Care of Acute Abdomen

Question 1

A patient presents with acute right lower quadrant pain, fever, nausea, and a positive Rovsing’s sign. What is the most likely diagnosis?
A. Cholecystitis
B. Pancreatitis
C. Appendicitis
D. Ectopic pregnancy

Answer 1

Correct Answer: C. Appendicitis
Rationale: RLQ pain, fever, nausea, and positive Rovsing’s sign (pain in RLQ when LLQ is palpated) are classic signs of appendicitis.

Question 2

True or False
The gallbladder is located in the left upper quadrant (LUQ) of the abdomen.

Answer 2

Answer: False
Rationale: The gallbladder is located in the right upper quadrant (RUQ), just below the liver.

Question 3

SATA: Which of the following are common signs and symptoms of cholecystitis?
A. RUQ pain that radiates to the right shoulder
B. Diarrhea and flatulence
C. Fever and jaundice
D. Nausea and vomiting
E. Bradycardia

Answer 3

Correct Answers: A, C, D
Rationale: Common signs of cholecystitis include RUQ pain that can radiate to the shoulder, fever, jaundice, and nausea/vomiting. Diarrhea and bradycardia are not typical signs.

Question 4

Which position is best for a patient experiencing referred shoulder pain after a laparoscopic cholecystectomy?
A. Supine
B. Sims position
C. Trendelenburg
D. High Fowler’s

Answer 4

Correct Answer: B. Sims position
Rationale: Sims position can help relieve referred shoulder pain due to CO₂ used during laparoscopic surgery.

Question 5

True or False
Listening to bowel sounds should begin in the right upper quadrant (RUQ).

Answer 5

Answer: False
Rationale: Auscultation of bowel sounds should always begin in the right lower quadrant (RLQ).

Question 6

SATA: Which are nursing interventions after a laparoscopic cholecystectomy?
A. Encourage early ambulation
B. Apply hot compresses to relieve pain
C. Monitor for shoulder pain
D. Teach patient to splint abdomen when coughing
E. Offer a high-fat diet for recovery

Answer 6

Correct Answers: A, C, D
Rationale: Patients should ambulate early, be monitored for shoulder pain (due to gas), and taught to splint their abdomen. Hot compresses and high-fat diets are contraindicated.

Question 7

Which diagnostic test is most useful for confirming an abdominal aortic aneurysm (AAA)?
A. MRI
B. CT scan
C. X-ray
D. ECG

Answer 7

Correct Answer: B. CT scan
Rationale: CT scan is the most accurate method for evaluating the size and shape of an AAA.

Question 8

True or False
A bruit heard over the abdominal aorta may indicate the presence of an aneurysm.

Answer 8

Answer: True
Rationale: A bruit may indicate turbulent blood flow, which is a warning sign of an abdominal aortic aneurysm.

Question 9

SATA: What are signs of obstructed bile flow in a patient with cholelithiasis?
A. Steatorrhea
B. Clay-colored stools
C. Dark amber urine
D. Hypertension
E. Pruritus

Answer 9

Correct Answers: A, B, C, E
Rationale: Obstructed bile flow can lead to steatorrhea, clay-colored stool, dark amber urine, and itching (pruritus). Hypertension is not related.

Question 10

A patient with suspected appendicitis reports pain that started at the umbilicus and has now moved to the RLQ. What is the name of the point used for palpating this pain?
A. McBurney’s point
B. Blumberg’s sign
C. Psoas sign
D. Obturator sign

Answer 10

Correct Answer: A. McBurney’s point
Rationale: McBurney’s point is located halfway between the umbilicus and the right iliac crest and is a key site of tenderness in appendicitis.

Question 11

Which assessment finding requires immediate intervention in a patient suspected of having an abdominal aortic aneurysm (AAA)?
A. Heart rate of 88 bpm
B. Abdominal bruit on auscultation
C. Pulsating abdominal mass
D. BP 130/85 mmHg

Answer 11

Correct Answer: C. Pulsating abdominal mass
Rationale: A pulsating mass in the abdomen is a serious sign of AAA and should never be palpated—requires immediate action and hospitalization.

