NR 509 FINAL EXAM STUDY GUIDE 2026 ALL
QUESTIONS AND CORRECT DETAILED ANSWERS
ALREADY A GRADED WIT EXPERT FEEDBACK |NEW
AND REVISED
1. Chapter 19: Abdomen: ...
2. An overweight 26-year-old public servant presents to the Emergency De-partment
with 12 hours of intense abdominal pain, light-headedness, and a fainting episode
that finally prompted her to seek medical attention. She has a strong family history
of gallstones and is concerned about this possibility. She has not had any vomiting or
diarrhea. She had a normal bowel movement this morning. Her β-human chorionic
gonadotropin (β-hCG) is positive at triage. She reports that her last period 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?: a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
3. A 63-year-old janitor with a history of adenomatous colonic polyps presents for a
well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect
for moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-
glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appoint-ment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most
consistent with hepatomegaly?: a. Liver span of 11 cm at the midclavicular line
,b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
4. A 63-year-old underweight administrative clerk with a 50-pack-year smok-ing
history presents with a several month history of recurrent epigastric
,abdominal discomfort. She feels fairly well otherwise and denies any nausea,
vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure,
148/92; respiratory rate, 16; oxygen saturation, 95%; and temper-ature, 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?: a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
5. A 76-year-old retired man with a history of prostate cancer and hypertension has
been screened annually for colon cancer using high sensitivity fecal occult blood
testing (FOBT). He presents for follow-up of his hypertension, during which the
clinician scans his chart to ensure he is up to date with his preventive health care. He has
a positive FOBT on one occasion at age 66 years and subse-quently went for a
colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of colorectal cancer or
adenomatous polyps. What are the U.S. Preventive Services Task Force (USPSTF)
screening recommendations for this patient?: a.
Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
6. An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a
3-year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks
each episode and is associated with onset of constipation. She describes infrequent,
small hard stool that she finds very difficult to pass. She has tried to increase
dietary fiber and water intake, but usually this is not
, sufficient and she resorts to over-the-counter laxatives, which she finds upset her
stomach but do resolve the constipation. Symptoms typically gradually resolve with
bowel movements. Which of the following is the most likely physiological mechanism
for her constipation?: a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
7. A 23-year-old woman comes to the respirology clinic for follow-up of her chronic
sinusitis and bronchiectasis that is associated with a rare congenital condition called
Kartagener syndrome. The preceptor notes that she has situs inversus and asks for a
physical exam. Which of the following descriptions best fits with findings on the abdominal
exam?: a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to chronic obstructive
pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
8. An otherwise healthy 28-year-old lawyer presents to the Emergency Depart-ment
with a 1-day history of severe abdominal pain. The emergency physician suspects
appendicitis and general surgery is consulted. The resident believes the patient has
signs of peritonitis on exam. Which of the following physical exam findings supports
peritonitis?: a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous process on a line drawn from
the umbilicus
e. Pain with internal rotation of the right hip
9. A 58-year-old man with a history of diabetes and alcohol addiction has been sober
for the last 10 months. He presents with a 4-month history of increasing
QUESTIONS AND CORRECT DETAILED ANSWERS
ALREADY A GRADED WIT EXPERT FEEDBACK |NEW
AND REVISED
1. Chapter 19: Abdomen: ...
2. An overweight 26-year-old public servant presents to the Emergency De-partment
with 12 hours of intense abdominal pain, light-headedness, and a fainting episode
that finally prompted her to seek medical attention. She has a strong family history
of gallstones and is concerned about this possibility. She has not had any vomiting or
diarrhea. She had a normal bowel movement this morning. Her β-human chorionic
gonadotropin (β-hCG) is positive at triage. She reports that her last period 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?: a. Ruptured tubal (or ectopic) pregnancy
b. Acute cholecystitis
c. Ruptured appendix
d. Perforated bowel wall
e. Ruptured ovarian cyst
3. A 63-year-old janitor with a history of adenomatous colonic polyps presents for a
well visit. Basic labs are performed to screen for diabetes mellitus and dyslipidemia.
