NUR611/NUR 611 Exam 4 V3 | Adv
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 45-year-old male presents with sudden onset of severe epigastric pain that radiates to
his back, accompanied by nausea and vomiting. Which diagnostic test is most specific for
confirming a diagnosis of acute pancreatitis?
A. The serum amylase level is the most specific marker.
B. A plain abdominal X-ray is the most specific test.
C. The serum lipase level is the most specific marker.
D. The white blood cell count is the most specific indicator.
Correct Answer: C
Expert Explanation: Serum lipase is more specific than amylase for the diagnosis of acute
pancreatitis because it remains elevated longer and is primarily produced by the pancreas.
While amylase rises quickly, it can be elevated in other conditions such as mumps or bowel
obstruction. Lipase levels greater than three times the upper limit of normal are highly
suggestive of pancreatic inflammation.
2. Which physical examination maneuver is specifically used to assess for acute cholecystitis?
A. Performing the McBurney’s point palpation.
B. Assessing for a positive Murphy’s sign.
,C. Checking for a positive Rovsing’s sign.
D. Testing for the Psoas sign.
Correct Answer: B
Expert Explanation: Murphy’s sign is performed by asking the patient to inhale while the
clinician applies pressure to the right upper quadrant. If the patient experiences a sudden
cessation of inspiration due to pain when the gallbladder contacts the examiner’s hand, the
sign is positive. This maneuver is highly associated with inflammation of the gallbladder,
known as cholecystitis.
3. A patient presents with symptoms of Gastroesophageal Reflux Disease (GERD) that have
not responded to twice-daily proton pump inhibitors (PPIs) for 8 weeks. What is the next
most appropriate step in management?
A. The patient should be referred for an upper endoscopy (EGD).
B. The patient should double the current PPI dose.
C. The clinician should switch the patient to an H2 blocker.
D. The patient should begin a strict clear liquid diet.
Correct Answer: A
Expert Explanation: Refractory GERD that does not respond to standard PPI therapy
warrants further investigation to rule out complications like Barrett’s esophagus or
eosinophilic esophagitis. An upper endoscopy allows for direct visualization of the
, esophageal mucosa and the ability to take biopsies if necessary. Persistent symptoms
despite treatment are considered a ‘red flag’ or an indication for diagnostic imaging.
4. A 65-year-old patient reports a change in bowel habits and thin, pencil-like stools over the
last three months. What is the primary concern for the nurse practitioner?
A. The primary concern is irritable bowel syndrome.
B. The primary concern is an internal hemorrhoid.
C. The primary concern is chronic constipation from low fiber.
D. The primary concern is a possible colorectal malignancy.
Correct Answer: D
Expert Explanation: Changes in stool caliber, particularly ‘pencil stools,’ are classic
warning signs for a distal colonic lesion or colorectal cancer. At age 65, any significant
change in bowel habits must be treated as a potential malignancy until proven otherwise. A
colonoscopy is the gold standard for evaluating these symptoms and screening for colon
cancer.
5. Which of the following is the most common cause of small bowel obstruction in adults in
the United States?
A. The most common cause is incarcerated hernias.
B. The most common cause is postoperative adhesions.
C. The most common cause is malignant tumors.
Practice Nursing I Q&A with Rationale |
William Paterson University
1. A 45-year-old male presents with sudden onset of severe epigastric pain that radiates to
his back, accompanied by nausea and vomiting. Which diagnostic test is most specific for
confirming a diagnosis of acute pancreatitis?
A. The serum amylase level is the most specific marker.
B. A plain abdominal X-ray is the most specific test.
C. The serum lipase level is the most specific marker.
D. The white blood cell count is the most specific indicator.
Correct Answer: C
Expert Explanation: Serum lipase is more specific than amylase for the diagnosis of acute
pancreatitis because it remains elevated longer and is primarily produced by the pancreas.
While amylase rises quickly, it can be elevated in other conditions such as mumps or bowel
obstruction. Lipase levels greater than three times the upper limit of normal are highly
suggestive of pancreatic inflammation.
2. Which physical examination maneuver is specifically used to assess for acute cholecystitis?
A. Performing the McBurney’s point palpation.
B. Assessing for a positive Murphy’s sign.
,C. Checking for a positive Rovsing’s sign.
D. Testing for the Psoas sign.
Correct Answer: B
Expert Explanation: Murphy’s sign is performed by asking the patient to inhale while the
clinician applies pressure to the right upper quadrant. If the patient experiences a sudden
cessation of inspiration due to pain when the gallbladder contacts the examiner’s hand, the
sign is positive. This maneuver is highly associated with inflammation of the gallbladder,
known as cholecystitis.
3. A patient presents with symptoms of Gastroesophageal Reflux Disease (GERD) that have
not responded to twice-daily proton pump inhibitors (PPIs) for 8 weeks. What is the next
most appropriate step in management?
A. The patient should be referred for an upper endoscopy (EGD).
B. The patient should double the current PPI dose.
C. The clinician should switch the patient to an H2 blocker.
D. The patient should begin a strict clear liquid diet.
Correct Answer: A
Expert Explanation: Refractory GERD that does not respond to standard PPI therapy
warrants further investigation to rule out complications like Barrett’s esophagus or
eosinophilic esophagitis. An upper endoscopy allows for direct visualization of the
, esophageal mucosa and the ability to take biopsies if necessary. Persistent symptoms
despite treatment are considered a ‘red flag’ or an indication for diagnostic imaging.
4. A 65-year-old patient reports a change in bowel habits and thin, pencil-like stools over the
last three months. What is the primary concern for the nurse practitioner?
A. The primary concern is irritable bowel syndrome.
B. The primary concern is an internal hemorrhoid.
C. The primary concern is chronic constipation from low fiber.
D. The primary concern is a possible colorectal malignancy.
Correct Answer: D
Expert Explanation: Changes in stool caliber, particularly ‘pencil stools,’ are classic
warning signs for a distal colonic lesion or colorectal cancer. At age 65, any significant
change in bowel habits must be treated as a potential malignancy until proven otherwise. A
colonoscopy is the gold standard for evaluating these symptoms and screening for colon
cancer.
5. Which of the following is the most common cause of small bowel obstruction in adults in
the United States?
A. The most common cause is incarcerated hernias.
B. The most common cause is postoperative adhesions.
C. The most common cause is malignant tumors.