A: A heart rate of 88 beats per minute is within the normal range (60–100 bpm). While vital signs should always be monitored, this heart rate does not suggest an immediate problem or indicate that the aneurysm is unstable or rupturing.

B:A bruit is a whooshing sound heard with a stethoscope that suggests turbulent blood flow, possibly from an aneurysm. While it is a significant finding that supports the diagnosis of AAA, it does not indicate an immediate life-threatening situation. It warrants further evaluation, not emergency intervention.

D: This blood pressure reading is slightly elevated but still within acceptable limits. A more concerning finding would be a sudden drop in blood pressure, which could indicate a ruptured aneurysm and internal bleeding. Therefore, this reading does not require immediate intervention.

Question 12

SATA: Which signs indicate possible appendicitis?
A. Pain relieved by eating
B. Positive Rovsing’s sign
C. Pain starting at the umbilicus and moving to the RLQ
D. Nausea and vomiting
E. High-pitched bowel sounds in all quadrants

Answer 12

Correct Answers: B, C, D
Rationale: Rovsing’s sign, RLQ pain, and nausea/vomiting are common in appendicitis. Pain is typically worsened (not relieved) by movement or food.

A:Pain relieved by eating is more typical of gastritis or peptic ulcer disease.In appendicitis, the pain typically worsens with time and is not relieved by food.

E:High-pitched or hyperactive bowel sounds are more often associated with gastroenteritis or early bowel obstruction.In appendicitis, bowel sounds are usually normal or decreased due to inflammation and guarding.

Question 13

True or False
Steatorrhea is a symptom of obstructed bile flow due to gallstones.

Answer 13

Answer: True
Rationale: Steatorrhea (fatty, foul-smelling stool) occurs when bile can’t flow into the intestine to break down fats.

Question 14

Which assessment technique should always be performed last during an abdominal exam?
A. Palpation
B. Auscultation
C. Inspection
D. Percussion

Answer 14

Correct Answer: A. Palpation
Rationale: Palpation is done last to avoid altering bowel sounds before auscultation.

Question 15

Select All That Apply
What are possible complications of untreated cholecystitis?
A. Pancreatitis
B. Sepsis
C. Peritonitis
D. GERD
E. Rupture of the gallbladder

Answer 15

Correct Answers: A, B, C, E
Rationale: Untreated cholecystitis can lead to pancreatitis, sepsis, peritonitis, and gallbladder rupture. GERD is not typically associated.

Question 16

What is the priority nursing intervention after a laparoscopic cholecystectomy?
A. Administering NSAIDs
B. Assessing return of bowel sounds
C. Encouraging a high-fat diet
D. Applying heat packs to the abdomen

Answer 16

Correct Answer: B. Assessing return of bowel sounds
Rationale: Monitoring GI function is crucial post-op. Heat is avoided due to bleeding risk. A low-fat diet is preferred.While pain management is important post-op, it is not the first priority. Pain meds are administered after ensuring the patient is stable and major systems (like GI and cardiovascular) are functioning properly.

Question 17

True or False
Pain from cholecystitis often occurs 3–6 hours after eating a fatty meal.

Answer 17

Answer: True
Rationale: Pain triggered by fatty foods is common in gallbladder disorders.

Question 18

Which sign indicates rebound tenderness in a patient with suspected appendicitis?
A. McBurney’s sign
B. Obturator sign
C. Blumberg’s sign
D. Psoas sign

Answer 18

Correct Answer: C. Blumberg’s sign
Rationale: Blumberg’s sign involves pain upon release of pressure, indicating peritoneal irritation.

Question 19

SATA: Which of the following are signs of a ruptured abdominal aortic aneurysm?
A. Hypertension
B. Hypotension
C. Tachycardia
D. Confusion
E. High urine output

Answer 19

Correct Answers: B, C, D
Rationale: A rupture can lead to shock (hypotension, tachycardia, confusion). Urine output decreases.

