NURS 612 Exam 3 Advanced Health Assessment (Maryville
University) Questions and Answers| Updated| Pass
Guaranteed
1. What is the correct sequence for the abdominal examination?
A. Inspection, auscultation, percussion, palpation
B. Inspection, palpation, percussion, auscultation
C. Palpation, inspection, auscultation, percussion
D. Auscultation, palpation, inspection, percussion
Answer: A. Inspection, auscultation, percussion, palpation
Rationale: Palpation and percussion can alter peristalsis and change the
frequency of bowel sounds, so auscultation is performed before them. This
is the only abdominal exam in which auscultation follows inspection directly.
2. Which finding represents normal bowel sounds in an adult?
A. Fewer than 1 sound in 2 minutes
B. Irregular clicks and gurgles about 5–30 times per minute
C. Continuous high-pitched tinkling sounds
D. One loud rushing sound every 10 minutes
Answer: B. Irregular clicks and gurgles about 5–30 times per minute
Rationale: Normal bowel sounds are irregular clicks and gurgles at roughly
5–30 per minute. Absent sounds are confirmed only after listening about 5
minutes in each quadrant; high-pitched tinkling suggests early obstruction.
3. A whooshing sound heard over the epigastric area during
auscultation of the abdomen most likely indicates:
A. Normal peristalsis
B. Fecal impaction
C. Turbulent flow from arterial stenosis or an aneurysm
D. Gastric air bubble
Answer: C. Turbulent flow from arterial stenosis or an aneurysm
Rationale: An abdominal bruit reflects turbulent arterial blood flow (aortic,
renal, iliac or femoral artery stenosis, or aneurysm). Bruits warrant further
vascular evaluation; they are not bowel-related.
NURS 612 Exam 3 Practice – Page 1
,4. During right upper quadrant palpation the patient abruptly stops
inspiring because of pain. This is a positive:
A. Rovsing sign
B. Psoas sign
C. Blumberg sign
D. Murphy sign
Answer: D. Murphy sign
Rationale: Murphy sign (inspiratory arrest during deep RUQ palpation
under the liver edge) is the classic physical finding of acute cholecystitis,
caused by an inflamed gallbladder contacting the examiner's hand.
5. Point tenderness located one-third of the distance from the anterior
superior iliac spine to the umbilicus on the right is called:
A. McBurney point tenderness, suggesting appendicitis
B. Murphy point tenderness, suggesting cholecystitis
C. Cullen point tenderness, suggesting pancreatitis
D. Kehr point tenderness, suggesting renal colic
Answer: A. McBurney point tenderness, suggesting appendicitis
Rationale: McBurney point is in the RLQ and localized tenderness there
supports acute appendicitis once pain has migrated from the periumbilical
area.
6. Palpation of the left lower quadrant produces pain in the right lower
quadrant. This is a positive:
A. Murphy sign
B. Rovsing sign
C. Obturator sign
D. Grey Turner sign
Answer: B. Rovsing sign
Rationale: Rovsing sign occurs when displacement of bowel gas by LLQ
palpation increases tension on an inflamed peritoneum in the RLQ. It
supports appendicitis.
NURS 612 Exam 3 Practice – Page 2
,7. Pain on passive extension of the right hip with the patient lying on
the left side (positive psoas sign) suggests:
A. A pelvic appendix
B. Cholecystitis
C. A retrocecal inflamed appendix irritating the psoas muscle
D. Gastric ulcer perforation
Answer: C. A retrocecal inflamed appendix irritating the psoas muscle
Rationale: The psoas sign indicates irritation of the iliopsoas muscle,
typically by a retrocecal appendix. A pelvic appendix is more likely to
produce a positive obturator sign.
8. Which maneuver is most useful for detecting a small to moderate
amount of free peritoneal fluid (ascites)?
A. Light palpation of all four quadrants
B. Auscultation for a succussion splash
C. Hooking technique
D. Shifting dullness
Answer: D. Shifting dullness
Rationale: Shifting dullness: tympany over bowel floats on top while
dullness occurs over dependent fluid; the dullness border shifts when the
patient rolls to the side. A fluid wave is less sensitive and only positive with
large-volume ascites.
