NR509 FINAL EXAM, NR 509 PRACTICE

NR509 FINAL EXAM, NR 509 PRACTICE

EXAM, ADVANCED PHYSI CAL

ASSESSMENT, NR509 QUESTIONS AND

ANSWERS, CHAMBERLAIN NR509,

NURSING EXAM PREP, CLINICAL

ASSESSMENT TEST

Question: An overweight 26-year-old public servant presents

to the Emergency Department 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?

• Ruptured tubal (or ectopic) pregnancy
• Acute cholecystitis
• Ruptured appendix

• Perforated bowel wall
• Ruptured ovarian cyst

Correct answer: a. Ruptured tubal (or ectopic) pregnancy

Question: 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 except 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 appointment and the clinician performs an abdominal exam to assess his liver. Which of the following findings would be most consistent with hepatomegaly?

• Liver span of 11 cm at the midclavicular line
• Liver span of 8 cm at the midsternal line
• Dullness to percussion over a span of 11 cm at the

midclavicular line

• Dullness to percussion over a span of 8 cm at the

midsternal line

• Liver palpable 3 cm below the right costal margin, mid

clavicular line, on expiration

Correct answer: e. Liver palpable 3 cm below the right costal

margin, mid clavicular line, on expiration

Question: A 63-year-old underweight administrative clerk

with a 50-pack-year smoking 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 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?

• Female gender
• History of smoking
• Underweight
• Family history of ruptured aneurysm
• Hypertension

Correct answer: b. History of smoking

Question: 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 subsequently 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?

• Do not screen routinely
• Continue annual FOBT screening until age 80 years
• Continue annual FOBT screening until age 85 years
• Repeat colonoscopy this year
• Sigmoidoscopy every 5 years with FOBT every 3 years

Correct answer: a. Do not screen routinely

Question: 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?