Electrolytes and liver enzymes were also measured. His labs are all normal expect
for moderate elevations of aspartate aminotransferase, alanine aminotransferase, γ-
glutamyl transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appoint-ment and the clinician performs an
abdominal exam to assess his liver. Which of the following findings would be most
consistent with hepatomegaly?: a. Liver span of 11 cm at the midclavicular line
,b. Liver span of 8 cm at the midsternal line
c. Dullness to percussion over a span of 11 cm at the midclavicular line
d. Dullness to percussion over a span of 8 cm at the midsternal line
e. Liver palpable 3 cm below the right costal margin, mid clavicular line, on expiration
4. A 63-year-old underweight administrative clerk with a 50-pack-year smok-ing
history presents with a several month history of recurrent epigastric
,abdominal discomfort. She feels fairly well otherwise and denies any nausea,
vomiting, diarrhea, or constipation. She reports that a first cousin died from a
ruptured aneurysm at age 68 years. Her vital signs are pulse, 86; blood pressure,
148/92; respiratory rate, 16; oxygen saturation, 95%; and temper-ature, 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?: a. Female gender
b. History of smoking
c. Underweight
d. Family history of ruptured aneurysm
e. Hypertension
5. A 76-year-old retired man with a history of prostate cancer and hypertension has
been screened annually for colon cancer using high sensitivity fecal occult blood
testing (FOBT). He presents for follow-up of his hypertension, during which the
clinician scans his chart to ensure he is up to date with his preventive health care. He has
a positive FOBT on one occasion at age 66 years and subse-quently went for a
colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found on
colonoscopy. He has no first-degree relatives with a history of colorectal cancer or
adenomatous polyps. What are the U.S. Preventive Services Task Force (USPSTF)
screening recommendations for this patient?: a.
Do not screen routinely
b. Continue annual FOBT screening until age 80 years
c. Continue annual FOBT screening until age 85 years
d. Repeat colonoscopy this year
e. Sigmoidoscopy every 5 years with FOBT every 3 years
Submit
6. An otherwise healthy 31-year-old accountant presents to an outpatient clinic with a
3-year history of recurrent crampy abdominal pain that lasts for about 1-2 weeks
each episode and is associated with onset of constipation. She describes infrequent,
small hard stool that she finds very difficult to pass. She has tried to increase
dietary fiber and water intake, but usually this is not
, sufficient and she resorts to over-the-counter laxatives, which she finds upset her
stomach but do resolve the constipation. Symptoms typically gradually resolve with
bowel movements. Which of the following is the most likely physiological mechanism
for her constipation?: a. A large, firm fecal mass in the rectum
b. Decreased fecal bulk
c. Functional change in bowel movement
d. Spasm of the external sphincter
e. Impairment of autonomic innervations
7. A 23-year-old woman comes to the respirology clinic for follow-up of her chronic
sinusitis and bronchiectasis that is associated with a rare congenital condition called
Kartagener syndrome. The preceptor notes that she has situs inversus and asks for a
physical exam. Which of the following descriptions best fits with findings on the abdominal
exam?: a. Tympany to percussion in the right upper quadrant, dullness to percussion of the left upper quadrant
b. Protuberant abdomen that has scattered areas of tympany and dullness; stool is felt on palpation
c. Liver dullness in the right upper quadrant that is displaced downward by the low diaphragm due to chronic obstructive
pulmonary disease
d. Dullness to percussion of the left lower anterior chest wall roughly at the anterior axillary line
e. A change in percussion from tympany to dullness in the left lower anterior chest wall on inspiration
8. An otherwise healthy 28-year-old lawyer presents to the Emergency Depart-ment
with a 1-day history of severe abdominal pain. The emergency physician suspects
appendicitis and general surgery is consulted. The resident believes the patient has
signs of peritonitis on exam. Which of the following physical exam findings supports
peritonitis?: a. Voluntary contraction of the abdominal wall that persists over several examinations
b. Pressing down onto the abdomen firmly and slowly and withdrawing the hand quickly produces pain
c. Abdominal pain that increases with hip flexion
d. Localized pain over McBurney point, which lies 2 inches from the anterior superior iliac spinous process on a line drawn from
the umbilicus
e. Pain with internal rotation of the right hip
9. A 58-year-old man with a history of diabetes and alcohol addiction has been sober
for the last 10 months. He presents with a 4-month history of increasing
