NR 509 WEEK 8 FINAL ACTUAL
PROCTORED EXAM (DUE MAY 2026) 100
Questions with Answers and Rationales
INSTRUCTIONS
● This comprehensive practice exam contains 100 questions for the NR
509 Advanced Physical Assessment Week 8 Final
● Questions are formatted as multiple choice and select-all-that-apply
● Each question includes the correct answer and a detailed rationale
● Topics include: abdominal assessment, cardiovascular assessment,
HEENT, neurological assessment, musculoskeletal, breast
assessment, and advanced physical examination techniques
SECTION 1: ABDOMINAL ASSESSMENT (Questions
1-25)
Question 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
Answer: C) Ruptured ectopic pregnancy
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 that requires immediate surgical consultation.
Question 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
Answer: C) Murphy's 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.
Question 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
Answer: B) Rovsing's sign
Rationale: Rovsing's sign is elicited by palpating the left lower quadrant,
which causes pain in the right lower quadrant. This occurs because the
pressure increases the volume within the colon, moving the inflamed
appendix and causing pain. It is a classic sign of appendicitis.
Question 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
Answer: C) Obturator 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.
, Question 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
Answer: C) Psoas 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.
Question 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
Answer: C) Colon cancer
PROCTORED EXAM (DUE MAY 2026) 100
Questions with Answers and Rationales
INSTRUCTIONS
● This comprehensive practice exam contains 100 questions for the NR
509 Advanced Physical Assessment Week 8 Final
● Questions are formatted as multiple choice and select-all-that-apply
● Each question includes the correct answer and a detailed rationale
● Topics include: abdominal assessment, cardiovascular assessment,
HEENT, neurological assessment, musculoskeletal, breast
assessment, and advanced physical examination techniques
SECTION 1: ABDOMINAL ASSESSMENT (Questions
1-25)
Question 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
Answer: C) Ruptured ectopic pregnancy
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 that requires immediate surgical consultation.
Question 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
Answer: C) Murphy's 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.
Question 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
Answer: B) Rovsing's sign
Rationale: Rovsing's sign is elicited by palpating the left lower quadrant,
which causes pain in the right lower quadrant. This occurs because the
pressure increases the volume within the colon, moving the inflamed
appendix and causing pain. It is a classic sign of appendicitis.
Question 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
Answer: C) Obturator 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.
, Question 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
Answer: C) Psoas 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.
Question 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
Answer: C) Colon cancer
