NSG 500 / NSG 500
Exam 2: Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Latest 2026/2027 Edition
Wilkes University
Passan School of Nursing
75 Questions | Comprehensive Examination
Aligned with Wilkes University NSG 500 Curriculum Standards
Advanced Health Assessment Competencies (2026-2027)
, Section 1: Abdominal and Gastrointestinal Assessment (Q1-Q15)
Q1. A nurse practitioner is performing an abdominal assessment on a 45-year-old patient presenting
with right upper quadrant pain. The patient reports the pain worsens after eating fatty meals. During
deep inspiration while the NP palpates the RUQ, the patient abruptly stops breathing due to pain.
Which clinical sign has been elicited?
A. McBurney's sign, indicating appendicitis
B. Murphy's sign, indicating cholecystitis [CORRECT]
C. Rovsing's sign, indicating peritoneal irritation
D. Psoas sign, indicating a psoas muscle abscess
Correct Answer: B
Rationale: Murphy's sign is elicited when deep inspiration during RUQ palpation causes the patient to abruptly halt
breathing due to pain, indicating gallbladder inflammation (cholecystitis). McBurney's point tenderness is located in the
RLQ and suggests appendicitis. Rovsing's sign refers to RLQ pain with palpation of the LLQ, indicating peritoneal irritation.
The psoas sign is assessed with the patient extending the right hip and suggests a psoas muscle abscess or appendicitis with
retrocecal location. Wilkes NSG 500 curriculum emphasizes differentiating these abdominal signs during systematic
assessment (Jarvis, 2026).
Q2. During an abdominal assessment, a nursing student asks the preceptor why auscultation must be
performed before percussion and palpation. Which response by the NP demonstrates the correct
understanding of the abdominal examination sequence?
A. Auscultation is performed first because it is the most comfortable technique for the patient.
B. Palpation and percussion can alter bowel sounds by increasing or decreasing peristalsis, leading to
inaccurate assessment. [CORRECT]
C. Auscultation helps identify areas of tenderness so the examiner can avoid them during palpation.
D. Percussion produces sounds that interfere with the stethoscope and make auscultation unreliable.
Correct Answer: B
Rationale: The correct abdominal assessment sequence is Inspection, Auscultation, Percussion, Palpation (IAPP).
Auscultation is performed before percussion and palpation because these mechanical manipulations can alter bowel sounds
by stimulating or suppressing peristalsis, resulting in inaccurate findings. While patient comfort is important, the primary
reason is to obtain unaltered bowel sound data. Identifying tenderness is helpful but not the primary rationale for the
auscultation-first approach. This is a foundational NSG 500 competency at Wilkes University (Bickley, 2026).
Q3. A 62-year-old male presents with abdominal distension, shifting dullness on percussion, and a
positive fluid wave test. Bulging flanks are noted when the patient is in a supine position. Which
condition best explains these findings?
A. Small bowel obstruction with hyperactive bowel sounds
B. Ascites due to accumulation of fluid in the peritoneal cavity [CORRECT]
C. Hepatomegaly secondary to fatty liver disease
D. Splenomegaly associated with infectious mononucleosis
Correct Answer: B
Rationale: Ascites is characterized by the accumulation of fluid in the peritoneal cavity. Key findings include shifting
dullness on percussion (dullness moves to the dependent side when the patient changes position), a positive fluid wave test,
and bulging flanks. Small bowel obstruction typically presents with abdominal distension but would have hyperactive or
NSG 500 Exam 2 | Advanced Health Assessment | Page 2
,absent bowel sounds depending on the stage, not shifting dullness. Hepatomegaly refers to liver enlargement and is assessed
by percussion of liver span (>12 cm) and palpation below the costal margin, not shifting dullness. Splenomegaly presents as
an enlarged spleen palpable in the LUQ. These findings are central to the NSG 500 abdominal assessment module (Wilkes
University, 2026).
Q4. An NP is assessing the abdomen of a 28-year-old female with acute RLQ pain, nausea, and
rebound tenderness. When the NP performs the obturator test by internally rotating the flexed right
thigh, the patient reports increased pain in the RLQ. Additionally, the psoas sign is positive. What is
the most likely diagnosis?
