NUR 509 CH. 11 FINAL QUESTIONS AND ANSWERS
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking
urine when she coughs or sneezes. She says this has been going on for about a year
now. She relates that she has not had a period for 2 years. She denies any recent
illness or injuries. Her past medical history is significant for four spontaneous vaginal
deliveries. She is married and has four children. She denies alcohol, tobacco, or drug
use. During her pelvic examination you note some atrophic vaginal tissue, but the
remainder of her pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence - Answers - Ans: A
Stress incontinence usually occurs when the intra-abdominal pressure goes up during
coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery are
often associated with these symptoms. Usually female patients are postmenopausal
when stress incontinence begins. Kegel exercises are usually recommended to
strengthen the pelvic floor muscles.
2. A 46-year-old former salesman presents to the ER, complaining of black stools for
the past few weeks. His past medical history is significant for cirrhosis. He has gained
weight recently, especially around his abdomen. He has smoked two packs of cigarettes
a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25
years. He has used IV heroin and smoked crack in the past. He denies any recent use.
He is currently unemployed and has never been married. On examination you find a
man appearing older than his stated age. His skin has a yellowish tint and he is thin,
with a prominent abdomen. You note multiple "spider angiomas" at the base of his neck.
Otherwise, his heart and lung examinations are normal. On inspection he has dilated
veins around his umbilicus. Increased bowel sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in the epigastric area. -
Answers - Ans: C
Varices are often found in alcoholic patients, but only when they have a diagnosis of
significant cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites,
spider hemangiomas, and dilated veins on his abdomen (caput medusa).
3. A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She
states that the stools are very loose and there is some cramping beforehand. She states
this has occurred on and off since she was in high school. She denies any nausea,
vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is
rare. She thinks the diarrhea is much worse when she is nervous. Her past medical
history is not significant. She is single and a junior in college majoring in accounting.
She smokes when she drinks alcohol but denies using any illegal drugs. Both of her
parents are healthy. Her entire physical examination is unremarkable.
What is most likely the etiology of her diarrhea?
, A) Secretory infections
B) Inflammatory infections
C) Irritable bowel syndrome
D) Malabsorption syndrome - Answers - Ans: C
Irritable bowel syndrome will cause loose bowel movements with cramps but no
systemic symptoms of fever, weight loss, or malaise. This syndrome is more likely in
young women with alternating symptoms of loose stools and constipation. Stress
usually makes the symptoms worse, as do certain foods.
4. A 42-year-old florist comes to your office, complaining of chronic constipation for the
last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or
cramping. She denies any recent illnesses or injuries. She denies any changes to her
diet or exercise program. She is on no new medications. During the review of systems
you note that she has felt fatigued, had some weight gain, has irregular periods, and
has cold intolerance. Her past medical history is significant for one vaginal delivery and
two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has
coronary artery disease. There is no family history of cancers. On examination she
appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat,
and neck examinations are normal. Her cardiac, lung, and abdo - Answers - Ans: D
Many metabolic conditions can interfere with bowel motility. In this case the patient has
many symptoms of hypothyroidism, including cold intolerance, weight gain, fatigue,
constipation, and irregular menstrual cycles. On examination, thyromegaly and delayed
reflexes can help to make the diagnosis. Medication will usually correct these
symptoms.
5. A 22-year-old law student comes to your office, complaining of severe abdominal
pain radiating to his back. He states it began last night after hours of heavy drinking. He
has had abdominal pain and vomiting in the past after drinking but never as bad as this.
He cannot keep any food or water down, and these symptoms have been going on for
almost 12 hours. He has had no recent illnesses or injuries. His past medical history is
unremarkable. He denies smoking or using illegal drugs but admits to drinking 6 to 10
beers per weekend night. He admits that last night he drank something like 14 drinks.
On examination you find a young male appearing his stated age in some distress. He is
leaning over on the examination table and holding his abdomen with his arms. His blood
pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination
reveals normal bowel sounds, but he is very tender in the left upper - Answers - Ans: D
Acute pancreatitis causes epigastric and left upper quadrant pain and often radiates into
the back. There is often a history of long-standing gallbladder disease or recent alcohol
ingestion. Severe abdominal pain and vomiting are often seen. Medications such as
proton pump inhibitors can also cause pancreatitis in people without these other risk
factors. Treatment includes hydration, pain management, and bowel rest.
6. A 76-year-old retired farmer comes to your office complaining of abdominal pain,
constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting,
or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the
1. A 52-year-old secretary comes to your office, complaining about accidentally leaking
urine when she coughs or sneezes. She says this has been going on for about a year
now. She relates that she has not had a period for 2 years. She denies any recent
illness or injuries. Her past medical history is significant for four spontaneous vaginal
deliveries. She is married and has four children. She denies alcohol, tobacco, or drug
use. During her pelvic examination you note some atrophic vaginal tissue, but the
remainder of her pelvic, abdominal, and rectal examinations are unremarkable.
