8/21/25, 7:45 PM NUR 500- Exam #3
NURS 500 Advanced Pathophysiology –MSN Nursing
Exam 3 Guide & study material \complete questions and
accurate detailed answers \verified 100%
-Without
Anemia
Drug-Induced Macrocytosis Causes:
-Excessive alcohol use
-Medications: Carbamazepine (Tegretol). Valproic acid
(Depakote). Phenytoin (Dilantin). Zidovudine (AZT).
-Ulcerative Colitis (UC): Affects mucosal layer of the colon.
IBD
-Crohn's Disease (CD): Affects any part of the GI tract, full
thickness (transmural).
-Colonoscopy with biopsy is gold standard
IBD gold standard/diagnosis -Use flex sigmoidoscopy if severe inflammation (avoid
perforation/toxic megacolon)
**Treat inflammation then get diagnostics to avoid perforation
/ 1/19
,8/21/25, 7:45 PM NUR 500- Exam #3
-CBC: anemia (iron deficiency = microcytic, B12/folate =
macrocytic, chronic disease = normocytic)
-CRP/ESR
IBD labs -↑WBC (in exacerbation)
-Stool: check for blood & mucus (UC), infection (bacterial, fungal,
parasitic)
-Malabsorption labs: ↓ Ca, Vit D, albumin (leads to fatty stools)
-Abdominal pain with:
Altered stool
IBS clinical presentation frequency Altered
stool form
Bloating/distentio
n
Straining, urgency, incomplete evacuation
-Fatigue, headache, myalgia
-Urologic, gynecologic symptoms
Additional IBS symptoms
-Heartburn, chest pain (non-cardiac)
-Anxiety, Depression
-IBS-C: Constipation-predominant (Type 1 & 2 stools)
IBS subtypes Using Bristol -IBS-D: Diarrhea-predominant (Type 6 & 7 stools)
Stool Form Scale -IBS-M: Mixed (≥25% diarrhea & ≥25% constipation)
-IBS-U: Unclassified
-Recurrent abdominal pain ≥1 day/week in last 3 months
-Associated with ≥2 of:
IBS Diagnosis: Rome IV Criteria -Related to defecation
-Change in stool frequency
-Change in stool form/appearance
Duration of IBS symptoms for Symptoms for 3 months, onset ≥6 months prior
diagnosis
-fair: more prevalent Caucasian
-fat: BMI >30 kg/m2 & HLD
Cholecystitis/cholelithiasis risk -female
factors -fertile: one or more children
-forty: age ≥40 years
-Onset: Acute mild to severe colicky epigastric or periumbilical
pain, vague at 1st
Appendicitis Classic Pain -Within 24 hrs: Localizes to RLQ
Pattern -Exacerbated by: Walking or coughing
-Radiation: To testicles in males
-May be associated with: Muscle spasms, rebound tenderness,
guarding, rigidity
/ 2/19
, 8/21/25, 7:45 PM NUR 500- Exam #3
-Pain precedes nausea & anorexia
-+/- Constipation or diarrhea
Appendicitis Associated
-Low-grade fever: 99-100°F (37-37.7°C)
Symptoms
-Pain may vary with appendix location (e.g., epigastrium, groin,
flank)
-Fever >102°F (38C)
-Findings of peritoneal inflammation
Signs of appendix rupture
-Pain lasting greater than 48 hours
-WBC >17,000 (or gangrene)
-Hypertension (due to pain)
Appendicitis vital signs
-Tachycardia (from fever)
Peritoneal inflammation with -referred pain (diagnostic signs)
appendicitis
Dullness on percussion with Abscess
appendicitis
1)Press LLQ-> RLQ pain
1) Rovsing
2) Extend right hip or resist hip flexion-> RLQ pain
2) Psoas
3) Flex/IR right hip-> RLQ pain
3) Obturator
4) Tender 1.5-2 in from anterior superior iliac
4) McBurney
5) Blumberg spine in a straight line to umbilicus->
point/localized tenderness
5) Rebound tenderness-> RLQ pain on release
Modified Alvarado score for -Max score is 9
appendicitis diagnosis -Score of 0-3: unlikely (work-up for other dx)
-Score of ≥4: further eval for appendicitis
/ 3/19
NURS 500 Advanced Pathophysiology –MSN Nursing
Exam 3 Guide & study material \complete questions and
accurate detailed answers \verified 100%
-Without
Anemia
Drug-Induced Macrocytosis Causes:
-Excessive alcohol use
-Medications: Carbamazepine (Tegretol). Valproic acid
(Depakote). Phenytoin (Dilantin). Zidovudine (AZT).
