric tenderness to palpation. Studies done is endoscopy and barium swallow
gastroesophageal reflux disease (GERD) - ANS-Patient will present with epigastric,
retrosternal pain. This pain will be intermittent. Patient may have sour taste, low-grade
bleeding, hoarseness, pharyngitis; worse with bending at the waist, NSAIDs, ASA,
alcohol, caffeine, recumbency; relieved with antacids. Test are barium swallow, upper
G.I., esophageal endoscopy with biopsy
gastritis - ANS-Patient will present with epigastric pain that is constant. May have
associated nausea, vomiting, diarrhea, fever, hemorrhage; worse with alcohol, NSAIDs,
aspirin; is rarely worse with food
salpingitis - ANS-Patient will present with right lower quadrant and or left lower quadrant
pain. Pain will be worse around menstruation and when ascending stairs. There will be
cervical motion and adnexal tenderness
irritable bowel syndrome (IBS) - ANS-Patient will present with left lower quadrant pain
right lower quadrant pain the pain will be intermittent and recurrent. Will have
associated diarrhea, mucus in store; worse with stress and eating; often relieved by
defecation. There will be: tender to palpation; small bowel follow through to rule out
other causes
Inflammatory bowel disease (Crohn's disease, ulcerative colitis) - ANS-Patient will
present with pain in the right lower quadrant and left lower quadrant; may have diarrhea,
weight loss, rectal bleeding, tenesmus, fever; worse with stress. Physical exam will
show tenderness in the right lower quadrant left lower quadrant; order CBC with
differential small bowel follow through (crohns) and a colonoscopy (UC)
gastroenteritis - ANS-This pain will be diffuse. May have associated nausea, vomiting,
diarrhea, fever, chills; worse with food; relieved with vomiting or defecation. Physical
exam will show hyperactive bowel sounds; stool ova and parasites, stool culture
Diverticulitis - ANS-Patient will present with left lower quadrant intermittent pain. May
have associated constipation, diarrhea, fever. Physical assessment Michelle left lower
quadrant mass, mild tenderness in the left iliac fossa; laparoscopy will diagnose; other
labs are normal
Cholecystitis/Cholelithiasis - ANS-Patient will present with right upper quadrant pain
radiating to the infrascapular region, also mid at the gastric pain; starts as visceral
progressing to parietal. May have associated nausea, vomiting, jaundice, dark urine,