A. Ovarian torsion
B. Ectopic pregnancy
C. Acute appendicitis [CORRECT]
D. Pelvic inflammatory disease
Correct Answer: C
Rationale: The combination of RLQ pain, rebound tenderness, positive obturator sign, and positive psoas sign strongly
suggests acute appendicitis. The obturator sign is assessed by internally rotating a flexed thigh, which stretches the obturator
internus muscle; pain indicates an inflamed appendix near the obturator internus. The psoas sign is elicited by extending the
right hip while the patient is lying on the left side; pain suggests an inflamed appendix overlying the psoas muscle. While
ovarian torsion, ectopic pregnancy, and PID can cause RLQ pain, the specific positive findings of both the obturator and
psoas signs are most characteristic of appendicitis. Differentiation of RLQ pathology is a key NSG 500 skill (Jarvis, 2026).
Q5. A nurse practitioner is performing a comprehensive abdominal examination. When percussing
the abdomen, the NP notes tympany over most of the abdominal area but dullness in the right
midclavicular line from the 5th to 7th intercostal spaces. The liver span is measured at 10 cm. How
should the NP interpret these findings?
A. The findings are abnormal and suggest hepatomegaly requiring further investigation.
B. The tympany indicates gastric dilation, and the dullness represents an enlarged spleen.
C. The findings are normal: tympany indicates gas-filled bowel, and the liver span of 10 cm is within
normal limits. [CORRECT]
D. The dullness in the right midclavicular line suggests a right kidney mass.
Correct Answer: C
Rationale: Tympany is the expected percussion note over most of the abdomen because it indicates the presence of gas in
the stomach and intestines. Dullness in the right midclavicular line from the 5th to 7th intercostal spaces is normal and
represents the liver. A normal adult liver span is 6-12 cm in the midclavicular line, so 10 cm is within normal limits.
Hepatomegaly would be suspected if the liver span exceeded 12 cm or if the liver was palpable well below the costal
margin. Dullness over the spleen would be found in the LUQ at Traube's space. A kidney mass would dull in the flank
region. Understanding normal percussion findings is essential in the NSG 500 curriculum (Bickley, 2026).
Q6. A 55-year-old patient with a history of chronic liver disease presents for an abdominal
examination. The NP observes dilated, tortuous veins radiating from the umbilicus. Which vascular
finding has been identified?
A. Spider angiomas, associated with hyperestrogenism in liver disease
B. Caput medusae, associated with portal hypertension [CORRECT]
C. Venous stasis dermatitis, associated with chronic venous insufficiency
D. Kaposi's sarcoma lesions, associated with immunocompromise
NSG 500 Exam 2 | Advanced Health Assessment | Page 3
, Correct Answer: B
Rationale: Caput medusae refers to dilated, tortuous veins radiating outward from the umbilicus, caused by portal
hypertension that diverts blood flow through collateral vessels (the paraumbilical veins) to the systemic circulation. Spider
angiomas are small, red, spider-like vascular lesions with a central arteriole and radiating vessels, associated with
hyperestrogenism in liver disease but visually distinct from caput medusae. Venous stasis dermatitis presents as brownish
discoloration and skin changes in the lower extremities, not the abdomen. Kaposi's sarcoma presents as violaceous plaques
or nodules, not vein patterns. Recognition of caput medusae is a critical NSG 500 assessment competency (Wilkes
University, 2026).
Q7. During inspection of a patient's abdomen, the NP observes that the contour is sunken, with a
visible concavity. The patient reports a recent 15-pound weight loss over two months and chronic
malnutrition. Which abdominal contour finding has been documented?
A. Scaphoid abdomen, associated with malnutrition or dehydration [CORRECT]
B. Protuberant abdomen, associated with obesity or ascites
C. Rounded abdomen, associated with normal fat distribution
D. Flat abdomen, associated with a well-nourished state
Correct Answer: A
Rationale: A scaphoid abdomen is concave or sunken in appearance and is commonly associated with malnutrition,
dehydration, or significant weight loss. Given this patient's reported 15-pound weight loss and chronic malnutrition,
scaphoid contour is the correct documentation. A protuberant abdomen is convex and distended, commonly seen with
obesity, ascites, pregnancy, or organomegaly. A rounded abdomen may be seen in normal individuals or in obesity. A flat
abdomen is level and may be normal in well-nourished individuals. Differentiating abdominal contours is a fundamental
NSG 500 skill (Jarvis, 2026).
