Ch 17
Completion Complete each statement. 1. Urinary incontinence that occurs from the inability to hold urine once the stimulus to urinate is perceived is called _____ incontinence.
1. ANS: urge Urge incontinence is the inability to delay urination once the urge to void occurs.
1. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the: a. peritoneum. b. mediastinum. c. periosteum. d. hilum.
1. ANS: A The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover.
Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 1. Your patient is a 48-year-old woman with complaints of severe cramping pain in the abdomen and right flank. Her past medical history includes a history of bladder calculi. You diagnose her with renal calculi at this time. Which of the following symptoms would you expect with her diagnosis? (Select all that apply.) a. Abdominal pain on palpation b. Blumberg sign c. Cullen sign d. CVA tenderness e. Fever f. Grey Turner sign g. Hematuria h. Nausea
1. ANS: A, D, E, G Abdominal pain on palpation, CVA tenderness, fever, hematuria, and nausea are all signs and symptoms of renal calculi. The Cullen sign is ecchymosis around the umbilicus, the Blumberg sign is rebound tenderness for appendicitis, the Grey Turner sign is ecchymosis in the flanks, and the McBurney sign is rebound tenderness at McBurney's point.
10. One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile.
10. ANS: C The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body.
11. Most nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon.
11. ANS: B Most absorption takes place in the small intestine. Very little absorption takes place in the stomach. The cecum and transverse colon are part of the large intestine, and their major function is water resorption.
12. The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption. d. glucose storage.
12. ANS: A The major function of the large intestine is the absorption of water and excretion of solid waste materials in the form of stool.
13. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: a. gallbladder. b. kidney. c. liver. d. pancreas.
13. ANS: C The liver is responsible for converting fat-soluble waste to water-soluble materials so that the kidneys can excrete them and convert ammonia to urea.
14. Contraction of the gallbladder propels bile into the: a. stomach. b. duodenum. c. jejunum. d. large intestine.
14. ANS: B With contraction of the gallbladder, bile is excreted into the duodenum.
15. Which organs have both an excretion function and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Pancreas and kidney d. Gallbladder and pancreas
15. ANS: C The pancreas excretes pancreatic juices and produces insulin and glucagons; the kidneys excrete urine and produce rennin and erythropoietin. Although the kidneys excrete urine and function as an endocrine gland, the gallbladder is an excretory organ that is not considered an endocrine gland. The liver and gallbladder are excretory organs and are not considered endocrine glands. Although the pancreas excretes pancreatic juices and produces insulin and glucagons, the gallbladder is an excretory organ that is not considered an endocrine gland.
16. The major occupant of the retroperitoneal space is the: a. kidneys. b. lungs. c. spleen. d. bladder.
16. ANS: A The kidneys occupy most of the retroperitoneal space, lying behind the abdominal cavity, beside the abdominal aorta. The lungs and bladder lie outside the peritoneum, but not in the retroperitoneal area. The spleen is within the peritoneum.
17. Mrs. James is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as: a. decreased movement through the colon and increased water absorption from the stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and fewer nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool.
17. ANS: A Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. Movement through the colon is decreased during pregnancy. The colon does not absorb nutrients. A tighter sphincter tone is not related to pregnancy.
18. The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased saliva secretion. c. decreased bile absorption. d. decreased motility.
18. ANS: D Motility of the intestine is the most pronounced GI change in older adults
19. The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it is: a. a common genetic disorder. b. one cause of malabsorption syndrome. c. a curable condition with medical intervention. d. the most frequent cause of diarrhea in general practice.
19. ANS: B Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent complaints.
2. You are examining the abdomen of a 45-year-old female patient. When percussing her urine-filled bladder, you will hear _______________ tones.
2. ANS: dull percussion Dullness is heard over organs and solid masses. A distended bladder produces dullness in the suprapubic area.
2. What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. Duodenum b. Ileum c. Jejunum d. Pylorus
2. ANS: A The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine.
2. Your patient returns to the office with multiple complaints regarding her abdomen. Which of the following are objective findings? (Select all that apply.) a. Nausea b. dullness on percussion c. rebound tenderness d. Vomiting e. Diarrhea f. burning pain in epigastrium
2. ANS: B, C, E, F Nausea, vomiting and diarrhea, and burning pain in epigastrium are subjective signs. Dullness on percussion and rebound tenderness are objective findings.
20. When assessing abdominal pain in a college-age woman, one must include: a. history of interstate travel. b. food likes and dislikes. c. age at completion of toilet training. d. the first day of the last menstrual period.
20. ANS: D Exploring abdominal pain complaints in a young woman can reveal multiple causes related to the menstrual cycle, including menstrual pain, ovulation discomfort, and abnormal menses. Asking the patient to tell you the first day of her last menstrual period can help discriminate among these factors. History of international travel and traveler's diarrhea can be related to abdominal pain, but interstate travel usually does not. Food preferences and age at completion of toilet training are not relevant.
21. Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. pancreatitis.
21. ANS: B Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that cause destruction of the bowel, and it becomes more apparent after feedings.
22. Inspection of the abdomen should begin with the patient supine and the examiner: a. seated at the patient's side. b. standing at the foot of the table. c. standing at the patient's left. d. walking around the table.
22. ANS: A Being seated at the patient's side is the preferred initial position because it allows tangential viewing of the abdomen for improved assessment of abdominal contour.
23. Before performing an abdominal examination, the examiner should: a. ascertain the patient's HIV status. b. have the patient empty his or her bladder. c. don double gloves. d. completely disrobe the patient.
23. ANS: B The patient should empty the bladder to ensure an accurate examination of organs and provide comfort for the patient.
24. Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach
24. ANS: A The hypogastric (pubic) area contains the ileum, bladder, and pregnant uterus.
25. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow.
25. ANS: C To help relax the abdominal musculature, it is helpful to place a small pillow under the patient's head and under slightly flexed knees. The other techniques are not helpful because they increase muscle flexion.
26. Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your examination, you ask the patient to raise her head and shoulders while she lies in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti.
26. ANS: D A diastasis recti occurs when the abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and usually occurs in women who have had repeated pregnancies and in obese patients.
27. After thorough inspection of the abdomen, the next assessment step is: a. percussion. b. palpation. c. auscultation. d. rectal examination.
27. ANS: C Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence occurs because palpation and percussion can alter the frequency and intensity of bowel sounds. Therefore, auscultation is done first.
28. Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint of constipation. During auscultation, you note borborygmi sounds. This is associated with: a. gastroenteritis. b. peritonitis. c. satiety. d. paralytic ileus.
28. ANS: A Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as does hunger.
29. Peritonitis produces bowel sounds that are: a. hypoactive. b. hyperactive. c. high-pitched. d. absent.
29. ANS: A Hypoactive bowel sounds occur with peritonitis and paralytic ileus.
3. Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach.
3. ANS: C The movement of food and digestive products is regulated by the autonomic nervous system.
30. To document absent bowel sounds correctly, one must listen continuously for: a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes.
30. ANS: D Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes.
31. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: a. descending aorta. b. lower liver border. c. medial border of the spleen. d. upper right kidney ridge.
31. ANS: B Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border of more than 2 to 3 cm signifies hepatomegaly.
32. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Venous hum
32. ANS: D Venous hum is associated with blood flow in the venous collaterals, as found in portal hypertension. Aortic bruit occurs during systole, whereas a venous hum is a continuous sound and softer than a bruit.
33. Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants.
33. ANS: D Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs.
34. When percussing a spleen, Traube's space is a: a. semilunar region. b. splenic percussion sign. c. left-sided pleural effusion. d. solid mass.
34. ANS: A Percussion of the spleen is more difficult because percussion tones elicited may be caused by other conditions. Traube's space is a semilunar region defined by the sixth ribs superiorly, the midaxillary line laterally, and the left costal margin inferiorly.
35. Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back and left scapula, with nausea and vomiting. Based on this history, your prioritized physical examination should be to: a. percuss for ascites. b. assess for rebound tenderness. c. inspect for ecchymosis of the flank. d. auscultate for abdominal bruits.
35. ANS: C Abdominal pain that radiates to the back could be caused by pancreatitis or a gastric ulcer, gallbladder pain usually radiates to the right or left scapula but not to the back, pancreatitis pain can radiate to the left shoulder or scapula, and nausea and vomiting usually occur with gallbladder, pancreas, or appendix conditions. Pancreatitis is a differential diagnosis for all these symptoms, so begin the examination by inspecting the flanks for the Grey Turner sign, an indication of pancreatitis.
36. To assess for liver enlargement in the obese person, you should: a. use the hook method. b. have the patient lean over at the waist. c. auscultate using the scratch technique. d. attempt palpation during deep exhalation.
36. ANS: C If the abdomen is obese or distended, or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver.
37. An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus.
37. ANS: C Expect two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally close spontaneously by 2 years, and pulsations to the abdomen in the epigastric area are common.
38. Failure to pass a meconium stool in the first 24 hours after birth, along with abdominal distention, are often the first signs of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios.
38. ANS: B Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease.
39. When palpating the aorta, a prominent lateral pulsation suggests: a. an aortic aneurysm. b. normal pulsation. c. a renal artery fistula. d. a vena cava varicosity.
39. ANS: A Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm.
4. The esophagus travels a route from: a. behind the trachea through the mediastinal cavity. b. lateral to the trachea through the diaphragm. c. left of the trachea through the peritoneum. d. the anterior trachea through the cardiac orifice.
