NR 509 Week 8 Latest Final EXAM (2025/2026)
QUESTIONS AND (elaborated) ANSWETRS WITH
COMPLETE SOLUTIONS
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Terms in this set (100)
,CHAPTER 19: Abdomen Ruptured tubal (or ectopic) pregnancy
An overweight 26-year-old Rationale: The constellation of abdominal pain, syncope,
public servant presents to the tachycardia, hypotension, positive β-hCG, and findings
Emergency Department with suggestive of peritoneal inflammation/irritation strongly
12 hours of intense abdominal suggest a ruptured ectopic pregnancy with significant intra-
pain, light-headedness, and a abdominal bleeding leading to peritoneal signs. This case is
fainting episode that finally emergent and requires immediate treatment of her
prompted her to seek medical hypotension and presumed blood loss as well as
attention. She has a strong gynecological consult for emergent surgery. Ruptured
family history of gallstones ectopic pregnancies can lead to life-threatening intra-
and is concerned about this abdominal bleeding. Although acute cholecystitis, ruptured
possibility. She has not had appendix, bowel wall perforation, and ruptured ovarian cyst
any vomiting or diarrhea. She are all possibilities, the positive β-hCG testing and her
had a normal bowel unstable vital signs make ruptured ectopic pregnancy more
movement this morning. Her likely.
β-human chorionic
gonadotropin (β-hCG) is
positive at triage. She reports
that her last periterm-12od
was 10 weeks ago. Her vital
signs at triage are pulse, 118;
blood pressure, 86/68;
respiratory rate, 20/min;
oxygen saturation, 99%; and
temperature, 37.3ºC orally.
The clinician performs an
abdominal exam prior to her
pelvic exam and, on palpation
of her abdomen, finds
involuntary rigidity and
rebound tenderness. What is
the most likely diagnosis?
,CHAPTER 19: Abdomen Liver palpable 3 cm below the right costal margin, mid
A 63-year-old janitor with a clavicular line, on expiration
history of adenomatous
colonic polyps presents for a Rationale: The liver being palpable 3 cm below the right
well visit. Basic labs are costal margin, midclavicular line, would be considered
performed to screen for normal on inspiration when the liver is pushed down into the
diabetes mellitus and abdominal cavity on inspiration, but is abnormal on
dyslipidemia. Electrolytes and expiration. Findings to support hepatomegaly would be
liver enzymes were also more convincing if, by percussion, the liver span was >12 cm
measured. His labs are all at the midclavicular line. For patients with obstructive lung
normal expect for moderate disease, air trapping in the lungs may displace the liver
elevations of aspartate downwards into the abdominal cavity. The liver span and
aminotransferase, alanine dullness to percussion refer to the same measurement.
aminotransferase, γ-glutamyl Measurements of 6-12 cm at the mid-clavicular line and 4-8
transferase, and alkaline cm at the midsternal line are considered normal.
phosphatase as well as a
mildly elevated total bilirubin.
He presents for a follow-up
appointment and the clinician
performs an abdominal exam
to assess his liver. Which of
the following findings would
be most consistent with
hepatomegaly?
, CHAPTER 19: Abdomen History of smoking
A 63-year-old underweight
administrative clerk with a 50- Rationale: History of smoking is her most significant risk
pack-year smoking history factor for an AAA. Male gender, not female gender, is
presents with a several month considered as risk factor. Underweight is not a risk factor for
history of recurrent epigastric AAA. Family history of ruptured aneurysm is vague and
abdominal discomfort. She could be a cerebral aneurysm. Further, her family history is in
feels fairly well otherwise and a first-degree cousin not a first-degree relative (biologic
denies any nausea, vomiting, parents, siblings, and children). Hypertension could
diarrhea, or constipation. She contribute to atherosclerosis, which is a risk factor. Further, a
reports that a first cousin died diagnosis of hypertension is not based on one elevated
from a ruptured aneurysm at blood pressure reading.
age 68 years. Her vital signs
are pulse, 86; blood pressure,
148/92; respiratory rate, 16;
oxygen saturation, 95%; and
temperature, 36.2ºC. Her
body mass index is 17.6. On
exam, her abdominal aorta is
prominent, which is
concerning for an abdominal
aortic aneurysm (AAA). Which
of the following is her most
significant risk factor for an
AAA?
