NR 509 Advanced Physical Assessment Week 5 Quiz: (Latest
2026/2027) Abdominal Assessment, Skin Lesions, Nutrition,
GI Disorders | Q&A | Grade A | 100% Correct Verified
Answers
Subject: Advanced Physical Assessment – Pernicious Anemia (Gastric Acid Secretion), Sweating
(Eccrine Glands, Inuit Sweating Patterns), Abdominal Assessment (RLQ Tenderness – Appendix, Deep
Palpation – Enlarged Organs, Percussion Notes – Tympany/Hyperresonance/Dullness, Bowel Sounds
– Borborygmi, Auscultation Before Percussion/Palpation, Murphy's Sign – Cholecystitis, Costovertebral
Angle Tenderness – Kidney Inflammation, Ascites, Aging Adult Abdominal Changes); Skin Assessment
(Xerosis, Lichenification, Confluent Lesions, Papule, Basal Cell Carcinoma, Marasmus – Hair Changes,
Aging Hair – Melanocytes, Newborn Skin Permeability); Stool (Black Tarry – GI Bleeding); Pregnancy
(Esophageal Reflux – Pyrosis); Pyloric Stenosis (Projectile Vomiting).
Source: NR 509 Week 5 Quiz 2026/2027, Bates' Guide to Physical Examination & History Taking.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
1) An older patient has been diagnosed with pernicious anemia. The FNP knows that this
condition could be related to
Correct Answer: Decreased gastric acid secretion
1. Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor, which is produced
by gastric parietal cells. Atrophic gastritis (decreased gastric acid secretion) often underlies this
condition.
2. Intrinsic factor is required for intestinal absorption of vitamin B12. Without it, B12 deficiency develops
over years, causing macrocytic anemia and neurologic symptoms.
3. Treatment: lifelong intramuscular B12 replacement. Oral B12 only if intrinsic factor present.
2) The FNP is examining a patient who tells the FNP "I sure sweat a lot especially on my face
and feet but it doesn't have an odor". The FNP knows that this could be related to
Correct Answer: The eccrine glands
1. Eccrine glands produce clear, odorless sweat primarily for thermoregulation. They are distributed
throughout the body (especially palms, soles, face, axillae).
2. Apocrine glands (axillae, groin, perianal) produce thicker, milky sweat that develops odor when broken
down by skin bacteria.
3. Primary hyperhidrosis may be treated with antiperspirants, anticholinergics, iontophoresis, or
botulinum toxin.
, 3) During an abdominal assessment the FNP elicits tenderness on light palpation in the right
lower quadrant. The FNP interprets that this finding could indicate a disorder of which of these
structures?
Correct Answer: Appendix
1. RLQ tenderness is classic for appendicitis (McBurney point – one-third distance from ASIS to
umbilicus). Other structures in RLQ: cecum, terminal ileum, right ovary/fallopian tube, right ureter.
2. Associated signs: Rovsing sign (LLQ palpation causes RLQ pain), psoas sign (pain on R hip
extension), obturator sign (pain on internal rotation of flexed R hip).
3. If peritonitis present, there will be guarding (voluntary or involuntary) and rebound tenderness.
4) An Inuit visiting Nevada from anchorage has come to the clinic in July during the hottest part
of the day. It so happens that the clinics air conditioning is broken and the temperature is very
hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?
Correct Answer: They will sweat more on their faces and less on their trunks and extremities
1. Acclimatization to cold climates (Inuit, Arctic populations) results in reduced sweating response on the
trunk and extremities, but facial sweating remains relatively preserved.
2. Heat acclimatization increases sweat rate and lowers sodium loss. Decacclimatization (moving from
cold to hot environment) leads to reduced sweating efficiency initially.
3. Individual variation exists; repeated heat exposure will improve sweating response.
5) The FNP notices that a patient has black, tarry stool and recalls that a possible cause would
be
Correct Answer: Gastrointestinal bleeding
1. Black, tarry stool (melena) indicates upper gastrointestinal bleeding (esophagus, stomach, duodenum)
– blood digested by gastric acid and enzymes turns black.
2. Common causes: peptic ulcer disease, gastritis, esophageal varices, Mallory-Weiss tear, malignancy.
Also from swallowed blood (epistaxis, hemoptysis).
3. False positives: iron supplements, bismuth (Pepto-Bismol), black licorice, blueberries. Distinguish by
testing stool for occult blood.
6) The FNP knows that during an abdominal assessment deep palpation is used to determine
Correct Answer: Enlarged organs
1. Deep palpation (4-5 cm) is used to detect abdominal masses, organomegaly (liver, spleen, kidneys,
ovaries), aortic aneurysm, and deep tenderness.
2. Light palpation (1-2 cm) assesses superficial tenderness, guarding, and superficial masses.
3. Order: Inspection → Auscultation → Percussion → Palpation (light then deep). Auscultation precedes
palpation to avoid altering bowel sounds.
