Q&A | Rasmussen College
1. Which assessment technique should the nurse perform immediately after inspection
during an abdominal examination?
A) Palpation
B) Percussion
C) Auscultation
D) Light palpation
Correct Answer: Auscultation
Rationale: The correct order for abdominal assessment is inspection, auscultation,
percussion, and palpation. Auscultation is performed before percussion and palpation
because manipulating the abdomen can alter bowel sounds. Palpation and percussion can
increase peristalsis, making auscultation findings less reliable.
2. What is the primary reason for performing auscultation before palpation during an
abdominal assessment?
A) To prevent patient discomfort
B) To avoid altering bowel sounds
C) To detect vascular sounds first
D) To assess for rebound tenderness
Correct Answer: To avoid altering bowel sounds
Rationale: Palpation and percussion can stimulate the bowel and change the frequency
and character of bowel sounds. Therefore, auscultation is performed before these
,techniques to obtain an accurate baseline of bowel activity. Preventing discomfort,
detecting vascular sounds, and assessing rebound tenderness are not the primary reasons
for this sequencing.
3. Which organ is located in the right upper quadrant (RUQ) of the abdomen?
A) Spleen
B) Liver
C) Sigmoid colon
D) Left ovary
Correct Answer: Liver
Rationale: The liver is primarily located in the right upper quadrant, along with the
gallbladder and parts of the duodenum. The spleen is in the left upper quadrant, the
sigmoid colon is in the left lower quadrant, and the left ovary is in the left lower quadrant.
4. A nurse is performing light palpation on a patient's abdomen. Which technique is
correct?
A) Depressing the abdomen 1–2 cm with the fingertips
B) Using deep pressure to assess for masses
C) Palpating the area of pain first
D) Using the palm of the hand to depress 5 cm
Correct Answer: Depressing the abdomen 1–2 cm with the fingertips
Rationale: Light palpation involves depressing the abdomen approximately 1–2 cm with
the fingertips to assess for tenderness, guarding, and superficial masses. Deep palpation
uses greater pressure to assess deeper structures. Palpating the area of pain first can cause
guarding and should be avoided.
, 5. Which finding is most consistent with voluntary guarding during abdominal palpation?
A) Board-like rigidity that does not relax
B) Muscle tension that relaxes with reassurance
C) Rebound tenderness
D) Absent bowel sounds
Correct Answer: Muscle tension that relaxes with reassurance
Rationale: Voluntary guarding is intentional muscle tension that can be relaxed with
reassurance, distraction, or repositioning. Board-like rigidity that does not relax suggests
involuntary guarding or peritonitis. Rebound tenderness indicates peritoneal inflammation,
and absent bowel sounds suggest ileus or peritonitis.
6. What is the significance of a positive Murphy sign?
A) It indicates appendicitis
B) It suggests cholecystitis
C) It indicates peritonitis
D) It suggests pancreatitis
Correct Answer: It suggests cholecystitis
Rationale: A positive Murphy sign is inspiratory arrest during deep palpation of the right
upper quadrant, suggesting cholecystitis. Appendicitis is associated with McBurney point
tenderness, peritonitis with rebound tenderness and rigidity, and pancreatitis with
epigastric pain radiating to the back.