A. Hypertension – Incorrect: A rupture typically causes severe blood loss, which leads to hypotension (low blood pressure), not high blood pressure.
B. Hypotension – Correct: A ruptured AAA results in internal bleeding, leading to sudden and significant hypotension, which is a medical emergency.
C. Tachycardia – Correct: The body compensates for blood loss by increasing the heart rate to maintain perfusion, so tachycardia (fast heart rate) is expected.
D. Confusion – Correct: Decreased blood flow to the brain due to blood loss can cause altered mental status or confusion.
E. High urine output – Incorrect: In a rupture, renal perfusion drops, leading to low urine output (oliguria), not high. This is a sign of shock and poor organ perfusion.

Question 20

True or False
Rosving’s sign is present when pain is felt in the right lower quadrant after palpating the left lower quadrant.

Answer 20

Answer: True
Rationale: This sign indicates appendicitis by showing referred pain from LLQ to RLQ.

Question 21

Which dietary teaching is most appropriate for a client recovering from a cholecystectomy?
A. “You can return to a regular high-fat diet within a few days.”
B. “You should remain NPO for one week post-op.”
C. “Stick to a low-fat diet for at least one month.”
D. “Consume high-protein, high-cholesterol foods for healing.”

Answer 21

Correct Answer: C. “Stick to a low-fat diet for at least one month.”
Rationale: A low-fat diet is recommended to prevent strain on the biliary system after gallbladder removal.

Question 22

SATA : Which physical signs are associated with appendicitis?
A. Murphy’s sign
B. McBurney’s point tenderness
C. Psoas sign
D. Obturator sign
E. Cullen’s sign

Answer 22

Correct Answers: B, C, D
Rationale: McBurney’s, Psoas, and Obturator signs are common in appendicitis. Murphy’s is linked to gallbladder issues, and Cullen’s sign indicates internal bleeding (e.g., pancreatitis, ectopic pregnancy).

Question 23

True or False
The diaphragm of the stethoscope is used to listen for vascular sounds in the abdomen.

Answer 23

Answer: False
Rationale: The bell of the stethoscope is used to listen for vascular sounds like bruits. The diaphragm is for bowel sounds.

Question 24

A nurse is assessing a patient with suspected cholelithiasis. Which finding most strongly suggests obstructed bile flow?
A. Frequent diarrhea
B. Yellowing of the sclera
C. Abdominal distension
D. Increased appetite

Answer 24

Correct Answer: B. Yellowing of the sclera
Rationale: Jaundice (especially in the sclera) is a hallmark of obstructed bile flow due to impaired bilirubin excretion.

Question 25

SATA: Which assessment findings support a diagnosis of cholecystitis? A. Positive Murphy’s sign B. RUQ pain after fatty meals C. Bradycardia D. Nausea and vomiting E. Hypoactive bowel sounds

Answer 25

Correct Answers: A, B, D Rationale: RUQ pain after meals, Murphy’s sign, and nausea/vomiting are classic findings. Bradycardia is not typical, and bowel sounds may be normal or hyperactive depending on inflammation.

Question 26

Which action is contraindicated for a patient with suspected appendicitis? A. Applying a cold compress to the RLQ B. Keeping the patient NPO C. Administering a laxative D. Monitoring vital signs

Answer 26

Correct Answer: C. Administering a laxative Rationale: Laxatives can increase the risk of rupture in appendicitis and should be avoided.

Question 27

True or False Auscultation should be performed before palpation in an abdominal assessment.

Answer 27

Answer: True Rationale: Palpation may alter bowel sounds, so auscultation is always done first.

Question 28

Which of the following are risk factors for cholelithiasis? A. High-fat diet B. Male gender under 40 C. Obesity D. Sedentary lifestyle E. Family history

Answer 28

Correct Answers: A, C, D, E Rationale: High-fat diets, obesity, lack of physical activity, and genetics are all risk factors. It’s more common in females and older adults, not young males.

Question 29

What should a nurse do if a pulsating mass is noted slightly left of a patient’s umbilicus during an abdominal assessment? A. Continue with deep palpation B. Notify the healthcare provider immediately C. Place the patient in Trendelenburg position D. Apply a binder for support

Answer 29

Correct Answer: B. Notify the healthcare provider immediately Rationale: A pulsating abdominal mass could indicate an AAA and should never be palpated or compressed—emergency referral is needed.

