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Abdominal Problems Flashcards

1
Q 
1
1.	A 35-year-old female patient is seen in the clinic complaining of abdominal pain. Which of the following should be included in the history and physical examination?
a.
Digital rectal exam
b.
Pelvic exam
c.
Sexual history
d.
All of the above
A

1
1. ANS: D PTS: 1

all of the above
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2
Q 
\_\_\_\_	2.	A patient comes to the office complaining of constipation. The patient lists all of the following medications. Which drug could be responsible for the constipation?
a.
Multivitamin
b.
Magnesium hydroxide
c.
Pepto-Bismol®
d.
Ibuprofen
A
  1. ANS: C PTS: 1pepto bismol
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3
Q

3

\_\_\_\_	3.	A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis?
a.
Gastroenteritis
b.
Inflammatory bowel disease
c.
Lactase deficiency
d.
All of the above
A
  1. ANS: D PTS: 1

All of the above

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4
Q
  1. Mr. J. K., 38 years old, is 5 feet 8 inches tall and weighs 189 pounds. He reports that he has had intermittent heartburn for several months and takes Tums® with temporary relief. He has been waking during the night with a burning sensation in his chest. Which additional information would lead you to believe that gastroesophageal reflux disease (GERD) is the cause of his pain?
    a.
    The pain seems better when he smokes to relieve his nerves.
    b.
    Coffee and fried foods don’t bother him,
    c.
    He wakes at night coughing with a bad taste in his mouth.
    d.
    All of the above
\_\_\_\_	5.	A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
a.
His gender
b.
His age
c.
His use of Alka-Seltzer
d.
His ethnic origin
A
  1. ANS: C PTS: 1He wakes at night coughing with a bad taste in his mouth.
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5
Q 
_	5.	A 29-year-old Englishman is seen in the office with complaints of pain in his chest and belly. He has been suffering the pain for 2 weeks and gets temporary relief from Alka-Seltzer®. The burning pain wakes him at night and radiates up to his chest. Which factor favors a diagnosis of gastric ulcer?
a.
His gender
b.
His age
c.
His use of Alka-Seltzer
d.
His ethnic origin
A
  1. ANS: C

His use of Alka-Seltzer

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6
Q
  1. Which of the following is most effective in diagnosing appendicitis?

History and physical.
Sedimentation rate.
Kidney, ureter, and bladder x-ray.
CBC with differential is

A
  1. A. History and physical
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7
Q

***Which of the following is associated with celiac disease or celiac sprue?

Malabsorption.
Constipation.
Rectal bleeding.
Esophageal ulceration.

A
  1. A. Malabsorption
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8
Q

A 45-year-old patient presents with a chief complaint of generalized abdominal pain. Her physical exam is remarkable for left lower quadrant tenderness. At this time which of the following should be considered in the differential diagnoses?

Endometriosis.
Colon cancer.
Diverticulitis.
All of the above.

A

8 . D. All of the above

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9
Q

A 46-year-old patient is seen in the clinic with abdominal pain. Which of the following tests is essential for this patient?

CBC with differential.
Urine HCG.
Barium enema.
CT of the abdomen

A
  1. B. Urine human chorionic gonadotropin
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10
Q

A 25 year old accountant is seen in the clinic complaining of crampy abdominal pain after meals. She is often constipated and takes laxatives, which are followed by couple of days of diarrhea. She temporarily feels better after bowel movement. She states she is embarrassed by flatulence and has abdominal distention. She has no weight loss or blood in her stool. This problem has going on for about six months. What should the next step be?

Obtain a complete history.
Order a barium enema.
Schedule of Bernstein’s test.
Prescribe a trial of anti-spasmodic’s.

A
  1. A. Obtain a complete history
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11
Q

A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals. She has frequent constipation, flatulence, and of Domino distention. Which of the data make a diagnosis of diverticulitis unlikely?

Her age.
Frequent constipation.
Flatulence.
Colicky abdominal pain

A
  1. A. Her age
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12
Q

A 28-year-old patient is seen with complaints of diarrhea. Which of the following part of the history questions would help the primary care physician establish the diagnosis of irritable bowel syndrome?

Feels relief after a bowel movement.
Sometimes is constipated.
Does not defecate in the middle of the night.
All of the above

A
  1. D. All of the above
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13
Q

A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett’s epithelium. Which of the following should the PCP include in the Explanation of the pathology report?

This is a pre-malignant tissue.
This tissue is resistant to gastric acid.
This tissue supports healing of the esophagus.
All of the above

A
  1. D. All of the above
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14
Q

Which of the following dietary instructions should be given to a patient with GERD?

Eliminate coffee.
Drink peppermint tea to relieve stomach distress.
Recline and rest after meals.
Limit the amount of antacids.

A
  1. A. Eliminate coffee
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15
Q

The patient with GERD should be instructed to illuminate which of these activities?

Swimming
Weightlifting
Golfing
Walking

A
  1. B. Weight lifting
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16
Q

A patient is diagnosed with giardia after a backpacking trip in the mountains. Which of the following would be an appropriate treatment?