9. The normal liver span in the right midclavicular line for an adult is
approximately:
A. 6–12 cm
B. 1–3 cm
C. 14–18 cm
D. 20–25 cm
Answer: A. 6–12 cm
Rationale: Percussion of liver dullness in the midclavicular line normally
measures 6–12 cm (smaller in women and shorter individuals). Larger
spans suggest hepatomegaly.
NURS 612 Exam 3 Practice – Page 3
, 10. Periumbilical ecchymosis (Cullen sign) and flank ecchymosis
(Grey Turner sign) are associated with:
A. Acute glomerulonephritis
B. Retroperitoneal or intraperitoneal hemorrhage such as hemorrhagic
pancreatitis
C. Irritable bowel syndrome
D. Chronic constipation
Answer: B. Retroperitoneal or intraperitoneal hemorrhage such as
hemorrhagic pancreatitis
Rationale: Both signs reflect blood tracking through tissue planes. They
are late, uncommon findings in severe hemorrhagic pancreatitis, and
Cullen sign is also reported with ruptured ectopic pregnancy.
11. A patient reports gnawing epigastric pain that occurs 2–3 hours
after meals, awakens him at night, and is relieved by eating or
antacids. This presentation is most consistent with:
A. Gastric ulcer
B. Acute cholecystitis
C. Duodenal ulcer
D. Irritable bowel syndrome
Answer: C. Duodenal ulcer
Rationale: Duodenal ulcer pain classically improves with food (buffering)
and returns when the stomach empties, including nocturnally. Gastric ulcer
pain often worsens with eating and may cause weight loss.
12. Which test is a recommended noninvasive method to detect active
Helicobacter pylori infection?
A. Serum IgG antibody test only to confirm eradication
B. Abdominal ultrasound
C. Serum amylase
D. Urea breath test or stool antigen test
Answer: D. Urea breath test or stool antigen test
Rationale: Urea breath or stool antigen tests detect active infection and
confirm eradication (PPIs held ~2 weeks and antibiotics ~4 weeks
beforehand to avoid false negatives). Serology cannot differentiate current
from past infection.
NURS 612 Exam 3 Practice – Page 4
University) Questions and Answers| Updated| Pass
Guaranteed
1. What is the correct sequence for the abdominal examination?
A. Inspection, auscultation, percussion, palpation
B. Inspection, palpation, percussion, auscultation
C. Palpation, inspection, auscultation, percussion
D. Auscultation, palpation, inspection, percussion
Answer: A. Inspection, auscultation, percussion, palpation
Rationale: Palpation and percussion can alter peristalsis and change the
frequency of bowel sounds, so auscultation is performed before them. This
is the only abdominal exam in which auscultation follows inspection directly.
2. Which finding represents normal bowel sounds in an adult?
A. Fewer than 1 sound in 2 minutes
B. Irregular clicks and gurgles about 5–30 times per minute
C. Continuous high-pitched tinkling sounds
D. One loud rushing sound every 10 minutes
Answer: B. Irregular clicks and gurgles about 5–30 times per minute
Rationale: Normal bowel sounds are irregular clicks and gurgles at roughly
5–30 per minute. Absent sounds are confirmed only after listening about 5
minutes in each quadrant; high-pitched tinkling suggests early obstruction.
3. A whooshing sound heard over the epigastric area during
auscultation of the abdomen most likely indicates:
A. Normal peristalsis
B. Fecal impaction
C. Turbulent flow from arterial stenosis or an aneurysm
D. Gastric air bubble
Answer: C. Turbulent flow from arterial stenosis or an aneurysm
Rationale: An abdominal bruit reflects turbulent arterial blood flow (aortic,
renal, iliac or femoral artery stenosis, or aneurysm). Bruits warrant further
vascular evaluation; they are not bowel-related.
NURS 612 Exam 3 Practice – Page 1
,4. During right upper quadrant palpation the patient abruptly stops
inspiring because of pain. This is a positive:
A. Rovsing sign
B. Psoas sign
C. Blumberg sign
D. Murphy sign
Answer: D. Murphy sign
Rationale: Murphy sign (inspiratory arrest during deep RUQ palpation
under the liver edge) is the classic physical finding of acute cholecystitis,
caused by an inflamed gallbladder contacting the examiner's hand.
