Quiz Questions

Reproductive Health

Question #1

During the school day, a 12-year-old male student comes to the nurse’s office complaining of severe pain in his scrotum. He reports that he was tackled while playing football at recess yesterday, and while the pain started then, it has gotten worse overnight. He is now walking hunched over, appears pale and distressed, and is cupping his genital area. He denies nausea but says the pain is “really bad” and not going away.

1. What serious condition should be suspected based on this student’s symptoms, and why is urgent medical evaluation important?
2. What immediate steps should the school nurse take to assess and respond to this situation, considering the potential for the condition?
3. What key health education points should be shared with the student and family to prevent delayed reporting and promote future awareness of testicular health?

Question #2

You are a nurse working in a public health clinic. The intake form for your next patient indicates the patient is a 19-year-old who identifies as non-binary and uses they/them pronouns. The patient has crossed out the legal name of Stephanie on the intake form and handwritten the name Kiry. Kiry is seeking help due to genital itching and appears anxious, keeping their head down even when spoken to, holding their hands tightly, and excessively biting their lips.

1. Identify 3 things you can do to promote an environment of inclusivity, respect, and dignity for Kiry during this visit. (6 points)
2. During the exam, the provider notes white, thick, cottage cheese-like discharge and vulvar erythema. What diagnosis do you anticipate based on these symptoms? (2 points)
3. The provider prescribes miconazole due to its low expense and availability over the counter. The provider instructs Kiry on how to apply the cream. While the provider is talking, you see Kiry grimace and struggle with tears. Regarding medication, what could you discuss with Kiry regarding their options? (2 points)

Taylor, 2021

Question #3

A Pregnant patient in her first trimester presents with severe lower abdominal pain and vaginal bleeding that began two days ago and has progressively worsened. She reports the pain is now at a level of 10/10. In the ER, the attending physician orders a vaginal ultrasound to assess the viability of the pregnancy and B-hCG test. However, while awaiting the results, the patient’s condition worsens. Her pain becomes increasingly unbearable, and she starts to vomit profusely. Ultrasound results come in and patient was taken to the OR for an emergency procedure.

Hx: endometriosis, Hypothyroidism , current smoker

Please provide general overviews of the questions as this topic is quite broad. Based on the scenario:

1. What likely led to the emergency procedure? Briefly explain the findings of the vaginal ultrasound.
2. What is the role of beta-human chorionic gonadotropin in confirming pregnancy and how might abnormal levels relate to the ultrasound findings in this scenario?
3. What would you monitor and assess after the patient returns from the procedure?

Question #4

Quinn, a 30-year-old female, presents to a clinic with complaints of chronic lower abdominal and pelvic pain, especially during her menstrual periods. She reports that the pain radiates to her lower back and has progressively worsened over the past two years. She also experiences pain during intercourse and has been unsuccessfully trying to conceive for over a year. During your nursing assessment, she rates her pain as 8/10 during menstruation and appears visibly uncomfortable when discussing her symptoms. She states she takes Tylenol for the pain, but it doesn’t help, and it interferes with daily activities.

1. What is the most likely diagnosis? Why? (hint: include risk factors and symptoms)
2. What is one of the diagnostic approaches that would help support suspicion or confirm the diagnosis? (State one method and a sentence on what it looks for)
3. What two pieces of education could you provide the patient regarding management? (Answers can include pharmacological interventions, surgical interventions, or supportive resources. Give 1-2 sentences on when and why each intervention is used)

Question #5

You are a nurse in an OB/GYN office. The patient is a 32 year old female here for a new problem visit. She is coming out of concern that she has been trying to conceive with her male partner for the past nine months without success. She is tracking her irregular cycles and the couple is having timed intercourse when her cervical fluid is egg-white consistency. She does report very painful periods since menarche at age 13. This past cycle she has had some intermittent LLQ pain bloating. Her in-office pregnancy test is negative.

1. Is she experiencing infertility?
2. When considering possible causes of her symptoms and presentation, list at least two disorders your patient might be facing. Describe them and include additional assessments or questions that would help support your differential.
3. What diagnostics evaluations do you anticipate today or in the future?

Question #6

You have been caring for a 45-year-old woman with recurrent cervical cancer. She has undergone multiple lines of treatment, including chemotherapy, immunotherapy, and radiation during her cancer journey. She recently discovered that her cancer has metastasized but is currently confined to her pelvis. The doctors believe that her cancer is resectable and discuss the possibility of performing a TPE procedure, which may be a curative option.

What is a TPE, and why is it a curative option? (2-3 sentences is sufficient)

What organs/anatomical body parts are involved in this surgery (name at least 5)?