Vancomycin
Penicillin
Metronidazole
Bactria

A
  1. C. Metronidazole
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17
Q

A 22-year-old is seen complaining of big belly pain. This type of pain is seen at what point and appendicitis?

Very early
3 to 4 hours after perforation
Late in inflammation
Appendicitis never presents with vague pain

A
  1. A. Very early
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18
Q

The nurse practitioner suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?

Use of NSAIDs
Cigarette smoker
Ethanol consumption
All of the above

A
  1. D. All of the above
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19
Q

The patient is seen with dark colored urine and the urine dipstick reveals a high level of bilirubin Which of the following could be a cause of this problem?

Increased breakdown of red blood cells
In adequate hepatocyte function
Biliary obstruction
All of the above

A
  1. C. Biliary obstruction
20
Q

A 21-year-old student presents with complaints of fatigue, headache, and a runny nose, all of which began about two weeks ago. She started taking vitamins and over the counter cold preparations but feels worse. The smell of food makes her nauseated. Her boyfriend had mononucleosis about a month ago and she wonders if she might have it also. Examination reveals cervical adenopathy and an in large liver and spleen. Which of the following labs would be most helpful in the differential diagnosis at this point

Stool culture
Liver enzymes
Anti-hepatitis D virus
Fibroid stimulating hormone test

A
  1. C. Anti-hepatitis D virus
21
Q

On further questioning, the 21-year-old patient with complaints of fatigue, headache, anorexia, and a runny nose explains that she is sexually active only with her boyfriend, does not use injectable drugs, and works as an aid in a daycare center. Which of the following test would be most helpful in confirming your diagnosis?

Hepatitis A virus – HAV- IgM
HAV IgG
Anti-HAcAg
Anti-HAsAg

A
  1. A. Hepatitis A virus, HAV, IgM
22
Q

A patient is seen in the clinic with right upper quadrant pain that is radiating to the middle of the back the NP suspects acute cholelithiasis. The NP should expect which of the following laboratory findings?

Decreased alanine aminotransferase and decreased aspartate aminotransferase
Elevated alkaline phosphatase
Elevated in direct Bilirubin
Decreased white blood cells

A
  1. B. Elevated alkaline phosphatase
23
Q

A patient has acute pancreatitis with seven of the diagnostic criteria from Ranson’s criteria. In order to plan care, the NP must understand that this criteria score has which of the following meanings?`

A high mortality rate
An increased chance of recurrence
A 7% chance of the disease becoming chronic
All of the above

A
  1. A. A high mortality rate
24
Q

The patient is seen in the office with complaints of 6 to 7 liquid bowel movements per day. Which of the following assessment findings would leave the NP to a diagnosis of inflammatory bowel disease?

Intermittent constipation with periods of diarrhea
Wakens at night with diarrhea
History of international travel
All of the above

A
  1. C. History of international travel
25
Q

Which of the following is part of the treatment plan for the patient with irritable bowel syndrome?

High-fiber diet
Tylenol with codeine
Daily laxatives
All of the above

A
  1. A. High-fiber diet
26
Q

Study guide

Celiac disease- Patient presentation
• Diverticulitis- Patient presentation and treatment
• Irritable bowel syndrome- Patient presentation and treatment
• Colon Cancer- Patient presentation and diagnosis
• Hepatitis C- Diagnosis and screening
• Hepatitis B- Diagnosis (lab work)
• Chronic pancreatitis- patient presentation and diagnosis

A

Study guide

Celiac disease- Patient presentation
• Diverticulitis- Patient presentation and treatment
• Irritable bowel syndrome- Patient presentation and treatment
• Colon Cancer- Patient presentation and diagnosis
• Hepatitis C- Diagnosis and screening
• Hepatitis B- Diagnosis (lab work)
• Chronic pancreatitis- patient presentation and diagnosis

27
Q

Colonic diverticulosis most commonly occurs in the walls of the

A. Ascending colon
B. Descending colon
C. Transverse colon
D. Sigmoid colon

A

.

D. Sigmoid colon

28
Q

Which of the following is most consistent with the presentation of a patient with colonic diverticulosis?

A. Diarrhea and leukocytosis,
B. constipation and fever,
c. if you are no symptoms,
D. Frank blood in the stool with reduced stool caliber

A

.c. Few symptoms

29
Q

Which of the following is most consistent with the presentation have a patient with acute colonic diverticulitis?

Cramping, diarrhea, and leukocytosis…
Constipation and fever…
Right sided abdominal pain…
Frank blood in the stool with reduced stool caliber

A

.a. Cramping, diarrhea, and leukocytosis…

30
Q

Major risk factors for diverticulosis include all of the following except:

A low fiber diet…
Family history of the condition…
Older age…
Select connective tissue disorder such as Marfan’s syndrome

A

. A low fiber diet…

31
Q

To avoid the development of acute diverticulitis, treatment of diverticulosis can include:

avoiding foods with seeds…
The use of fiber supplements…
Ceasing cigarette smoking…
Limiting alcohol intake

A

. The use of fiber supplements…

32
Q

The location of discomfort with acute diverticulitis is usually in which of the following areas of the abdomen?