2026/2027) Abdominal Assessment, Skin Lesions, Nutrition,
GI Disorders | Q&A | Grade A | 100% Correct Verified
Answers
Subject: Advanced Physical Assessment – Pernicious Anemia (Gastric Acid Secretion), Sweating
(Eccrine Glands, Inuit Sweating Patterns), Abdominal Assessment (RLQ Tenderness – Appendix, Deep
Palpation – Enlarged Organs, Percussion Notes – Tympany/Hyperresonance/Dullness, Bowel Sounds
– Borborygmi, Auscultation Before Percussion/Palpation, Murphy's Sign – Cholecystitis, Costovertebral
Angle Tenderness – Kidney Inflammation, Ascites, Aging Adult Abdominal Changes); Skin Assessment
(Xerosis, Lichenification, Confluent Lesions, Papule, Basal Cell Carcinoma, Marasmus – Hair Changes,
Aging Hair – Melanocytes, Newborn Skin Permeability); Stool (Black Tarry – GI Bleeding); Pregnancy
(Esophageal Reflux – Pyrosis); Pyloric Stenosis (Projectile Vomiting).
Source: NR 509 Week 5 Quiz 2026/2027, Bates' Guide to Physical Examination & History Taking.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
1) An older patient has been diagnosed with pernicious anemia. The FNP knows that this
condition could be related to
Correct Answer: Decreased gastric acid secretion
1. Pernicious anemia results from vitamin B12 deficiency due to lack of intrinsic factor, which is produced
by gastric parietal cells. Atrophic gastritis (decreased gastric acid secretion) often underlies this
condition.
2. Intrinsic factor is required for intestinal absorption of vitamin B12. Without it, B12 deficiency develops
over years, causing macrocytic anemia and neurologic symptoms.
3. Treatment: lifelong intramuscular B12 replacement. Oral B12 only if intrinsic factor present.
2) The FNP is examining a patient who tells the FNP "I sure sweat a lot especially on my face
and feet but it doesn't have an odor". The FNP knows that this could be related to
Correct Answer: The eccrine glands
1. Eccrine glands produce clear, odorless sweat primarily for thermoregulation. They are distributed
throughout the body (especially palms, soles, face, axillae).
2. Apocrine glands (axillae, groin, perianal) produce thicker, milky sweat that develops odor when broken
down by skin bacteria.
3. Primary hyperhidrosis may be treated with antiperspirants, anticholinergics, iontophoresis, or
botulinum toxin.
, 3) During an abdominal assessment the FNP elicits tenderness on light palpation in the right
lower quadrant. The FNP interprets that this finding could indicate a disorder of which of these
structures?
Correct Answer: Appendix
1. RLQ tenderness is classic for appendicitis (McBurney point – one-third distance from ASIS to
umbilicus). Other structures in RLQ: cecum, terminal ileum, right ovary/fallopian tube, right ureter.
2. Associated signs: Rovsing sign (LLQ palpation causes RLQ pain), psoas sign (pain on R hip
extension), obturator sign (pain on internal rotation of flexed R hip).
3. If peritonitis present, there will be guarding (voluntary or involuntary) and rebound tenderness.
4) An Inuit visiting Nevada from anchorage has come to the clinic in July during the hottest part
of the day. It so happens that the clinics air conditioning is broken and the temperature is very
hot. The FNP knows that which of these statements is true about the Inuit sweating tendencies?
Correct Answer: They will sweat more on their faces and less on their trunks and extremities
1. Acclimatization to cold climates (Inuit, Arctic populations) results in reduced sweating response on the
trunk and extremities, but facial sweating remains relatively preserved.
2. Heat acclimatization increases sweat rate and lowers sodium loss. Decacclimatization (moving from
cold to hot environment) leads to reduced sweating efficiency initially.
3. Individual variation exists; repeated heat exposure will improve sweating response.
5) The FNP notices that a patient has black, tarry stool and recalls that a possible cause would
be
Correct Answer: Gastrointestinal bleeding
1. Black, tarry stool (melena) indicates upper gastrointestinal bleeding (esophagus, stomach, duodenum)
– blood digested by gastric acid and enzymes turns black.
2. Common causes: peptic ulcer disease, gastritis, esophageal varices, Mallory-Weiss tear, malignancy.
Also from swallowed blood (epistaxis, hemoptysis).
3. False positives: iron supplements, bismuth (Pepto-Bismol), black licorice, blueberries. Distinguish by
testing stool for occult blood.
6) The FNP knows that during an abdominal assessment deep palpation is used to determine
Correct Answer: Enlarged organs
1. Deep palpation (4-5 cm) is used to detect abdominal masses, organomegaly (liver, spleen, kidneys,
ovaries), aortic aneurysm, and deep tenderness.
2. Light palpation (1-2 cm) assesses superficial tenderness, guarding, and superficial masses.
3. Order: Inspection → Auscultation → Percussion → Palpation (light then deep). Auscultation precedes
palpation to avoid altering bowel sounds.