Which type of urinary incontinence does she have?
A) Stress incontinence
B) Urge incontinence
C) Overflow incontinence - Answers - Ans: A
Stress incontinence usually occurs when the intra-abdominal pressure goes up during
coughing, sneezing, or laughing. This is usually due to a weakness of the pelvic floor,
with inadequate muscle support of the bladder. Vaginal deliveries and pelvic surgery are
often associated with these symptoms. Usually female patients are postmenopausal
when stress incontinence begins. Kegel exercises are usually recommended to
strengthen the pelvic floor muscles.
2. A 46-year-old former salesman presents to the ER, complaining of black stools for
the past few weeks. His past medical history is significant for cirrhosis. He has gained
weight recently, especially around his abdomen. He has smoked two packs of cigarettes
a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25
years. He has used IV heroin and smoked crack in the past. He denies any recent use.
He is currently unemployed and has never been married. On examination you find a
man appearing older than his stated age. His skin has a yellowish tint and he is thin,
with a prominent abdomen. You note multiple "spider angiomas" at the base of his neck.
Otherwise, his heart and lung examinations are normal. On inspection he has dilated
veins around his umbilicus. Increased bowel sounds are heard during auscultation.
Palpation reveals diffuse tenderness that is more severe in the epigastric area. -
Answers - Ans: C
Varices are often found in alcoholic patients, but only when they have a diagnosis of
significant cirrhosis. This patient has symptoms of cirrhosis, including jaundice, ascites,
spider hemangiomas, and dilated veins on his abdomen (caput medusa).
3. A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She
states that the stools are very loose and there is some cramping beforehand. She states
this has occurred on and off since she was in high school. She denies any nausea,
vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is
rare. She thinks the diarrhea is much worse when she is nervous. Her past medical
history is not significant. She is single and a junior in college majoring in accounting.
She smokes when she drinks alcohol but denies using any illegal drugs. Both of her
parents are healthy. Her entire physical examination is unremarkable.
What is most likely the etiology of her diarrhea?
, A) Secretory infections
B) Inflammatory infections
C) Irritable bowel syndrome
D) Malabsorption syndrome - Answers - Ans: C
Irritable bowel syndrome will cause loose bowel movements with cramps but no
systemic symptoms of fever, weight loss, or malaise. This syndrome is more likely in
young women with alternating symptoms of loose stools and constipation. Stress
usually makes the symptoms worse, as do certain foods.
4. A 42-year-old florist comes to your office, complaining of chronic constipation for the
last 6 months. She has had no nausea, vomiting, or diarrhea and no abdominal pain or
cramping. She denies any recent illnesses or injuries. She denies any changes to her
diet or exercise program. She is on no new medications. During the review of systems
you note that she has felt fatigued, had some weight gain, has irregular periods, and
has cold intolerance. Her past medical history is significant for one vaginal delivery and
two cesarean sections. She is married, has three children, and owns a flower shop. She
denies tobacco, alcohol, or drug use. Her mother has type 2 diabetes and her father has
coronary artery disease. There is no family history of cancers. On examination she
appears her stated age. Her vital signs are normal. Her head, eyes, ears, nose, throat,
and neck examinations are normal. Her cardiac, lung, and abdo - Answers - Ans: D
Many metabolic conditions can interfere with bowel motility. In this case the patient has
many symptoms of hypothyroidism, including cold intolerance, weight gain, fatigue,
constipation, and irregular menstrual cycles. On examination, thyromegaly and delayed
reflexes can help to make the diagnosis. Medication will usually correct these
symptoms.
5. A 22-year-old law student comes to your office, complaining of severe abdominal
pain radiating to his back. He states it began last night after hours of heavy drinking. He
has had abdominal pain and vomiting in the past after drinking but never as bad as this.
He cannot keep any food or water down, and these symptoms have been going on for
almost 12 hours. He has had no recent illnesses or injuries. His past medical history is
unremarkable. He denies smoking or using illegal drugs but admits to drinking 6 to 10
beers per weekend night. He admits that last night he drank something like 14 drinks.
On examination you find a young male appearing his stated age in some distress. He is
leaning over on the examination table and holding his abdomen with his arms. His blood
pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination
reveals normal bowel sounds, but he is very tender in the left upper - Answers - Ans: D
Acute pancreatitis causes epigastric and left upper quadrant pain and often radiates into
the back. There is often a history of long-standing gallbladder disease or recent alcohol
ingestion. Severe abdominal pain and vomiting are often seen. Medications such as
proton pump inhibitors can also cause pancreatitis in people without these other risk
factors. Treatment includes hydration, pain management, and bowel rest.
6. A 76-year-old retired farmer comes to your office complaining of abdominal pain,
constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting,
or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the
