NR 509 Final Exam Study Guide 2026

NR 509 Final Exam Study Guide 2025 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 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?: 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 Department 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 weakness, recurrent epigastric pain radiating to his back, chronic diarrhea with stools 6-8 times daily, and weight loss of 18 lb over 4 months. What is the mechanism of his most likely diagnosis?: a. Helicobacter pylori infection b. Inflammation of the gallbladder c. Inflammation of colonic diverticulum d. Reduced blood supply to the bowel e. Fibrosis of the pancreas 10. A 46-year-old executive who is obese and otherwise healthy presents to a family medicine clinic with a 3-month course of recurrent severe abdominal pain that usually resolves on its own after a few hours. Her last episode was prolonged lasting 6 hours, and she is frustrated that she has had to leave or miss work on three separate occasions. She would like a diagnosis and the problem fixed. Which symptoms or signs would be most suggestive of a diagnosis of biliary colic?: a. Exacerbating factor includes alcohol intake b. Positive McBurney point tenderness