Q8. An NP auscultates a patient's abdomen and hears high-pitched, rushing sounds that coincide
with abdominal cramping. The bowel sounds occur approximately 45 times per minute. Which
interpretation of these findings is most accurate?
A. Normal bowel sounds indicating healthy gastrointestinal motility
B. Hypoactive bowel sounds suggestive of paralytic ileus
C. Hyperactive bowel sounds (borborygmi) suggestive of bowel obstruction or gastroenteritis
[CORRECT]
D. Absent bowel sounds indicating peritonitis
Correct Answer: C
Rationale: Normal bowel sounds occur 5-30 times per minute. This patient's bowel sounds at approximately 45 times per
minute are hyperactive (borborygmi), characterized by high-pitched, rushing sounds. Hyperactive bowel sounds are
associated with early bowel obstruction, gastroenteritis, diarrhea, or GI stimulant use. Hypoactive bowel sounds (<5/min)
suggest decreased motility as seen in paralytic ileus, post-surgical states, or late bowel obstruction. Absent bowel sounds
after 5 minutes of continuous auscultation suggest peritonitis or complete bowel paralysis. This distinction is a core NSG
500 learning objective at Wilkes University (Bickley, 2026).
Q9. A patient presents with a protuberant mass in the groin that appears when standing and
disappears when lying supine. The NP asks the patient to bear down (Valsalva maneuver), and the
mass becomes more pronounced. The NP is unable to reduce the mass by gentle pressure. Which type
of hernia complication is most likely present?
A. Reducible hernia with no complications
NSG 500 Exam 2 | Advanced Health Assessment | Page 4
Exam 2: Advanced Health Assessment
Questions and Verified Answers | 100% Correct | Grade A
Latest 2026/2027 Edition
Wilkes University
Passan School of Nursing
75 Questions | Comprehensive Examination
Aligned with Wilkes University NSG 500 Curriculum Standards
Advanced Health Assessment Competencies (2026-2027)
, Section 1: Abdominal and Gastrointestinal Assessment (Q1-Q15)
Q1. A nurse practitioner is performing an abdominal assessment on a 45-year-old patient presenting
with right upper quadrant pain. The patient reports the pain worsens after eating fatty meals. During
deep inspiration while the NP palpates the RUQ, the patient abruptly stops breathing due to pain.
Which clinical sign has been elicited?
A. McBurney's sign, indicating appendicitis
B. Murphy's sign, indicating cholecystitis [CORRECT]
C. Rovsing's sign, indicating peritoneal irritation
D. Psoas sign, indicating a psoas muscle abscess
Correct Answer: B
Rationale: Murphy's sign is elicited when deep inspiration during RUQ palpation causes the patient to abruptly halt
breathing due to pain, indicating gallbladder inflammation (cholecystitis). McBurney's point tenderness is located in the
RLQ and suggests appendicitis. Rovsing's sign refers to RLQ pain with palpation of the LLQ, indicating peritoneal irritation.
The psoas sign is assessed with the patient extending the right hip and suggests a psoas muscle abscess or appendicitis with
retrocecal location. Wilkes NSG 500 curriculum emphasizes differentiating these abdominal signs during systematic
assessment (Jarvis, 2026).
Q2. During an abdominal assessment, a nursing student asks the preceptor why auscultation must be
performed before percussion and palpation. Which response by the NP demonstrates the correct
understanding of the abdominal examination sequence?
A. Auscultation is performed first because it is the most comfortable technique for the patient.
B. Palpation and percussion can alter bowel sounds by increasing or decreasing peristalsis, leading to
inaccurate assessment. [CORRECT]
C. Auscultation helps identify areas of tenderness so the examiner can avoid them during palpation.
D. Percussion produces sounds that interfere with the stethoscope and make auscultation unreliable.
Correct Answer: B
Rationale: The correct abdominal assessment sequence is Inspection, Auscultation, Percussion, Palpation (IAPP).
