NSG 500 EXAM 2 – WILKES ADVANCED
HEALTH ASSESSMENT (2026) MASTER
STUDY GUIDE: 250 VERIFIED PRACTICE
QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES
Section 1: Abdominal & Gastrointestinal Assessment
(Questions 1–40)
Question 1
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
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 .
Question 2
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.
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 .
,Question 3
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
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 absent bowel sounds depending on the stage, not shifting dullness .
Question 4
A patient presents with a 2-day history of fever, cough, and productive sputum. The
healthcare provider notes crackles in the right lower lobe. Which type of history is most
appropriate for this visit?
A. Comprehensive history
B. Focused history
C. Review of systems
D. Family history
Correct Answer: B
, Rationale: Focused history is problem-oriented and addresses specific chief complaints;
comprehensive is for new patients or annual exams. A focused history is appropriate for
this acute presentation .
Question 5
Which component of the health history is considered subjective data?
A. Patient reports of chest pain
B. Vital signs
C. Physical examination findings
D. Laboratory results
Correct Answer: A
Rationale: Subjective data include patient-reported symptoms, while objective data are
measured or observed. Vital signs, physical examination findings, and laboratory results
are objective data .
Question 6
The mnemonic OLD CARTS is used to assess which component of the health history?
A. Past medical history
B. Characteristics of the chief complaint
C. Family history
D. Social history
Correct Answer: B
HEALTH ASSESSMENT (2026) MASTER
STUDY GUIDE: 250 VERIFIED PRACTICE
QUESTIONS WITH CORRECT ANSWERS &
DETAILED RATIONALES
Section 1: Abdominal & Gastrointestinal Assessment
(Questions 1–40)
Question 1
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
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 .
Question 2
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.
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 .
,Question 3
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
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 absent bowel sounds depending on the stage, not shifting dullness .
Question 4
A patient presents with a 2-day history of fever, cough, and productive sputum. The
healthcare provider notes crackles in the right lower lobe. Which type of history is most
appropriate for this visit?
A. Comprehensive history
B. Focused history
C. Review of systems
D. Family history
Correct Answer: B
, Rationale: Focused history is problem-oriented and addresses specific chief complaints;
comprehensive is for new patients or annual exams. A focused history is appropriate for
this acute presentation .
Question 5
Which component of the health history is considered subjective data?
A. Patient reports of chest pain
B. Vital signs
C. Physical examination findings
D. Laboratory results
Correct Answer: A
Rationale: Subjective data include patient-reported symptoms, while objective data are
measured or observed. Vital signs, physical examination findings, and laboratory results
are objective data .
Question 6
The mnemonic OLD CARTS is used to assess which component of the health history?
A. Past medical history
B. Characteristics of the chief complaint
C. Family history
D. Social history
Correct Answer: B
