NUR 216 EXAM 4 | COMPLETE QUESTIONS &
ANSWERS (100% VERIFIED SOLUTIONS)
2025/2026 UPDATE 2 versions
Question 1
A nurse is assessing a client's abdomen and notes a pulsatile mass in the periumbilical
area. Which of the following conditions should the nurse suspect?
A. Aortic aneurysm
B. Normal aortic pulsation
C. Hernia
D. Ascites
*Correct Answer: A. Aortic aneurysm. *
Rationale: A pulsatile mass in the periumbilical area is a concerning finding that may
indicate an abdominal aortic aneurysm. This requires immediate further evaluation and is
not a normal finding .
Question 2
When assessing the abdomen, which of the following findings would the nurse
document as a positive Murphy's sign?
A. Pain in the right lower quadrant upon palpation
B. Pain in the right upper quadrant upon inspiration during palpation
C. Pain in the left upper quadrant upon percussion
D. Rebound tenderness in the right lower quadrant
*Correct Answer: B. Pain in the right upper quadrant upon inspiration during
palpation. *
Rationale: Murphy's sign is elicited by palpating the right costal margin while the client
takes a deep breath. A positive sign is pain or an abrupt stop in inspiration, indicating
gallbladder inflammation (cholecystitis) .
,Question 3
A client presents with a history of irritable bowel syndrome (IBS). Which of the following
findings is consistent with this condition?
A. Bloody stools
B. Alternating diarrhea and constipation
C. Severe abdominal pain with fever
D. Weight loss
*Correct Answer: B. Alternating diarrhea and constipation. *
Rationale: IBS is a functional gastrointestinal disorder characterized by alternating
diarrhea and constipation, often accompanied by abdominal cramping and bloating.
Bloody stools, fever, and weight loss are not typical of IBS and would suggest other
conditions .
Question 4
Which of the following is the most accurate method for assessing for ascites?
A. Inspecting for abdominal distention
B. Auscultating for bowel sounds
C. Palpating for a fluid wave and percussing for shifting dullness
D. Measuring abdominal girth only
*Correct Answer: C. Palpating for a fluid wave and percussing for shifting
dullness. *
Rationale: The most accurate method for detecting ascites is a combination of palpating
for a fluid wave and percussing for shifting dullness. These techniques help confirm the
presence of free fluid in the peritoneal cavity .
,Question 5
A client reports a history of "heartburn" after meals. The nurse should assess for which
additional symptom that may indicate gastroesophageal reflux disease (GERD)?
A. Regurgitation of sour-tasting fluid
B. Constipation
C. Flank pain
D. Headache
*Correct Answer: A. Regurgitation of sour-tasting fluid. *
Rationale: GERD is characterized by the backflow of gastric contents into the esophagus,
causing heartburn and regurgitation. Clients may also report a sour taste in the mouth,
especially when lying down .
Question 6
Which of the following is an abnormal finding when inspecting the anus and rectum?
A. A moist, hairless area
B. A darkly pigmented area
C. A visible, protruding, red mass
D. A tightly closed sphincter
*Correct Answer: C. A visible, protruding, red mass. *
Rationale: A visible, protruding, red mass from the anus is a sign of rectal prolapse or
prolapsed hemorrhoids. This is an abnormal finding that requires further assessment .
Question 7
A client reports a history of a "pilonidal cyst." The nurse understands this condition is
located in which area?
A. The anus
B. The sacrococcygeal area
C. The inguinal area
D. The perineal area
, *Correct Answer: B. The sacrococcygeal area. *
Rationale: A pilonidal cyst is located in the sacrococcygeal area (at the top of the
buttocks). It can become infected and cause pain and drainage .
Question 8
When examining a male client's prostate, the nurse would palpate for which of the
following characteristics?
A. Size, shape, consistency, and tenderness
B. Color and moisture
C. Temperature and turgor
D. Hair distribution and lesions
*Correct Answer: A. Size, shape, consistency, and tenderness. *
Rationale: During a digital rectal exam, the nurse or provider assesses the prostate for size,
shape, consistency (should be rubbery and smooth), and tenderness. These characteristics
help differentiate between benign prostatic hyperplasia, prostatitis, and prostate cancer .
Question 9
Which of the following is a risk factor for prostate cancer?
A. Asian descent
B. Age over 50
C. High estrogen levels
D. Vegetarian diet
*Correct Answer: B. Age over 50. *
Rationale: The primary risk factors for prostate cancer are age (over 50), African American
descent, and a family history of prostate cancer. Age is the most significant non-
modifiable risk factor .