Auscultation is performed before percussion and palpation because these mechanical manipulations can alter bowel sounds
by stimulating or suppressing peristalsis, resulting in inaccurate findings. While patient comfort is important, the primary
reason is to obtain unaltered bowel sound data. Identifying tenderness is helpful but not the primary rationale for the
auscultation-first approach. This is a foundational NSG 500 competency at Wilkes University (Bickley, 2026).
Q3. A 62-year-old male presents with abdominal distension, shifting dullness on percussion, and a
positive fluid wave test. Bulging flanks are noted when the patient is in a supine position. Which
condition best explains these findings?
A. Small bowel obstruction with hyperactive bowel sounds
B. Ascites due to accumulation of fluid in the peritoneal cavity [CORRECT]
C. Hepatomegaly secondary to fatty liver disease
D. Splenomegaly associated with infectious mononucleosis
Correct Answer: B
Rationale: Ascites is characterized by the accumulation of fluid in the peritoneal cavity. Key findings include shifting
dullness on percussion (dullness moves to the dependent side when the patient changes position), a positive fluid wave test,
and bulging flanks. Small bowel obstruction typically presents with abdominal distension but would have hyperactive or
NSG 500 Exam 2 | Advanced Health Assessment | Page 2
,absent bowel sounds depending on the stage, not shifting dullness. Hepatomegaly refers to liver enlargement and is assessed
by percussion of liver span (>12 cm) and palpation below the costal margin, not shifting dullness. Splenomegaly presents as
an enlarged spleen palpable in the LUQ. These findings are central to the NSG 500 abdominal assessment module (Wilkes
University, 2026).
Q4. An NP is assessing the abdomen of a 28-year-old female with acute RLQ pain, nausea, and
rebound tenderness. When the NP performs the obturator test by internally rotating the flexed right
thigh, the patient reports increased pain in the RLQ. Additionally, the psoas sign is positive. What is
the most likely diagnosis?
A. Ovarian torsion
B. Ectopic pregnancy
C. Acute appendicitis [CORRECT]
D. Pelvic inflammatory disease
Correct Answer: C
Rationale: The combination of RLQ pain, rebound tenderness, positive obturator sign, and positive psoas sign strongly
suggests acute appendicitis. The obturator sign is assessed by internally rotating a flexed thigh, which stretches the obturator
internus muscle; pain indicates an inflamed appendix near the obturator internus. The psoas sign is elicited by extending the
right hip while the patient is lying on the left side; pain suggests an inflamed appendix overlying the psoas muscle. While
ovarian torsion, ectopic pregnancy, and PID can cause RLQ pain, the specific positive findings of both the obturator and
psoas signs are most characteristic of appendicitis. Differentiation of RLQ pathology is a key NSG 500 skill (Jarvis, 2026).
Q5. A nurse practitioner is performing a comprehensive abdominal examination. When percussing
the abdomen, the NP notes tympany over most of the abdominal area but dullness in the right
midclavicular line from the 5th to 7th intercostal spaces. The liver span is measured at 10 cm. How
should the NP interpret these findings?
A. The findings are abnormal and suggest hepatomegaly requiring further investigation.
B. The tympany indicates gastric dilation, and the dullness represents an enlarged spleen.
C. The findings are normal: tympany indicates gas-filled bowel, and the liver span of 10 cm is within
normal limits. [CORRECT]
D. The dullness in the right midclavicular line suggests a right kidney mass.
Correct Answer: C
Rationale: Tympany is the expected percussion note over most of the abdomen because it indicates the presence of gas in
the stomach and intestines. Dullness in the right midclavicular line from the 5th to 7th intercostal spaces is normal and
represents the liver. A normal adult liver span is 6-12 cm in the midclavicular line, so 10 cm is within normal limits.
