NSG 6320 AGNP Board Exam – Gastroenterology
Assessment Exam
1. Question:
When percussing a protuberant abdomen, tympany is audible. This is
consistent with all of the following conditions except:
intestinal obstruction.
increased intestinal gas production.
a large solid tumor. Correct
a paralytic ileus.
Explanation:
A protuberant abdomen that is tympanic throughout when percussed can
suggest intestinal obstruction, increased gas production, or a paralytic ileus.
A solid mass gives a dull sound on percussion.
2. Question:
Stool that appears bloody, mucoid, or with pus, may indicate:
constipation.
a lesion in the sigmoid colon.
hemorrhoids.
Crohn's disease. Correct
Explanation:
Crohn's disease usually presents with blood, mucus, or pus in the stool. Thin,
pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid
colon. Constipation produces hard, dry stool. In the presence of hemorrhoids,
the stool may appear blood streaked.
3. Question:
A patient was recently diagnosed with gluten intolerance and needs
instructions on what foods to eat. The patient should be told that a gluten
restricted diet includes:
corn. Correct
wheat.
, barley.
rye.
Explanation:
A gluten-free diet is a diet that excludes the protein gluten. Gluten is found
in grains such as wheat, barley, rye and triticale (a cross between wheat and
rye). Corn and rice, and soybean products are allowed but processed foods
are not.
4. Question:
A patient presents with symptoms of bloody stools, new onset constipation,
and weight loss. These symptoms could be associated with:
hemorrhoids.
colon cancer. Correct
ischemic colitis.
adenomatous polyps.
Explanation:
Colon cancer can cause bloody stools but usually presents with changes in
bowel habits and weight loss. Lower abdominal pain accompanied by fever
or shock in older adults could be consistent with ischemic colitis. Generally,
the abdomen is soft on palpation. Hemorrhoids typically present with
noticeable blood on the tissue paper, surface of stool, or dripping in the
toilet. Blood in the stool is usually the only symptom seen with adenomatous
polyps.
5. Question:
Spider angiomas, palmar erythema, and Terry's nails can be associated with:
chronic renal failure.
leukemia.
liver disease. Correct
infective endocarditis.
Explanation:
Jaundice, spider angiomas and other telangiectasias, palmar erythema,
Terry’s nails, pruritus, purpura, and caput medusae are skin conditions
,associated with liver disease. These skin conditions are not seen in patients
who have chronic renal failure, leukemia, or infective carditis.
6. Question:
Which is NOT a mode of transmission for hepatitis C?
Intravenous (IV) drug use
Transfusion of unscreened blood
Sexual intercourse
Breast milk Correct
Explanation:
Hepatitis C is not spread through breast milk, food, water or by casual
contact such as hugging, kissing and sharing food or drinks with an infected
person. Hepatitis C is transmitted by intravenous drug use, sexual
intercourse, and transfusion of unscreened contaminated blood.
7. Question:
In the abdominal assessment of a 2-year-old, which one of the following
would be considered abnormal?
A pot belly.
Tinkling sounds audible every 10-20 seconds on auscultation.
The liver palpable 4 cm below the right costal margin (RCM). Correct
A palpable spleen 2 cm below the left costal margin (LCM).
Explanation:
The normal findings for a 2-year-old are a pot belly, spleen located 2 cm
below the LCM, and tinkling sounds heard every 10-30 seconds. The liver
should be approximately 1-3 cm palpable below the RCM; 4 cm is considered
abnormal.
8. Question:
Percussion of the abdomen should be avoided when:
trying to determine if the bladder is full.
trying to detect the size of an abdominal organ.
assessing for feces-filled intestines.
an abdominal aneurysm is suspected. Correct
, Explanation:
If an abdominal aneurysm is suspected, percussion of the abdomen could
cause the aneurysm to rupture, a catastrophic event. The finding of a
pulsatile mass in the center of the abdomen is highly suspicious of an
abdominal aneurysm. Listening with a stethoscope may also reveal a bruit
produced by turbulent blood flow within the aneurysm. Percussion is not a
contraindication for the other choices.
9. Question:
Abdominal percussion is performed to assess:
local inflammation.
generalized tenderness.
density of tissues and organs. Correct
size and placement of the kidneys.
Explanation:
Indirect percussion can be performed to evaluate borders and sizes of
abdominal organs and masses. Because percussion produces sounds of
varying loudness and pitch, these sounds can also assist in identifying
density of tissues and organs. Percussion could assess the size but palpation
determines the position.
10. Question:
When assessing the liver, have the patient inhale while palpating:
approximately 3 cm below the right costal region in the midclavicular
line. Correct
the lower left rib cage and adjacent soft tissue.
behind the patient just below and parallel to the twelve rib on the right
side.
deep in the left upper quadrant.
Explanation:
If the patient inhales, the liver can be palpated about 3 cm below the right
costal margin in the midclavicular line. The liver is not palpated posterior or
on the left side of the body.