ANSWERS (100% VERIFIED SOLUTIONS)
2025/2026 UPDATE 2 versions
Question 1
A nurse is assessing a client's abdomen and notes a pulsatile mass in the periumbilical
area. Which of the following conditions should the nurse suspect?
A. Aortic aneurysm
B. Normal aortic pulsation
C. Hernia
D. Ascites
*Correct Answer: A. Aortic aneurysm. *
Rationale: A pulsatile mass in the periumbilical area is a concerning finding that may
indicate an abdominal aortic aneurysm. This requires immediate further evaluation and is
not a normal finding .
Question 2
When assessing the abdomen, which of the following findings would the nurse
document as a positive Murphy's sign?
A. Pain in the right lower quadrant upon palpation
B. Pain in the right upper quadrant upon inspiration during palpation
C. Pain in the left upper quadrant upon percussion
D. Rebound tenderness in the right lower quadrant
*Correct Answer: B. Pain in the right upper quadrant upon inspiration during
palpation. *
Rationale: Murphy's sign is elicited by palpating the right costal margin while the client
takes a deep breath. A positive sign is pain or an abrupt stop in inspiration, indicating
gallbladder inflammation (cholecystitis) .
,Question 3
A client presents with a history of irritable bowel syndrome (IBS). Which of the following
findings is consistent with this condition?
A. Bloody stools
B. Alternating diarrhea and constipation
C. Severe abdominal pain with fever
D. Weight loss
*Correct Answer: B. Alternating diarrhea and constipation. *
Rationale: IBS is a functional gastrointestinal disorder characterized by alternating
diarrhea and constipation, often accompanied by abdominal cramping and bloating.
Bloody stools, fever, and weight loss are not typical of IBS and would suggest other
conditions .
Question 4
Which of the following is the most accurate method for assessing for ascites?
A. Inspecting for abdominal distention
B. Auscultating for bowel sounds
C. Palpating for a fluid wave and percussing for shifting dullness
D. Measuring abdominal girth only
*Correct Answer: C. Palpating for a fluid wave and percussing for shifting
dullness. *
Rationale: The most accurate method for detecting ascites is a combination of palpating
for a fluid wave and percussing for shifting dullness. These techniques help confirm the
presence of free fluid in the peritoneal cavity .
,Question 5
A client reports a history of "heartburn" after meals. The nurse should assess for which
additional symptom that may indicate gastroesophageal reflux disease (GERD)?
A. Regurgitation of sour-tasting fluid
B. Constipation
C. Flank pain
D. Headache
*Correct Answer: A. Regurgitation of sour-tasting fluid. *
Rationale: GERD is characterized by the backflow of gastric contents into the esophagus,
causing heartburn and regurgitation. Clients may also report a sour taste in the mouth,
especially when lying down .
Question 6
Which of the following is an abnormal finding when inspecting the anus and rectum?
A. A moist, hairless area
B. A darkly pigmented area
C. A visible, protruding, red mass
D. A tightly closed sphincter
*Correct Answer: C. A visible, protruding, red mass. *
Rationale: A visible, protruding, red mass from the anus is a sign of rectal prolapse or
prolapsed hemorrhoids. This is an abnormal finding that requires further assessment .
Question 7
A client reports a history of a "pilonidal cyst." The nurse understands this condition is
located in which area?
A. The anus
B. The sacrococcygeal area
C. The inguinal area
D. The perineal area
, *Correct Answer: B. The sacrococcygeal area. *
Rationale: A pilonidal cyst is located in the sacrococcygeal area (at the top of the
buttocks). It can become infected and cause pain and drainage .
Question 8
When examining a male client's prostate, the nurse would palpate for which of the
following characteristics?
A. Size, shape, consistency, and tenderness
B. Color and moisture
C. Temperature and turgor
D. Hair distribution and lesions
*Correct Answer: A. Size, shape, consistency, and tenderness. *
Rationale: During a digital rectal exam, the nurse or provider assesses the prostate for size,
shape, consistency (should be rubbery and smooth), and tenderness. These characteristics
help differentiate between benign prostatic hyperplasia, prostatitis, and prostate cancer .
Question 9
Which of the following is a risk factor for prostate cancer?
A. Asian descent
B. Age over 50
C. High estrogen levels
D. Vegetarian diet
*Correct Answer: B. Age over 50. *
Rationale: The primary risk factors for prostate cancer are age (over 50), African American
descent, and a family history of prostate cancer. Age is the most significant non-
modifiable risk factor .
