NR 511 Final Exam Questions and
Complete Answers
mesenteric infarction - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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) - Answer: 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) - Answer: 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 - Answer: 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 - Answer: 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) - Answer: 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) - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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, light colored stools, fever, chills; worse with
high fat foods, estrogen containing medication, cholestyramine. Order ultrasound, CBC with
differential, liver function test, amylase
Complete Answers
mesenteric infarction - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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) - Answer: 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) - Answer: 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 - Answer: 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 - Answer: 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) - Answer: 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) - Answer: 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 - Answer: 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 - Answer: 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 - Answer: 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, light colored stools, fever, chills; worse with
high fat foods, estrogen containing medication, cholestyramine. Order ultrasound, CBC with
differential, liver function test, amylase
