NRNP 6541 WEEK 7 – COURTNEY
GRAHAM GI CASE: COMPREHENSIVE
EXAM LATEST UPDATE 2026
SECTION 1: HISTORY TAKING (Questions 1–20)
Question 1
A 16-year-old female presents with nausea, vomiting, diarrhea, and
abdominal cramps for 24 hours. What is the FIRST question you should
ask?
A) “Have you eaten any raw seafood?”
B) “When was your last menstrual period?”
C) “Do you have a fever?”
D) “Have you traveled recently?”
Answer: B
Rationale: In any menstruating female with nausea/vomiting/abdominal
pain, pregnancy must be ruled out immediately before proceeding with
other history or diagnostics. Ectopic pregnancy can present with GI
symptoms.
Question 2
Which symptom in the history is MORE consistent with viral
,gastroenteritis than appendicitis?
A) Pain localized to the right lower quadrant
B) Diarrhea preceding the onset of pain
C) Anorexia
D) Pain that worsens with coughing
Answer: B
Rationale: Viral gastroenteritis often presents with diarrhea before or
simultaneously with abdominal pain. Appendicitis typically presents with
periumbilical pain that migrates to RLQ, followed by vomiting and
anorexia; diarrhea is uncommon early.
Question 3
The patient reports eating a chicken sandwich from the school
cafeteria 18 hours ago. Which pathogen is most likely?
A) Staphylococcus aureus
B) Clostridium perfringens
C) Salmonella species
D) Norovirus
Answer: C
Rationale: Salmonella has an incubation period of 6–72 hours
(commonly 12–36 hours) and is strongly associated with undercooked
poultry. S. aureus onset is 2–8 hours; C. perfringens 8–16 hours;
norovirus 12–48 hours but more commonly associated with person-to-
person spread.
,Question 4
How many episodes of vomiting in 24 hours suggests moderate
dehydration in an adolescent?
A) 1–2
B) 3–4
C) 5–6
D) >6
Answer: D
Rationale: More than 6 episodes of vomiting or diarrhea in 24 hours
significantly increases the risk of moderate-to-severe dehydration,
especially when combined with poor oral intake.
Question 5
The patient is sexually active with condoms and oral contraceptive pills
(OCPs). Which statement is correct?
A) OCPs prevent pregnancy completely
B) Condoms alone are 99% effective with perfect use
C) OCPs do not protect against STIs
D) Pregnancy test is unnecessary if she uses OCPs
Answer: C
Rationale: OCPs provide no protection against sexually transmitted
infections. Condoms reduce STI risk but are not 100% effective.
Pregnancy is still possible with OCPs, especially with missed doses or
vomiting.
, Question 6
A history of sick contacts is most helpful in identifying which cause?
A) Salmonella food poisoning
B) Norovirus
C) C. difficile colitis
D) Appendicitis
Answer: B
Rationale: Norovirus is highly contagious and spreads via person-to-
person contact, so sick contacts (family, classmates) support the
diagnosis. Food poisoning is more sporadic.
Question 7
Which question best screens for possible appendicitis?
A) “Does the pain wake you up at night?”
B) “Did the pain start around your belly button and move to the lower
right?”
C) “Do you have heartburn?”
D) “Is the pain relieved by eating?”
Answer: B
Rationale: Classic migratory pain from periumbilical to RLQ is
characteristic of appendicitis, occurring in 50-60% of cases.
Question 8
What is the significance of asking about blood in the stool?
A) Blood rules out viral gastroenteritis
B) Blood indicates need for immediate colectomy
GRAHAM GI CASE: COMPREHENSIVE
EXAM LATEST UPDATE 2026
SECTION 1: HISTORY TAKING (Questions 1–20)
Question 1
A 16-year-old female presents with nausea, vomiting, diarrhea, and
abdominal cramps for 24 hours. What is the FIRST question you should
ask?
A) “Have you eaten any raw seafood?”
B) “When was your last menstrual period?”
C) “Do you have a fever?”
D) “Have you traveled recently?”
Answer: B
Rationale: In any menstruating female with nausea/vomiting/abdominal
pain, pregnancy must be ruled out immediately before proceeding with
other history or diagnostics. Ectopic pregnancy can present with GI
symptoms.
Question 2
Which symptom in the history is MORE consistent with viral
,gastroenteritis than appendicitis?
A) Pain localized to the right lower quadrant
B) Diarrhea preceding the onset of pain
C) Anorexia
D) Pain that worsens with coughing
Answer: B
Rationale: Viral gastroenteritis often presents with diarrhea before or
simultaneously with abdominal pain. Appendicitis typically presents with
periumbilical pain that migrates to RLQ, followed by vomiting and
anorexia; diarrhea is uncommon early.
Question 3
The patient reports eating a chicken sandwich from the school
cafeteria 18 hours ago. Which pathogen is most likely?
A) Staphylococcus aureus
B) Clostridium perfringens
C) Salmonella species
D) Norovirus
Answer: C
Rationale: Salmonella has an incubation period of 6–72 hours
(commonly 12–36 hours) and is strongly associated with undercooked
poultry. S. aureus onset is 2–8 hours; C. perfringens 8–16 hours;
norovirus 12–48 hours but more commonly associated with person-to-
person spread.
,Question 4
How many episodes of vomiting in 24 hours suggests moderate
dehydration in an adolescent?
A) 1–2
B) 3–4
C) 5–6
D) >6
Answer: D
Rationale: More than 6 episodes of vomiting or diarrhea in 24 hours
significantly increases the risk of moderate-to-severe dehydration,
especially when combined with poor oral intake.
Question 5
The patient is sexually active with condoms and oral contraceptive pills
(OCPs). Which statement is correct?
A) OCPs prevent pregnancy completely
B) Condoms alone are 99% effective with perfect use
C) OCPs do not protect against STIs
D) Pregnancy test is unnecessary if she uses OCPs
Answer: C
Rationale: OCPs provide no protection against sexually transmitted
infections. Condoms reduce STI risk but are not 100% effective.
Pregnancy is still possible with OCPs, especially with missed doses or
vomiting.
, Question 6
A history of sick contacts is most helpful in identifying which cause?
A) Salmonella food poisoning
B) Norovirus
C) C. difficile colitis
D) Appendicitis
Answer: B
Rationale: Norovirus is highly contagious and spreads via person-to-
person contact, so sick contacts (family, classmates) support the
diagnosis. Food poisoning is more sporadic.
Question 7
Which question best screens for possible appendicitis?
A) “Does the pain wake you up at night?”
B) “Did the pain start around your belly button and move to the lower
right?”
C) “Do you have heartburn?”
D) “Is the pain relieved by eating?”
Answer: B
Rationale: Classic migratory pain from periumbilical to RLQ is
characteristic of appendicitis, occurring in 50-60% of cases.
Question 8
What is the significance of asking about blood in the stool?
A) Blood rules out viral gastroenteritis
B) Blood indicates need for immediate colectomy
