NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED EXAM Advanced Physical Assessment — Comprehensive Practice Questions with Rationales 2026/202

NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED EXAM
Advanced Physical Assessment — Comprehensive Practice
Questions with Rationales 2026/2027

EXAM OVERVIEW:
 Number of Questions: 100
 Time Allotted: 120 minutes
 Format: Multiple-choice, case-based questions testing clinical reasoning, physical
exam techniques, diagnostic accuracy, and differential diagnosis


SECTION 1: ABDOMINAL ASSESSMENT
Questions 1 – 20


1. An overweight 26-year-old presents with 12 hours of intense abdominal pain, light-
headedness, and syncope. β-hCG is positive. Vital signs: pulse 118, BP 86/68.
Abdominal exam reveals involuntary rigidity and rebound tenderness. What is the
most likely diagnosis?
 A) Acute cholecystitis
 B) Ruptured appendicitis
 C) Ruptured ectopic pregnancy
 D) Pancreatitis
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension, positive
β-hCG, and peritoneal signs strongly suggests a ruptured ectopic pregnancy with intra-
abdominal bleeding — an emergent condition requiring immediate surgical consultation.


2. On abdominal exam, the clinician places the left hand under the patient's right
posterior rib cage and the right hand deep below the right costal margin. The patient

,is asked to take a deep breath and stops inspiring due to pain. This finding is positive
for which sign?
 A) McBurney's sign
 B) Rovsing's sign
 C) Murphy's sign
 D) Psoas sign
Rationale: Inspiratory arrest during deep palpation of the right upper quadrant (Murphy's
sign) is highly indicative of acute cholecystitis. The maneuver specifically tests for
gallbladder inflammation.


3. During an abdominal exam, the clinician presses deeply and evenly in the left
lower quadrant and then quickly withdraws the fingers. The patient reports pain in
the right lower quadrant. This is known as:
 A) Murphy's sign
 B) Rovsing's sign
 C) Obturator sign
 D) Psoas sign
Rationale: Rovsing's sign is elicited by palpating the left lower quadrant, which causes pain
in the right lower quadrant. This occurs because pressure increases volume within the
colon, moving the inflamed appendix and causing pain. It is a classic sign of appendicitis.


4. A patient with right lower quadrant abdominal pain experiences increased pain
when the right thigh is flexed at the hip and the leg is rotated internally at the hip.
This maneuver tests which sign?
 A) Murphy's sign
 B) Rovsing's sign
 C) Obturator sign
 D) McBurney's sign

,Rationale: The obturator sign is performed by flexing the patient's right thigh at the hip with
the knee bent and rotating the leg internally. Stretching the obturator muscle produces pain
when an inflamed appendix is in contact with the obturator muscle. It is a sign of
appendicitis.


5. A patient presents with right lower quadrant pain. The clinician raises the patient's
right leg while the patient is in the supine position and asks them to push down
against the examiner's hand. Pain in the right lower quadrant suggests:
 A) Rovsing sign
 B) Obturator sign
 C) Psoas sign
 D) Murphy's sign
Rationale: The psoas sign is elicited by asking the patient to raise the right thigh against the
examiner's hand or by extending the right leg while the patient lies on the left side. Pain
indicates irritation of the psoas muscle, often caused by a retrocecal or retroileal appendix.


6. A 60-year-old presents with a recent change in bowel habits, pencil-thin stools, and
unintentional weight loss. She reports intermittent hematochezia. The most
concerning diagnosis to rule out is:
 A) Hemorrhoids
 B) Irritable bowel syndrome
 C) Colon cancer
 D) Diverticulitis
Rationale: Changes in stool caliber (pencil-thin stools), changes in bowel habits,
hematochezia, and unintentional weight loss are red flags for colorectal cancer.


7. A patient presents with right upper quadrant pain radiating to the right shoulder,
nausea, and vomiting after a high-fat meal. On exam, deep palpation of the RUQ
causes inspiratory arrest. This presentation is most consistent with:

,  A) Acute pancreatitis
 B) Acute appendicitis
 C) Acute cholecystitis
 D) Gastritis
Rationale: Right upper quadrant pain radiating to the right shoulder or back after a fatty
meal, combined with Murphy's sign (inspiratory arrest on palpation), is classic for acute
cholecystitis. The right shoulder pain is referred pain from phrenic nerve irritation.


8. A 30-year-old presents with acute onset of severe lower abdominal pain, dysuria,
and fever. On exam, the patient has cervical motion tenderness and adnexal
tenderness. Which diagnosis is most likely?
 A) Appendicitis
 B) Pelvic inflammatory disease (PID)
 C) Ovarian cyst rupture
 D) Urinary tract infection
Rationale: Cervical motion tenderness (chandelier sign) and adnexal tenderness are classic
findings in pelvic inflammatory disease. Patients with PID typically present with lower
abdominal pain, abnormal vaginal discharge, fever, and dysuria.


9. When performing an abdominal exam for suspected appendicitis, where is
McBurney's point located?
 A) Halfway between the umbilicus and the xiphoid process
 B) Two-thirds of the distance from the umbilicus to the anterior superior iliac
spine
 C) At the midline, just below the umbilicus
 D) At the costovertebral angle
Rationale: McBurney's point is located approximately two-thirds of the distance from the
umbilicus to the right anterior superior iliac spine. Tenderness at this point is a classic sign
of appendicitis.