What are some postoperative and patient care considerations involved with this surgery? Hint: Please consider topics such as mental health, drains/ostomies, infection, etcetera. Name and briefly discuss at least 3 considerations.

Digestive System

Question #7

A 14-year-old girl named Stella presents to the emergency department with acute onset right lower quadrant abdominal pain, nausea, and vomiting. Her pain began approximately 6 hours ago and has progressively worsened. On assessment, she has guarding and rebound tenderness in the right lower quadrant. She has not yet started menstruating but reports intermittent lower abdominal cramping over the past week.

Briefly: What are your priority nursing assessments (2 points) and interventions (2 points)? What tests/imaging do you anticipate differentiating between ovarian torsion and appendicitis (2 points). What are two pharmacological interventions you might anticipate (2 points)? How might this case be managed differently between pediatrics and adults? (2 points)

Question #8

A 14-year-old client with cerebral palsy and a right-sided shunt is experiencing persistent vomiting and has not had a bowel movement in over 36 hours. Client has vomited multiple times in an hour period and is requiring constant suctioning. He is showing signs of discomfort, including intermittent crying, swinging his hands, and he is unable to verbally communicate his needs. He is severely malnourished and receives continuous 24-hour GJ tube feeds, with only short pauses for medication administration. Despite receiving Miralax, an enema and Tylenol, client is still showing signs of discomfort and no bowel movement.

Client is taken to the ED for a workup. You are giving report to the ED nurse on client’s medications. Here is a list of his medications: metoclopramide, docusate, levetiracetam, miralax, and erythromycin.

Given his symptoms and risk factors, could this be an indication of acute pancreatitis? What labs and assessments are necessary to confirm that the client has pancreatitis?

Question #9

A 16-year-old adolescent named Alsil is brought to the emergency department with chief complaints of excruciating, sharp, constant 10/10 abdominal pain aggravated by movement that began eight hours ago in the periumbilical region and now more concentrated to the right iliac fossa. Patient also reports nausea and vomiting but denies diarrhea, hematemesis, hematochezia and melena. Vital signs taken revealed a low-grade fever of 101 F, BP of 130/70 mmHg, PR of 80 bpm, RR of 16 cpm and O2 saturation of 96% at room air. Upon physical examination, pain, guarding and tenderness noted on palpation of the right lower quadrant of the abdomen. Patient had no bowel or urinary symptoms and no previous abdominal problems. The attending physician performed the appropriate assessment including Figure 1.

1. Kindly explain the steps and significance of performing Figure 1.
2. What are the other diagnostic adjuncts needed to evaluate Alsil’s condition and arrive at a likely diagnosis?

Question #10

You are a nurse in a primary care clinic. A 19-year-old female presents to you with a chief complaint of upper abdominal pain and nausea. She states that she has been experiencing this pain intermittently for the past 3 months, worse at night at around 11 PM to 12 AM. The patient mentions that she also experiences bloating after eating and feeling full after only consuming a small amount of food during meals. Labs revealed a normal blood count and positive urea breath test.

1. What is this patient’s most likely diagnosis? Please include rationale by using this patient’s clinical presentation. 3 points
2. Considering the positive urea breath test, what treatment regimen would you expect to be prescribed for this patient? Please include specific medications used in the chosen treatment regimen. (Hint: expected answer is a type of eradication therapy) 3 points
3. The patient asks when she should schedule a follow-up appointment. What should you tell her? 3 points

References and in-text citations: 1 point

Question #11

Part 1 (4pts)

Nataly, a 23-year-old female, presents with a history of recent onset diarrhea, initially mild, but progressing to frequent episodes (4-6 daily) of blood and mucus diarrhea, rectal urgency and tenesmus. She also reports severe abdominal pain localized to the lower abdomen, fatigue, nausea, and unintentional weight loss. Colonoscopy reveals continuous inflammation extending from the rectum proximally. Which of the following is the MOST likely diagnosis?

(A) Crohn's Disease

(B) Irritable Bowel Syndrome (IBS)

(D) Microscopic Colitis

Part 2 (6pts)

Considering Nataly’s likely diagnosis, outline two potential pharmacological treatments and two possible surgical procedures she might undergo during the course of her disease. For each treatment and procedure, explain its purpose and when it would be considered. Finally, briefly describe the regular monitoring and procedures Nataly will need throughout her life.

Question #12

Barbie is a 25-year-old female with no significant past medical hx. She presents to the ED with complaints of intermittent lower abdominal pain, mild cramping, and bloating over the past several weeks. Denies fever, vomiting, or changes in bowel habits. Her VS are stable, and physical exam reveals mild tenderness in the lower abdomen without rebound or guarding.