Question 30

True or False Blumberg’s sign is positive when pressing on the RLQ causes pain upon release.

Answer 30

Answer: True Rationale: Rebound tenderness is a key indicator of peritoneal irritation, which may be seen in appendicitis or peritonitis.

Question 31

Which laboratory value is most likely to be elevated in a patient with obstructive jaundice caused by cholelithiasis? A. Lipase B. Bilirubin C. Creatinine D. Hematocrit

Answer 31

Correct Answer: B. Bilirubin Rationale: Obstructive jaundice from gallstones prevents bile and bilirubin from draining, leading to increased serum bilirubin.

Question 32

Which clinical signs would support a diagnosis of cholelithiasis with bile duct obstruction? A. Steatorrhea B. Clay-colored stool C. Hypertension D. Pruritus E. Dark, foamy urine

Answer 32

Correct Answers: A, B, D, E Rationale: These are classic signs of bile duct obstruction. Hypertension is not directly linked.

Question 33

True or False Cholecystitis pain often radiates to the left shoulder.

Answer 33

Answer: False Rationale: Pain from cholecystitis typically radiates to the right shoulder or scapula.

Question 34

What is the most appropriate position to help relieve gas pain following laparoscopic gallbladder surgery? A. Prone B. Sims (left side) C. Supine D. High Fowler’s

Answer 34

Correct Answer: B. Sims (left side) Rationale: This position helps gas rise and escape from the abdomen post-laparoscopy.

Question 35

What is the most reliable method for confirming appendicitis in a female patient of childbearing age? A. Pelvic exam B. Pregnancy test and ultrasound C. CT scan only D. CBC with differential

Answer 35

Correct Answer: B. Pregnancy test and ultrasound Rationale: Rule out ectopic pregnancy first, then imaging can confirm appendicitis.

Question 36

SATA: Which physical signs are associated with appendicitis? A. Positive Blumberg’s sign B. Pain relieved by defecation C. Positive Psoas sign D. Nausea E. RLQ pain shifting from periumbilical area

Answer 36

Correct Answers: A, C, D, E Rationale: These are classic findings. Pain is not typically relieved by defecation.

Question 37

True or False McBurney’s point is located halfway between the umbilicus and the right anterior superior iliac spine.

Answer 37

Answer: True Rationale: This landmark helps locate tenderness in appendicitis.

Question 38

Which is the highest priority nursing action for a patient with a suspected ruptured AAA? A. Apply oxygen and call the surgeon B. Start IV fluids and monitor vitals C. Apply abdominal binder D. Palpate for the mass to confirm location

Answer 38

Correct Answer: A. Apply oxygen and call the surgeon Rationale: This is a surgical emergency; supporting ABCs and notifying the team is urgent.

Question 39

Which signs and symptoms may indicate a ruptured AAA? A. Severe back or abdominal pain B. Bruising at the flank (Grey-Turner’s sign) C. Bounding pulses D. Hypotension E. Decreased level of consciousness

Answer 39

Correct Answers: A, B, D, E Rationale: Classic signs of AAA rupture. Pulses may be weak, not bounding.

Question 40

True or False AAA is most commonly located in the descending thoracic aorta.

Answer 40

Answer: False Rationale: Most AAAs occur below the kidneys in the abdominal portion, not the thoracic.

Question 41

What percussion sound is expected over air-filled areas of the abdomen? A. Dullness B. Tympany C. Resonance D. Flatness

Answer 41

Correct Answer: B. Tympany Rationale: Tympany is the normal sound heard over air-filled bowel areas.

Question 42

SATA: Which questions should the nurse ask during abdominal pain assessment? A. “What does the pain feel like?” B. “Where is the pain located?” C. “What were you doing when it started?” D. “Have you had your gallbladder removed?” E. “Does the pain radiate anywhere?”