Assessment Exam
1. Question:
When percussing a protuberant abdomen, tympany is audible. This is
consistent with all of the following conditions except:
intestinal obstruction.
increased intestinal gas production.
a large solid tumor. Correct
a paralytic ileus.
Explanation:
A protuberant abdomen that is tympanic throughout when percussed can
suggest intestinal obstruction, increased gas production, or a paralytic ileus.
A solid mass gives a dull sound on percussion.
2. Question:
Stool that appears bloody, mucoid, or with pus, may indicate:
constipation.
a lesion in the sigmoid colon.
hemorrhoids.
Crohn's disease. Correct
Explanation:
Crohn's disease usually presents with blood, mucus, or pus in the stool. Thin,
pencil-like stool occurs in an obstructing “apple-core” lesion of the sigmoid
colon. Constipation produces hard, dry stool. In the presence of hemorrhoids,
the stool may appear blood streaked.
3. Question:
A patient was recently diagnosed with gluten intolerance and needs
instructions on what foods to eat. The patient should be told that a gluten
restricted diet includes:
corn. Correct
wheat.
, barley.
rye.
Explanation:
A gluten-free diet is a diet that excludes the protein gluten. Gluten is found
in grains such as wheat, barley, rye and triticale (a cross between wheat and
rye). Corn and rice, and soybean products are allowed but processed foods
are not.
4. Question:
A patient presents with symptoms of bloody stools, new onset constipation,
and weight loss. These symptoms could be associated with:
hemorrhoids.
colon cancer. Correct
ischemic colitis.
adenomatous polyps.
Explanation:
Colon cancer can cause bloody stools but usually presents with changes in
bowel habits and weight loss. Lower abdominal pain accompanied by fever
or shock in older adults could be consistent with ischemic colitis. Generally,
the abdomen is soft on palpation. Hemorrhoids typically present with
noticeable blood on the tissue paper, surface of stool, or dripping in the
toilet. Blood in the stool is usually the only symptom seen with adenomatous
polyps.
5. Question:
Spider angiomas, palmar erythema, and Terry's nails can be associated with:
chronic renal failure.
leukemia.
liver disease. Correct
infective endocarditis.
Explanation:
Jaundice, spider angiomas and other telangiectasias, palmar erythema,
Terry’s nails, pruritus, purpura, and caput medusae are skin conditions
,associated with liver disease. These skin conditions are not seen in patients
who have chronic renal failure, leukemia, or infective carditis.
6. Question:
Which is NOT a mode of transmission for hepatitis C?
Intravenous (IV) drug use
Transfusion of unscreened blood
Sexual intercourse
Breast milk Correct
Explanation:
Hepatitis C is not spread through breast milk, food, water or by casual
contact such as hugging, kissing and sharing food or drinks with an infected
person. Hepatitis C is transmitted by intravenous drug use, sexual
intercourse, and transfusion of unscreened contaminated blood.
7. Question:
In the abdominal assessment of a 2-year-old, which one of the following
would be considered abnormal?
A pot belly.
Tinkling sounds audible every 10-20 seconds on auscultation.
The liver palpable 4 cm below the right costal margin (RCM). Correct
A palpable spleen 2 cm below the left costal margin (LCM).
Explanation:
The normal findings for a 2-year-old are a pot belly, spleen located 2 cm
below the LCM, and tinkling sounds heard every 10-30 seconds. The liver
should be approximately 1-3 cm palpable below the RCM; 4 cm is considered
abnormal.
8. Question:
Percussion of the abdomen should be avoided when:
trying to determine if the bladder is full.
trying to detect the size of an abdominal organ.
assessing for feces-filled intestines.
an abdominal aneurysm is suspected. Correct
, Explanation:
If an abdominal aneurysm is suspected, percussion of the abdomen could
cause the aneurysm to rupture, a catastrophic event. The finding of a
pulsatile mass in the center of the abdomen is highly suspicious of an
abdominal aneurysm. Listening with a stethoscope may also reveal a bruit
produced by turbulent blood flow within the aneurysm. Percussion is not a
contraindication for the other choices.
9. Question:
Abdominal percussion is performed to assess:
local inflammation.
generalized tenderness.
density of tissues and organs. Correct
size and placement of the kidneys.
Explanation:
Indirect percussion can be performed to evaluate borders and sizes of
abdominal organs and masses. Because percussion produces sounds of
varying loudness and pitch, these sounds can also assist in identifying
density of tissues and organs. Percussion could assess the size but palpation
determines the position.
10. Question:
When assessing the liver, have the patient inhale while palpating:
approximately 3 cm below the right costal region in the midclavicular
line. Correct
the lower left rib cage and adjacent soft tissue.
behind the patient just below and parallel to the twelve rib on the right
side.
deep in the left upper quadrant.
Explanation:
If the patient inhales, the liver can be palpated about 3 cm below the right
costal margin in the midclavicular line. The liver is not palpated posterior or
on the left side of the body.