-Ulcerative Colitis (UC): Affects mucosal layer of the colon.
IBD
-Crohn's Disease (CD): Affects any part of the GI tract, full
thickness (transmural).
-Colonoscopy with biopsy is gold standard
IBD gold standard/diagnosis -Use flex sigmoidoscopy if severe inflammation (avoid
perforation/toxic megacolon)
**Treat inflammation then get diagnostics to avoid perforation
/ 1/19
,8/21/25, 7:45 PM NUR 500- Exam #3
-CBC: anemia (iron deficiency = microcytic, B12/folate =
macrocytic, chronic disease = normocytic)
-CRP/ESR
IBD labs -↑WBC (in exacerbation)
-Stool: check for blood & mucus (UC), infection (bacterial, fungal,
parasitic)
-Malabsorption labs: ↓ Ca, Vit D, albumin (leads to fatty stools)
-Abdominal pain with:
Altered stool
IBS clinical presentation frequency Altered
stool form
Bloating/distentio
n
Straining, urgency, incomplete evacuation
-Fatigue, headache, myalgia
-Urologic, gynecologic symptoms
Additional IBS symptoms
-Heartburn, chest pain (non-cardiac)
-Anxiety, Depression
-IBS-C: Constipation-predominant (Type 1 & 2 stools)
IBS subtypes Using Bristol -IBS-D: Diarrhea-predominant (Type 6 & 7 stools)
Stool Form Scale -IBS-M: Mixed (≥25% diarrhea & ≥25% constipation)
-IBS-U: Unclassified
-Recurrent abdominal pain ≥1 day/week in last 3 months
-Associated with ≥2 of:
IBS Diagnosis: Rome IV Criteria -Related to defecation
-Change in stool frequency
-Change in stool form/appearance
Duration of IBS symptoms for Symptoms for 3 months, onset ≥6 months prior
diagnosis
-fair: more prevalent Caucasian
-fat: BMI >30 kg/m2 & HLD
Cholecystitis/cholelithiasis risk -female
factors -fertile: one or more children
-forty: age ≥40 years
-Onset: Acute mild to severe colicky epigastric or periumbilical
pain, vague at 1st
Appendicitis Classic Pain -Within 24 hrs: Localizes to RLQ
Pattern -Exacerbated by: Walking or coughing
-Radiation: To testicles in males
-May be associated with: Muscle spasms, rebound tenderness,
guarding, rigidity
/ 2/19
, 8/21/25, 7:45 PM NUR 500- Exam #3
-Pain precedes nausea & anorexia
-+/- Constipation or diarrhea
Appendicitis Associated
-Low-grade fever: 99-100°F (37-37.7°C)
Symptoms
-Pain may vary with appendix location (e.g., epigastrium, groin,
flank)
-Fever >102°F (38C)
-Findings of peritoneal inflammation
Signs of appendix rupture
-Pain lasting greater than 48 hours
-WBC >17,000 (or gangrene)
-Hypertension (due to pain)
Appendicitis vital signs
-Tachycardia (from fever)
Peritoneal inflammation with -referred pain (diagnostic signs)
appendicitis
Dullness on percussion with Abscess
appendicitis
1)Press LLQ-> RLQ pain
1) Rovsing
2) Extend right hip or resist hip flexion-> RLQ pain
2) Psoas
3) Flex/IR right hip-> RLQ pain
3) Obturator
4) Tender 1.5-2 in from anterior superior iliac
4) McBurney
5) Blumberg spine in a straight line to umbilicus->
point/localized tenderness
5) Rebound tenderness-> RLQ pain on release
Modified Alvarado score for -Max score is 9
appendicitis diagnosis -Score of 0-3: unlikely (work-up for other dx)
-Score of ≥4: further eval for appendicitis
/ 3/19