Her pelvic ultrasound and blood tests reveal no acute abnormalities. A colonoscopy was performed due to persistent symptoms and a family hx of colon polyps. Small polyps were found and scheduled for removal via a polypectomy.

What is Barbies diagnosis and name the planned surgical procedure for this patient?

Bonus* what is the significance of early detection of polyps for Barbie?

Question #13

Situation:

Sam, a 27-year-old male with a medical history of seasonal allergies and atopic dermatitis, has been referred to a gastroenterologist by his PCP due to complaints of progressive dysphagia and chest discomfort while eating solid foods. He reports that over the last 6 months, he has had to chew his food excessively and often drink extra water when trying to get food to go down his esophagus. Sam reports that his father and one of his brothers have Eosinophilic Esophagitis, and experienced symptoms similar to his.

Sam undergoes an upper endoscopy (EGD) which shows longitudinal mucosal furrows and whitish mucosal plaques in the esophagus. Esophageal biopsies confirm a diagnosis of Eosinophilic Esophagitis (EoE).

Questions:

1) Briefly explain the pathophysiology behind EoE in 2-3 sentences.
2) Aside from the histopathology results that confirmed the diagnosis of EoE, what about Sam’s medical history and family history indicated that he may have EoE?
3) Treatment for EoE may look different depending on the patient. Name and briefly explain three management techniques that may help Sam with his symptoms.

Question #14

Heather is a 28-year-old female with history of prior appendectomy and ulcerative colitis who presents to the emergency department with complaints of abdominal pain. She describes it as cramping in nature, periumbilical and started about 5-6 hours ago. She has associated nausea and vomiting, she states “I can’t keep anything down.” She states her stomach feels bloated and hasn’t passed gas all day.

Vitals:

Temp: 36.8
HR: 105
BP: 95/60
RR: 16
SpO2: 95%

Heather gets a CT scan with contrast, which shows the right image.

1. What do you suspect that Heather is suffering from? (2 pts) Small bowel obstruction
2. Beyond the CT scan, what additional assessments might you as the nurse perform to confirm your suspicion? Name 2 assessments and what assessment findings you would expect to find with Heather’s diagnosis. (2 pts)
3. What is included in typical treatment of this condition? List general management for non-surgical and surgical options. (6 pts)

From: Abdominal CT: LITFL • Radiology Library

Question #15

You are the bedside nurse for Earl, a 38-year-old patient with the only past medical history being heavy drinking, which he reports is still about 0.5 liters of vodka a day. He is presenting with the primary concerns of increased fatigue, weight loss, abdominal pain, and progressive confusion. On assessment, you notice a slight yellow tinge to the skin and sclera of their eyes, and some significant rounding in the abdomen. Earl reports they just thought they were really bloated. Earl has been taking simethicone and 1000 mg of Tylenol every 4 hours to try to help relieve the abdominal bloating, with no help. The provider orders an abdominal ultrasound, which shows copious fluid in the abdomen, indicating ascites. Additionally, on lab workup, you notice Earl has a significantly elevated ammonia level and liver enzymes, and Earl’s urine sample is tea-colored.

1. Given this information, what is the likely diagnosis involving the liver for this patient?
2. What procedure do you expect the patient to receive to alleviate the fluid collection in their abdomen?
3. To help lower the patient’s ammonia, the provider orders lactulose. Name at least two points of education you will provide when administering this medication.

(Science Photo Library, n.d.).

Question #16

Mr. Jones, a 45-year-old male with a PMH of HTN, type II diabetes, and schizophrenia. His home medications include lisinopril 20 mg daily, metformin ER 750 mg daily, and clozapine (Clozaril) 350 mg BID. He presents to the emergency department with complaints of worsening abdominal pain. Per the patient, he has been experiencing constipation for the past 2 weeks, diffuse, cramping abdominal pain over the past 5 days, and no bowel movements or flatulence for the past 2 days. When asked if anything changed that made him come into the ED today, Mr. Jones replied, “Well, the pain got really bad then went away for a bit. Then the pain came back, and I just didn’t feel right, which scared me.” On assessment, his vital signs, pertinent physical exam finding, and relevant labs are:

Temp: 101.8°F (38.8°C)
HR: 118 bpm
BP: 98/60 mmHg
RR: 24/min
SpO2: 95% on room air
Abdomen: distended, firm, and tender to palpation with guarding and rebound tenderness
Labs
WBC: 15,600/mm³
pH: 7.35
HCO3: 18 mEq/L
PaCO2: 28 mmHg
Anion gap: 18
Lactate: 3.8 mmol/L

(Bell, 2025)

Mr. Jones was sent to get an abdominal CT, and the resulting image is included.

