Abdominal
Question 1. A patient asks how to avoid contracting pharyngitis and tonsillitis. Which piece of advice is not
appropriate for this patient?
“Take antibiotics when well to avoid future infections.”
Question 2. Stacy, a nursing student, is to begin her series of hepatitis B vaccinations. You test her for a serological
marker, and the results show hepatitis B surface antibodies (HBsAb). You tell Stacy that she:
Is permanently immune to hepatitis B.
Question 3. You are counseling Lillian, who is lactose intolerant, about foods to avoid. You know she
misunderstands the teaching when she tells you she can have:
Foods containing whey.
Question 4. Susan, age 59, has no specific complaints when she comes in for her annual examination. She does,
however, have type 2 diabetes mellitus (DM), slight hypertension, dyslipidemia, and central obesity. How would you
diagnose her?
As having metabolic syndrome.
Question 5. Simon, age 72, states that he is worried because he has a bowel movement only every third day. You
respond:
“There is no such thing as a ‘normal’ pattern of defecation.”
Question 6. Martina, age 34, has AIDS and currently suffers from diarrhea. You suspect she has which protozoal
infection of the bowel?
Cryptosporidiosis.
- Cryptosporidiosis, a protozoal infection of the bowel, is common in immunocompromised clients. It causes villous
atrophy and mild inflammatory changes and may secrete an enterotoxin.
Question 7. Tina has a chronic hepatitis C infection. She asks you how to prevent its transmission. You respond:
“Abstain from sex during your period.”
- Because the hepatitis C virus is transmitted in blood, including menstrual blood, clients should abstain from sex
during menstruation. You might also test Tina to see which genotype her hepatitis C is to see if she is a candidate for
Harvoni or Epclusa.
Question 8. Marcie just returned from Central America with traveler’s diarrhea. Which is the best treatment?
Supportive care.
- Enterotoxigenic Escherichia coli (ETEC) is the most common cause of traveler’s diarrhea, which occurs after
ingesting contaminated food or water. It is usually self-limiting, requiring no treatment other than supportive care. It
is common in developing countries. Traveler’s diarrhea caused by E coli used to be frequently treated with a 3- to 5-
day course of a quinolone antibiotic, such as ciprofloxacin (Cipro).
Question 9. Your client’s 2-month-old daughter is admitted with gastroenteritis and dehydration after 2 days of
vomiting and diarrhea. When the father asks you what is causing the child’s diarrhea, how do you respond?
“The infectious agent invaded the stomach lining and is affecting the balance of water and nutrients.”
1
,Question 10. Sandy, age 52, presents with jaundice, dark urine, and light-colored stools, stating that she is slightly
improved over last week’s symptoms. Which stage of viral hepatitis do you suspect?
Icteric.
- In the icteric stage of viral hepatitis, there is jaundice, dark urine, and light-colored stools. There are continued
prodromal complaints, with gradual improvement.
Question 11. When Sammy asks you what he can do to help his wife, who has dumping syndrome, what do you
suggest he encourage her to do?
Eat foods with a moderate fat and protein content.
Question 12. You suspect that Harry has a peptic ulcer and tell him that it has been found to be strongly associated
with:
Infection by Helicobacter pylori.
- About 90% of cases of peptic ulcers have been found to be caused by infection with the bacteria H pylori.
Question 13. You are trying to differentiate between functional (acquired) constipation and Hirschsprung disease in a
neonate. Distinguishing features of Hirschsprung disease include which of the following?
Small ribbonlike stools.
Question 14. Shelby has recently been diagnosed with pancreatitis. Of the following objective findings that can result
from the pancreatic inflammatory process, which is known as Grey Turner sign?
Bluish discoloration over the flanks.
- Grey Turner sign is a bluish discoloration over the flanks.
Question 15. You suspect that Nikki has a gastroduodenal ulcer caused by Helicobacter pylori and plan to treat her
empirically. What medications should you order?
A proton pump inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl).
- All of the drugs listed are used in the eradication of H pylori. Traditional 14-day “triple therapy” with a proton pump
inhibitor (omeprazole), tetracycline or amoxicillin, and metronidazole (Flagyl) has consistently produced eradication
rates of approximately 95% and is the least expensive therapy.
Question 16. A 45-year-old homeless man presents to your urgent care clinic for evaluation. His chief complaint is
diarrhea. The patient states he started to have diarrhea 2-3 days ago, and it is getting progressively worse. He also
notes nausea without vomiting, dry mouth, and double vision. On exam you notice his pupillary reflex is absent. The
patient states he lives on the street and eats mostly canned goods that he scavenges from a grocery store dumpster.
What is the likely cause of the patient’s symptoms?
Botulism.
- This patient has a gastrointestinal illness associated with descending neurological symptoms after eating canned
food; this is the presentation of botulism.
2
, Question 17. A 75-year-old male presents for a routine physical. He is obese and has no abdominal pain or recent
injuries or problems. He has no complaints. He lies supine for his abdominal exam. He is nontender to palpation and
has a normal exam. When he sits up you see a large mass protrude from his abdomen. It is central to his abdomen and
inferior to his rib cage. It disappears when he is sitting up fully. What is the patient’s diagnosis?
Ventral (epigastric) hernia.
- This is the hernia described in the question; most of these hernias are asymptomatic.
Question 18. A 50-year-old female presents to the urgent care clinic complaining of left lower quadrant pain. She has
associated nausea and vomiting, and her vital signs are as follows: temperature 102.5°F, pulse 110, blood pressure
150/90, pulse oximetry 99% on room air. What is the best test to evaluate this patient?
Computed tomography (CT) scan with oral contrast.
- This is the best diagnostic choice. While diverticulitis is likely the cause of the patient’s symptoms, a CT of the
abdomen would show if the patient has any gynecologic etiology (such as ovarian cyst or tumor) of this pain.
Question 19. The screening guidelines for colon cancer recommend which of the following for the general
population?
Colonoscopy starting at age 50.
Question 20. Which of the following is not a risk factor for cholecystitis?
Younger age.
- The risk of cholecystitis actually increases with age.
Question 21. Zena just had a hemorrhoidectomy. You know she has not understood your teaching when she tells you
she will:
Decrease her dietary fiber for 1 month.
- For clients who have just had a hemorrhoidectomy, teaching would include advising them to maintain an adequate
intake of dietary fiber to maintain stool bulk.
Question 22. Timothy, age 68, complains of an abrupt change in his defecation pattern. You evaluate him for:
Colorectal cancer.
- A middle-aged or older client with an abrupt change in defecation pattern must be evaluated for colorectal cancer.
Question 23. Anson tells you he thinks his antacids are causing his diarrhea. You respond:
“Antacids may contain magnesium, which decreases bowel transit time and may contain poorly absorbed salts
that draw fluid into the bowel.”
Question 24. Lucy, age 49, has pain in both the left and right lower quadrants. What might you suspect?
Pelvic inflammatory disease.
- The pain associated with pelvic inflammatory disease can be palpated in both the right and left lower quadrants.
Question 25. You elicit costovertebral angle tenderness in Gordon, age 29. Which condition do you suspect?
Inflammation of the kidney.
Question 26. A mother brings in her 4-year-old child, who she states has acute abdominal pain and a rash. Which of
the following do you initially rule out?
Appendicitis.
3