Answer 42

Correct Answers: A, B, C, E Rationale: These follow the OPQRSTU pain assessment model. Asking about past surgeries is useful, but not specific to pain onset.

Question 43

True or False The presence of a bruit during abdominal auscultation is a normal finding.

Answer 43

Answer: False Rationale: Bruits suggest turbulent blood flow and are not normal—may indicate AAA or vascular issue.

Question 44

Which is a priority nursing action for a patient admitted with suspected appendicitis? A. Apply a warm compress to the abdomen B. Administer a laxative for constipation C. Keep the patient NPO D. Encourage ambulation

Answer 44

Correct Answer: C. Keep the patient NPO Rationale: The patient must remain NPO in case emergency surgery is needed. Heat and laxatives are contraindicated due to risk of rupture.

Question 45

Post-operative nursing care after an appendectomy includes which of the following? A. Monitor for signs of infection B. Assess bowel sounds C. Encourage use of incentive spirometer D. Allow hot baths for comfort E. Teach splinting when coughing

Answer 45

Correct Answers: A, B, C, E Rationale: Post-op care includes infection monitoring, respiratory exercises, bowel assessments, and splinting. Baths are contraindicated to protect the surgical site.

Question 46

True or False Laxatives should be avoided in patients with suspected appendicitis.

Answer 46

Answer: True Rationale: Laxatives can increase the risk of appendix rupture and should not be used.

Question 47

What should be included in discharge teaching for a patient post-laparoscopic cholecystectomy? A. Resume a high-fat diet within 2 days B. You may shower, but avoid baths C. Expect heavy bleeding from incision sites D. Avoid walking until pain resolves

Answer 47

Correct Answer: B. You may shower, but avoid baths Rationale: Showers are usually allowed, but baths are avoided to prevent infection. A low-fat diet is recommended.

Question 48

SATA: Which are appropriate post-op nursing interventions after a laparoscopic cholecystectomy? A. Place the patient in Sims position for referred pain B. Monitor for shoulder pain C. Encourage early ambulation D. Offer high-fat meals to test bile flow E. Monitor bowel sounds and return of flatus

Answer 48

Correct Answers: A, B, C, E Rationale: Sims position relieves gas pain, shoulder pain is common, ambulation aids recovery, and monitoring GI function is essential. High-fat meals are avoided.

Question 49

True or False Murphy’s sign is used to assess for appendicitis.

Answer 49

Answer: False Rationale: Murphy’s sign is used for cholecystitis, not appendicitis.

Question 50

A patient presents with a suspected abdominal aortic aneurysm (AAA). Which is the most important nursing action? A. Palpate the abdominal mass to confirm size B. Apply a warm pack to relieve pain C. Monitor BP closely and avoid palpation D. Place patient in Trendelenburg position

Answer 50

Correct Answer: C. Monitor BP closely and avoid palpation Rationale: Palpation of an AAA is contraindicated. BP must be carefully monitored to avoid rupture.

Question 51

After a laparoscopic appendectomy, a patient asks when they can return to normal activity. What’s the best response? A. "You can return to full activity within 3 days." B. "Resume full activity after 2-3 weeks." C. "Wait 6–8 weeks before doing anything strenuous." D. "It depends on your pain level."

Answer 51

Correct Answer: B. "Resume full activity after 2-3 weeks." Rationale: Recovery from laparoscopic surgery typically takes 2–3 weeks, longer for open procedures.

Question 52

A 20-year-old patient is admitted with suspected appendicitis. Which finding would cause the nurse to question the diagnosis and notify the provider immediately? A. Pain localized to McBurney’s point B. Positive Blumberg’s sign C. Relief of pain followed by increased abdominal distension D. Nausea and mild fever

Answer 52

Correct Answer: C. Relief of pain followed by increased abdominal distension Rationale: This may indicate a ruptured appendix, where pain decreases as the appendix decompresses, but peritonitis develops. This is a medical emergency.