Epigastrium…
Left lower quadrant…
Right lower quadrant…
Suprapubic

A

. Left lower quadrant…

33
Q

Which of the following best describes colonic diverticulosis?

Bulging pockets in the intestinal wall…
Poorly contracting intestinal walls…
Structures of the intestinal lemon…
Flaccidity of the small intestine

A

. Bulging pockets in the intestinal wall…

34
Q

You are seeing Mr. Lopez, a 68-year-old man was suspected acute colonic diverticulitis. And choosing an appropriate imaging study, which of the following abdominal imaging studies is most appropriate

Flat plate…
Ultrasound…
CT scan with contrast…
Barium enema

A

. CT scan with contrast…

35
Q 
51. In the evaluation of acute diverticulitis, the most appropriate diagnostic approach to rule out free air in the abdomen includes:
A. barium enema.
B. plain abdominal film.
C. abdominal ultrasound.
D. lower endoscopy.
A

B . Plain abd film

36
Q 
52. A 56-year-old woman is diagnosed with mild diverticulitis. In addition to counseling her about increased fluid intake and adequate rest, you recommend antimicrobial treatment with:
A. amoxicillin with clarithromycin.
B. linezolid with daptomycin.
C. ciprofloxacin with metronidazole.
D. nitrofurantoin with doxycycline.
A

C. Ciproflixin and metronidazole

37
Q
  1. Lower GI hemorrhage associated with diverticular disease usually manifests as:
    A. a painless event.
    B. a condition noted to be found with a marked febrile response.
    C. a condition accompanied by severe cramp-like abdominal pain.
    D. a common chronic condition.

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

A. A painless event

38
Q
  1. Measures to prevent colonic diverticulosis and diverticulitis include all of the following except:
    A. increased whole grain intake.
    B. regular aerobic exercise.
    C. adequate hydration.
    D. refraining from excessive alcohol intake.
    (Fitzgerald 168)
A

D. refraining from excessive alcohol intake.

39
Q

. A serological marker for acute hepatitis A virus (HAV) infection is:
A. HAV IgM.
B. HAV viral RNA.
C. TNF-α.
D. IL-10. (Fitzgerald 178)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

A. HAV IgM.

40
Q

You are caring for a 45-year-old woman from a developing country. She reports that she had “yellow jaundice” as a young child. Her physical examination is unremarkable. Her laboratory studies are as follows: AST, 22 U/L (normal, 0 to 31 U/L); alanine aminotransferase (ALT), 25 U/L (normal, 0 to 40 U/L);
hepatitis A virus immunoglobulin G (HAV IgG) positive. Laboratory testing reveals:
A. chronic hepatitis A.
B. no evidence of prior or current hepatitis A infection.
C. resolved hepatitis A infection.
D. prodromal hepatitis A. (Fitzgerald 178)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

C. resolved hepatitis A infection.

41
Q
  1. In a well adult with modest hepatic enzyme elevation and hepatitis B surface antigen (HBsAg) positive, these findings are most consistent with:
    A. no evidence of hepatitis B infection.
    B. resolved hepatitis B infection.
    C. chronic hepatitis B.
    D. evidence of effective hepatitis B immunization. (Fitzgerald 178)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

resolved hepatitis B infection.

42
Q
  1. A 38-year-old man with a recent history of injection drug use presents with malaise, nausea, fatigue, and “yellow eyes” for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated laboratory results include:
    A. the presence of hepatitis B surface antibody (HBsAb).
    B. neutrophilia.
    C. thrombocytosis.
    D. the presence of HBsAg. (Fitzgerald 179)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

D. the presence of HBsAg. (Fitzgerald 179)

43
Q
  1. A 38-year-old man with a recent history of injection drug use presents with malaise, nausea, fatigue, and “yellow eyes” for the past week. After ordering diagnostic tests, you confirm the diagnosis of acute hepatitis B. Anticipated laboratory results include:
    A. the presence of hepatitis B surface antibody (HBsAb).
    B. neutrophilia.
    C. thrombocytosis.
    D. the presence of HBsAg. (Fitzgerald 179)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

D. the presence of HBsAg. (Fitzgerald 179)

44
Q
  1. Which of the following groups should be screened for hepatitis B surface antigen (HBsAg)?
    A. pregnant women with no history of receiving HBV vaccine
    B. pregnant women with documented prior HBV infection
    C. all pregnant women regardless of HBV vaccine history
    D. all newborn infants born to mothers with chronic HBV infection (Fitzgerald 179)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

C. all pregnant women regardless of HBV vaccine history

45
Q
  1. Routine testing for the presence of HBsAb after immunization with the HBV vaccine is recommended for all of the following except:
    A. healthcare providers.
    B. immunocompromised patients.
    C. restaurant workers.
    D. dialysis patients. (Fitzgerald 179)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

C. restaurant workers.

46
Q
  1. You see a 22-year-old male who is an injection drug user who has recently been diagnosed with chronic HBV infection. You recommend additional testing for all of the following except:
    A. Lyme disease.
    B. HIV.
    C. HAV.
    D. HCV. (Fitzgerald 180)

Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.

A

A. Lyme disease.

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