QUESTIONS AND (elaborated) ANSWETRS WITH
COMPLETE SOLUTIONS
Save
Terms in this set (100)
,CHAPTER 19: Abdomen Ruptured tubal (or ectopic) pregnancy
An overweight 26-year-old Rationale: The constellation of abdominal pain, syncope,
public servant presents to the tachycardia, hypotension, positive β-hCG, and findings
Emergency Department with suggestive of peritoneal inflammation/irritation strongly
12 hours of intense abdominal suggest a ruptured ectopic pregnancy with significant intra-
pain, light-headedness, and a abdominal bleeding leading to peritoneal signs. This case is
fainting episode that finally emergent and requires immediate treatment of her
prompted her to seek medical hypotension and presumed blood loss as well as
attention. She has a strong gynecological consult for emergent surgery. Ruptured
family history of gallstones ectopic pregnancies can lead to life-threatening intra-
and is concerned about this abdominal bleeding. Although acute cholecystitis, ruptured
possibility. She has not had appendix, bowel wall perforation, and ruptured ovarian cyst
any vomiting or diarrhea. She are all possibilities, the positive β-hCG testing and her
had a normal bowel unstable vital signs make ruptured ectopic pregnancy more
movement this morning. Her likely.
β-human chorionic
gonadotropin (β-hCG) is
positive at triage. She reports
that her last periterm-12od
was 10 weeks ago. Her vital
signs at triage are pulse, 118;
blood pressure, 86/68;
respiratory rate, 20/min;
oxygen saturation, 99%; and
temperature, 37.3ºC orally.
The clinician performs an
abdominal exam prior to her
pelvic exam and, on palpation
of her abdomen, finds
involuntary rigidity and
rebound tenderness. What is
the most likely diagnosis?
,CHAPTER 19: Abdomen Liver palpable 3 cm below the right costal margin, mid
A 63-year-old janitor with a clavicular line, on expiration
history of adenomatous
colonic polyps presents for a Rationale: The liver being palpable 3 cm below the right
well visit. Basic labs are costal margin, midclavicular line, would be considered
performed to screen for normal on inspiration when the liver is pushed down into the
diabetes mellitus and abdominal cavity on inspiration, but is abnormal on
dyslipidemia. Electrolytes and expiration. Findings to support hepatomegaly would be
liver enzymes were also more convincing if, by percussion, the liver span was >12 cm
measured. His labs are all at the midclavicular line. For patients with obstructive lung
normal expect for moderate disease, air trapping in the lungs may displace the liver
elevations of aspartate downwards into the abdominal cavity. The liver span and
aminotransferase, alanine dullness to percussion refer to the same measurement.
aminotransferase, γ-glutamyl Measurements of 6-12 cm at the mid-clavicular line and 4-8
transferase, and alkaline cm at the midsternal line are considered normal.
phosphatase as well as a
mildly elevated total bilirubin.
He presents for a follow-up
appointment and the clinician
performs an abdominal exam
to assess his liver. Which of
the following findings would
be most consistent with
hepatomegaly?
, CHAPTER 19: Abdomen History of smoking
A 63-year-old underweight
administrative clerk with a 50- Rationale: History of smoking is her most significant risk
pack-year smoking history factor for an AAA. Male gender, not female gender, is
presents with a several month considered as risk factor. Underweight is not a risk factor for
history of recurrent epigastric AAA. Family history of ruptured aneurysm is vague and
abdominal discomfort. She could be a cerebral aneurysm. Further, her family history is in
feels fairly well otherwise and a first-degree cousin not a first-degree relative (biologic
denies any nausea, vomiting, parents, siblings, and children). Hypertension could
diarrhea, or constipation. She contribute to atherosclerosis, which is a risk factor. Further, a
reports that a first cousin died diagnosis of hypertension is not based on one elevated
from a ruptured aneurysm at blood pressure reading.
age 68 years. Her vital signs
are pulse, 86; blood pressure,
148/92; respiratory rate, 16;
oxygen saturation, 95%; and
temperature, 36.2ºC. Her
body mass index is 17.6. On
exam, her abdominal aorta is
prominent, which is
concerning for an abdominal
aortic aneurysm (AAA). Which
of the following is her most
significant risk factor for an
AAA?