Question 53

SATA: A post-op patient following a laparoscopic cholecystectomy reports pain in the shoulder, abdominal fullness, and hasn’t passed gas. Which nursing actions are appropriate? A. Document and reassess in 4 hours B. Place patient in left Sims position C. Encourage ambulation D. Insert NG tube immediately E. Educate the patient that this is a common post-op effect

Answer 53

Correct Answers: B, C, E Rationale: Shoulder pain is due to CO₂ retention. Ambulation and positioning help gas expel. NG tube isn’t required unless there's bowel obstruction.

Question 54

Which task can the nurse safely delegate to the unregulated care provider (UCP) caring for a patient 12 hours post-open appendectomy? A. Monitor the patient’s abdominal dressing for signs of infection B. Assist the patient with ambulating to the bathroom C. Educate the patient on signs of wound infection D. Assess bowel sounds and document findings

Answer 54

Correct Answer: B. Assist the patient with ambulating to the bathroom Rationale: UCPs can assist with mobility. Education and assessment are within the RN’s scope.

Question 55

SATA: A patient with a known AAA suddenly becomes diaphoretic, pale, and reports intense back pain. What should the nurse do next? A. Administer prescribed oral acetaminophen B. Notify the provider immediately C. Place the patient in high Fowler’s position D. Monitor blood pressure and heart rate E. Prepare for emergency surgery

Answer 55

Correct Answers: B, D, E Rationale: These are signs of rupture. Immediate intervention is needed. Oral meds and incorrect positioning delay life-saving care.

Question 56

A patient with suspected cholecystitis has the following labs: WBC: 15,000 ALT: 100 U/L (↑) AST: 90 U/L (↑) Bilirubin: 2.8 mg/dL (↑) Which complication should the nurse suspect? A. Acute pancreatitis B. Obstructive jaundice due to bile duct blockage C. Liver cirrhosis D. Renal failure

Answer 56

Correct Answer: B. Obstructive jaundice due to bile duct blockage Rationale: Elevated bilirubin and LFTs with cholecystitis indicate impaired bile flow, often due to obstruction by gallstones.

Question 57

T/F: Palpating a pulsating mass near the umbilicus is a critical step in diagnosing abdominal aortic aneurysm (AAA).

Answer 57

Answer: False Rationale: Palpation is contraindicated due to rupture risk. The mass is considered a “hands off” finding.

Question 58

SATA: A nurse is performing an abdominal assessment on a post-op appendectomy patient. Which findings require immediate follow-up? A. Bowel sounds present in all quadrants B. Patient rates pain 6/10 in RLQ C. Tense, distended abdomen with dull percussion D. No flatus 12 hours post-op E. Patient reports sudden shoulder tip pain

Answer 58

Correct Answers: C, E Rationale: A distended, dull abdomen may suggest bleeding or obstruction. Referred shoulder pain may signal internal irritation or gas pain—requires assessment to rule out serious issues. A. Bowel sounds present in all quadrants – Normal finding; indicates return of bowel activity. B. Pain 6/10 in RLQ – Expected post-op; monitor and manage with pain medication. C. Tense, distended abdomen with dull percussion – Concerning for complications like internal bleeding, bowel obstruction, or peritonitis. Requires immediate follow-up. D. No flatus 12 hours post-op – Not urgent; bowel function may take 24–48 hours to return after surgery. E. Sudden shoulder tip pain – Can indicate diaphragmatic irritation from free air (e.g., perforation) or internal bleeding. Needs immediate follow-up.

Question 59

A nurse is assessing a patient 4 hours after open cholecystectomy. Which finding is most concerning? A. Hypoactive bowel sounds B. Small amount of serosanguinous drainage on dressing C. Respiratory rate of 24 breaths/min D. Abdominal rigidity and rebound tenderness

Answer 59

Correct Answer: D. Abdominal rigidity and rebound tenderness Rationale: These are signs of peritonitis and could indicate internal bleeding or bile leakage—requires immediate evaluation. A. Hypoactive bowel sounds – Normal after abdominal surgery due to anesthesia and bowel manipulation. B. Small amount of serosanguinous drainage on dressing – Normal in the first 24 hours post-surgery. C. Respiratory rate of 24 breaths/min – Slightly elevated but acceptable post-op, especially with pain.