NR 511 final exam QUESTIONS &
SOLUTIONS
mesenteric infarction - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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) - ANSWERPatient 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) - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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) - ANSWERPatient 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) - ANSWERPatient 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 - ANSWERThis 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 - ANSWERPatient 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 - ANSWERPatient 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
Appendicitis - ANSWERPatient will present with epigastrium or Peri umbilical pain later
may turn into right lower quadrant pain. Pain starts as a cute visceral progressing to
parietal. May present with vomiting, fever, constipation; pain is worse with movement
SOLUTIONS
mesenteric infarction - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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) - ANSWERPatient 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) - ANSWERPatient 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 - ANSWERPatient 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 - ANSWERPatient 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) - ANSWERPatient 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) - ANSWERPatient 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 - ANSWERThis 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 - ANSWERPatient 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 - ANSWERPatient 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
Appendicitis - ANSWERPatient will present with epigastrium or Peri umbilical pain later
may turn into right lower quadrant pain. Pain starts as a cute visceral progressing to
parietal. May present with vomiting, fever, constipation; pain is worse with movement