Hepatomegaly would be suspected if the liver span exceeded 12 cm or if the liver was palpable well below the costal
margin. Dullness over the spleen would be found in the LUQ at Traube's space. A kidney mass would dull in the flank
region. Understanding normal percussion findings is essential in the NSG 500 curriculum (Bickley, 2026).
Q6. A 55-year-old patient with a history of chronic liver disease presents for an abdominal
examination. The NP observes dilated, tortuous veins radiating from the umbilicus. Which vascular
finding has been identified?
A. Spider angiomas, associated with hyperestrogenism in liver disease
B. Caput medusae, associated with portal hypertension [CORRECT]
C. Venous stasis dermatitis, associated with chronic venous insufficiency
D. Kaposi's sarcoma lesions, associated with immunocompromise
NSG 500 Exam 2 | Advanced Health Assessment | Page 3
, Correct Answer: B
Rationale: Caput medusae refers to dilated, tortuous veins radiating outward from the umbilicus, caused by portal
hypertension that diverts blood flow through collateral vessels (the paraumbilical veins) to the systemic circulation. Spider
angiomas are small, red, spider-like vascular lesions with a central arteriole and radiating vessels, associated with
hyperestrogenism in liver disease but visually distinct from caput medusae. Venous stasis dermatitis presents as brownish
discoloration and skin changes in the lower extremities, not the abdomen. Kaposi's sarcoma presents as violaceous plaques
or nodules, not vein patterns. Recognition of caput medusae is a critical NSG 500 assessment competency (Wilkes
University, 2026).
Q7. During inspection of a patient's abdomen, the NP observes that the contour is sunken, with a
visible concavity. The patient reports a recent 15-pound weight loss over two months and chronic
malnutrition. Which abdominal contour finding has been documented?
A. Scaphoid abdomen, associated with malnutrition or dehydration [CORRECT]
B. Protuberant abdomen, associated with obesity or ascites
C. Rounded abdomen, associated with normal fat distribution
D. Flat abdomen, associated with a well-nourished state
Correct Answer: A
Rationale: A scaphoid abdomen is concave or sunken in appearance and is commonly associated with malnutrition,
dehydration, or significant weight loss. Given this patient's reported 15-pound weight loss and chronic malnutrition,
scaphoid contour is the correct documentation. A protuberant abdomen is convex and distended, commonly seen with
obesity, ascites, pregnancy, or organomegaly. A rounded abdomen may be seen in normal individuals or in obesity. A flat
abdomen is level and may be normal in well-nourished individuals. Differentiating abdominal contours is a fundamental
NSG 500 skill (Jarvis, 2026).
Q8. An NP auscultates a patient's abdomen and hears high-pitched, rushing sounds that coincide
with abdominal cramping. The bowel sounds occur approximately 45 times per minute. Which
interpretation of these findings is most accurate?
A. Normal bowel sounds indicating healthy gastrointestinal motility
B. Hypoactive bowel sounds suggestive of paralytic ileus
C. Hyperactive bowel sounds (borborygmi) suggestive of bowel obstruction or gastroenteritis
[CORRECT]
D. Absent bowel sounds indicating peritonitis
Correct Answer: C
Rationale: Normal bowel sounds occur 5-30 times per minute. This patient's bowel sounds at approximately 45 times per
minute are hyperactive (borborygmi), characterized by high-pitched, rushing sounds. Hyperactive bowel sounds are
associated with early bowel obstruction, gastroenteritis, diarrhea, or GI stimulant use. Hypoactive bowel sounds (<5/min)
suggest decreased motility as seen in paralytic ileus, post-surgical states, or late bowel obstruction. Absent bowel sounds
after 5 minutes of continuous auscultation suggest peritonitis or complete bowel paralysis. This distinction is a core NSG
500 learning objective at Wilkes University (Bickley, 2026).
Q9. A patient presents with a protuberant mass in the groin that appears when standing and
disappears when lying supine. The NP asks the patient to bear down (Valsalva maneuver), and the
mass becomes more pronounced. The NP is unable to reduce the mass by gentle pressure. Which type
of hernia complication is most likely present?
A. Reducible hernia with no complications
NSG 500 Exam 2 | Advanced Health Assessment | Page 4