4. ANS: A The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters the stomach. The esophagus connects the pharynx to the stomach.
40. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition? a. Positive psoas sign b. Positive McBurney sign c. Consistent right lower quadrant (RLQ) pain d. Rebound tenderness
40. ANS: C A positive psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the RLQ are signs of appendicitis. The absence of pain migration makes appendicitis less likely.
41. When using the bimanual technique for palpating the abdomen, you should: a. push down with the bottom hand and the other hand on top. b. push down with the top hand and concentrate on sensation with the bottom hand. c. place the hands side by side and push equally. d. place one hand anteriorly and the other hand posteriorly, squeezing the hands together.
41. ANS: B The bimanual technique uses one hand on top of the other. Exert pressure with the top hand while concentrating on sensation with the other hand.
42. A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. A patient response to a history of present illness questions that further supports a tentative diagnosis of renal calculi is which of the following? a. "My urine has been a bright yellow." b. "I have had fever and chills for 2 days." c. "I also have a headache and neck ache." d. "My left testicle and shoulder hurt as well."
42. ANS: D Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder).
43. Which of the following is the most useful adjunct to the history of present illness when assessing the quantity and degree of a patient's abdominal pain? a. Appetite and recall of last meal b. Family comments about the patient c. Patient's previous medical record d. Finding abdominal scars
43. ANS: A Inquiring about hunger and eating patterns is an important indicator. It is unlikely that hunger will persist with an acute intraabdominal infection.
44. Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings usually associated with: a. diverticulitis. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture.
44. ANS: A Only diverticulitis has all these presenting symptoms.
45. A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: a. use a topical, over the counter hemorrhoid treatment for 1 week. b. exercise and eat more fiber. c. come to the laboratory for a stool guaiac test. d. eat six small meals a day.
45. ANS: C Blood in the stool is an abnormal finding that should never be ignored, even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years.
46. A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. Which organ is most likely injured? a. Gallbladder b. Liver c. Spleen d. Stomach
46. ANS: C Spleen laceration or rupture is always suspected with abdominal injury because of the spleen's anatomic location. The patient's presenting symptoms confirm this suspicion.
47. Costovertebral angle tenderness should be assessed whenever you suspect that the patient may have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis.
47. ANS: C Pyelonephritis is characterized by flank pain and costovertebral angle tenderness.
48. The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. pyloric stenosis. c. intussusception. d. Meckel diverticulum.
48. ANS: D Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract.
49. Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis
49. ANS: A Intussusception refers to the prolapse of one segment of the intestine into another, causing intestinal obstruction. A sausage-shaped mass may be palpated in the right or left upper quadrant, whereas the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age.
5. Which of the following organs is part of the alimentary tract? a. Pancreas b. Stomach c. Gallbladder d. Liver
5. ANS: B The term alimentary tract refers to the continuous tract from the mouth to the esophagus, stomach, small intestine, large intestine, and anus.
50. A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child's diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n): a. fixed mass palpated in the hypogastric area. b. tender, midline abdominal mass. c. olive-sized mass of the right upper quadrant. d. nontender, slightly movable, flank mass.
50. ANS: D A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension, fever, malaise, and a firm nontender mass deep within the flank that is only slightly movable and is usually unilateral.
51. In older adults, overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. fecal impaction. d. fistula formation.
51. ANS: C Constipation with overflow occurs when the rectum contains hard stool and soft feces above a leak around the mass of stool.
52. When examining the abdomen, what is the first examination technique used? a. Inspection b. Light palpation c. Percussion d. Auscultation
52. ANS: A Inspection is always used as the first technique in all stages of the physical examination, including the abdomen. In the abdomen, the auscultation is completed prior to percussion or palpation.
6. The most superior part of the stomach is the: a. body. b. fundus. c. pylorus. d. pyloric orifice.
6. ANS: B The most superior aspect of the stomach is the fundus, followed by the body and then the most distal part, the pylorus.
7. Which of the following is true regarding the stomach? a. It lies in the lower right quadrant of the abdomen. b. It secretes gastric lipase, which digests protein. c. Very little absorption takes place in the stomach. d. The stomach produces most of the body's bile.
7. ANS: C The stomach has a very small role in the absorption of nutrients. The stomach lies across the upper abdomen, not in the lower right quadrant. The stomach secretes gastric lipase, but gastric lipase does not digest protein. The stomach does not produce most of the body's bile.
8. The appendix is an extension of the: a. stomach. b. pancreas. c. small intestine. d. large intestine.
8. ANS: D The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum.
9. When palpating the abdomen, you should note whether the liver is enlarged in the: a. left lower quadrant. b. midepigastric region. c. periumbilical area. d. right upper quadrant.
9. ANS: D The liver is located in the right upper quadrant of the abdomen.