Which of the following is the most likely causing Mr. Jones’ symptoms?

A) Acute appendicitis
B) GI viral illness
C) Small bowel perforation
D) Severe constipation with referred pain

After speaking with the provider, the nurse informed Mr. Jones that they need to start an IV to give him fluids and IV antibiotics and get him prepped for surgery. Mr. Jones says, “Surgery? Why do I need surgery? Also, I really don’t like needles. Getting that blood drawn was all of the needles I can handle for today. I promise I’ll drink as much water as you need me to and take whatever pills I have to, just please no more needles.” How should the nurse respond to this?

At this point, Mr. Jones’ wife arrives and convinces Mr. Jones to allow the nurse to get IV access. Mrs. Jones asks the nurse to explain to her what is going on with her husband, and the nurse does so after getting permission from Mr. Jones. After taking a few minutes to process what the nurse told her, Mrs. Jones asks, “What could have caused this, and how can we make sure it doesn’t happen again?” How should the nurse respond, keeping in mind Mr. Jone’s PMH/home medications?

Question #17

Ruth is a 48-year-old female with a past medical history of obesity, type 2 diabetes, hypertension, and gallstones. She arrived to the ED with fever, irretractable nausea, emesis (X3), and severe RUQ abdominal pain that she is rating as 10/10. You are taking her history and ask her to confirm the medications listed in the chart. She tells you, “I just started taking that fat shot that starts with a Z about 2 months ago. I buy it from this pharmacy in Canada”. After helping the patient look up her medication, you determine that she has been taking 5mg of Tirzepatide (Zepbound) SubQ weekly (last dose 48 hours ago).

Describe the physiology/pharmacokinetics behind Tirzepatide and how it might be influencing Ruth’s digestive symptoms (please use in-text citations) – 6 pts.

A CT scan is ordered, and she is diagnosed with acute calculous cholecystitis and is scheduled for surgery. She is admitted to your unit for supportive care and will return to your unit post-op. The anesthesiologist comes to evaluate Ruth 2 hours before surgery and says they are going to ultrasound her gastric area prior to surgery. Briefly describe why the anesthesiologist might do this and what post-op precautions you need to initiate when she returns from surgery. (Hint: this question is related to Tirzepatide, and you may find the ASA guidelines helpful. Please use in-text citations). – 4 pts.

Question #18

Marco is a 64-year-old male with decompensated cirrhosis due to non-alcoholic steatohepatitis (NASH), presents with confusion, lethargy, and a strong musty odor to his breath. His family reports that he’s been forgetful and irritable over the past several days. He was recently started on a high-protein nutritional supplement. On exam, he is oriented only to person, has asterixis (flapping tremor), and appears mildly dehydrated. His current medications include furosemide, spironolactone, and lactulose.

Labs:

Ammonia: 87 mcg/dL (elevated)
Sodium: 130 mmol/L
Potassium: 5.2 mmol/L

1) What complication of cirrhosis is Marco most likely experiencing, and what is the underlying pathophysiology?

2) Identify one pharmacologic and one non-pharmacologic treatment priority for this condition. Briefly explain the rationale for each.

OpenAI. (2025). A nurse assessing a patient for asterixis (flapping tremor)

Question #19

A 72-year-old male presents to the Emergency Department complaining of feeling weak and dizzy over the past two days. He reports several episodes of dark, tarry stools. He denies hematemesis or abdominal pain. His past medical history includes peptic ulcer disease and atrial fibrillation, for which he takes apixaban (Eliquis). Arrived at the Emergency Department by private vehicle and walked in with his son. V/T: 97.8F, HR 100, BP 95/60, SPO2 95%.

1. What is the likely diagnosis, and how would you describe it? (2 points)
2. What interventions would you provide for this patient? (at least 3) (6 points)
3. What nursing education would you offer to this patient? (at least 2) (2 points)

Late Submission

Question #20 (Submitted at 3:47 pm on Wednesday, 05/28/2025)

You are precepting a new graduate nurse in the PICU and admit Sarah, a 15 year old female arriving via the emergency department following a Tylenol ingestion. As you begin your initial assessment, you notice that Sarah’s level of consciousness is rapidly declining and there is blood noted when you place her NG to LIS. You gather supplies, including a Belmont rapid infuser and lab draw supplies. What would you teach your orientee about Sarah’s likely diagnosis and the rationale for necessary lab, medication and assessment interventions for Sarah? What primary functions of the liver will cause the most immediate risk to Sarah?

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