5. Point tenderness located one-third of the distance from the anterior
superior iliac spine to the umbilicus on the right is called:
A. McBurney point tenderness, suggesting appendicitis
B. Murphy point tenderness, suggesting cholecystitis
C. Cullen point tenderness, suggesting pancreatitis
D. Kehr point tenderness, suggesting renal colic
Answer: A. McBurney point tenderness, suggesting appendicitis
Rationale: McBurney point is in the RLQ and localized tenderness there
supports acute appendicitis once pain has migrated from the periumbilical
area.
6. Palpation of the left lower quadrant produces pain in the right lower
quadrant. This is a positive:
A. Murphy sign
B. Rovsing sign
C. Obturator sign
D. Grey Turner sign
Answer: B. Rovsing sign
Rationale: Rovsing sign occurs when displacement of bowel gas by LLQ
palpation increases tension on an inflamed peritoneum in the RLQ. It
supports appendicitis.
NURS 612 Exam 3 Practice – Page 2
,7. Pain on passive extension of the right hip with the patient lying on
the left side (positive psoas sign) suggests:
A. A pelvic appendix
B. Cholecystitis
C. A retrocecal inflamed appendix irritating the psoas muscle
D. Gastric ulcer perforation
Answer: C. A retrocecal inflamed appendix irritating the psoas muscle
Rationale: The psoas sign indicates irritation of the iliopsoas muscle,
typically by a retrocecal appendix. A pelvic appendix is more likely to
produce a positive obturator sign.
8. Which maneuver is most useful for detecting a small to moderate
amount of free peritoneal fluid (ascites)?
A. Light palpation of all four quadrants
B. Auscultation for a succussion splash
C. Hooking technique
D. Shifting dullness
Answer: D. Shifting dullness
Rationale: Shifting dullness: tympany over bowel floats on top while
dullness occurs over dependent fluid; the dullness border shifts when the
patient rolls to the side. A fluid wave is less sensitive and only positive with
large-volume ascites.
9. The normal liver span in the right midclavicular line for an adult is
approximately:
A. 6–12 cm
B. 1–3 cm
C. 14–18 cm
D. 20–25 cm
Answer: A. 6–12 cm
Rationale: Percussion of liver dullness in the midclavicular line normally
measures 6–12 cm (smaller in women and shorter individuals). Larger
spans suggest hepatomegaly.
NURS 612 Exam 3 Practice – Page 3
, 10. Periumbilical ecchymosis (Cullen sign) and flank ecchymosis
(Grey Turner sign) are associated with:
A. Acute glomerulonephritis
B. Retroperitoneal or intraperitoneal hemorrhage such as hemorrhagic
pancreatitis
C. Irritable bowel syndrome
D. Chronic constipation
Answer: B. Retroperitoneal or intraperitoneal hemorrhage such as
hemorrhagic pancreatitis
Rationale: Both signs reflect blood tracking through tissue planes. They
are late, uncommon findings in severe hemorrhagic pancreatitis, and
Cullen sign is also reported with ruptured ectopic pregnancy.
11. A patient reports gnawing epigastric pain that occurs 2–3 hours
after meals, awakens him at night, and is relieved by eating or
antacids. This presentation is most consistent with:
A. Gastric ulcer
B. Acute cholecystitis
C. Duodenal ulcer
D. Irritable bowel syndrome
Answer: C. Duodenal ulcer
Rationale: Duodenal ulcer pain classically improves with food (buffering)
and returns when the stomach empties, including nocturnally. Gastric ulcer
pain often worsens with eating and may cause weight loss.
12. Which test is a recommended noninvasive method to detect active
Helicobacter pylori infection?
A. Serum IgG antibody test only to confirm eradication
B. Abdominal ultrasound
C. Serum amylase
D. Urea breath test or stool antigen test
Answer: D. Urea breath test or stool antigen test
Rationale: Urea breath or stool antigen tests detect active infection and
confirm eradication (PPIs held ~2 weeks and antibiotics ~4 weeks
beforehand to avoid false negatives). Serology cannot differentiate current
from past infection.
NURS 612 Exam 3 Practice – Page 4
