NSG 500 Exam 3 Actual Exam V1 | NSG 500 Advanced Health
Assessment (NSG500 Exam 3) [PDF] | Wilkes University
1. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right scapula. During the physical examination, the practitioner asks the patient to take a
deep breath while deeply palpating under the right costal margin, causing the patient to
abruptly stop her inspiration. This finding is known as:
A. McBurney’s sign
B. Murphy’s sign
C. Rovsing’s sign
D. Grey Turner’s sign
Answer: B
Rationale: Murphy’s sign is highly suggestive of acute cholecystitis. It occurs when the
inflamed gallbladder comes into contact with the examiner’s hand during deep inspiration.
The resulting pain causes a sudden cessation of the inspiratory effort.
2. When performing an abdominal assessment, in which order should the nurse practitioner
perform the following techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Inspection, Auscultation, Percussion, Palpation
C. Auscultation, Inspection, Percussion, Palpation
D. Percussion, Palpation, Auscultation, Inspection
Answer: B
Rationale: The correct sequence for abdominal assessment is inspection followed by
auscultation. This is done because percussion and palpation can increase peristalsis, which
would alter the bowel sounds heard during auscultation. By auscultating first, the
practitioner gets a more accurate representation of the patient’s bowel activity.
3. A patient presents with a complaint of periumbilical pain that has now shifted to the right
lower quadrant (RLQ). On examination, the practitioner applies pressure to the left lower
quadrant, and the patient feels pain in the right lower quadrant. This is an example of:
A. Rovsing’s sign
B. The Obturator sign
C. The Psoas sign
,D. Rebound tenderness
Answer: A
Rationale: Rovsing’s sign is a clinical indicator of peritoneal irritation, often associated
with appendicitis. By pressing on the left side, the gas is displaced toward the cecum,
causing pain in the inflamed right side. This maneuver helps confirm the presence of
localized inflammation in the RLQ.
4. During an assessment of the renal system, the practitioner uses blunt percussion over the
costovertebral angles (CVA). The patient winces and reports sharp pain. This finding most
likely indicates:
A. Acute pyelonephritis
B. Splenomegaly
C. Abdominal aortic aneurysm
D. Cholelithiasis
Answer: A
Rationale: CVA tenderness is a classic sign of kidney inflammation or infection, such as
pyelonephritis. The percussion vibrates the kidney and the surrounding capsule, which
elicits pain if the organ is inflamed. Other conditions like kidney stones may also cause this
type of discomfort.
5. A 60-year-old male with a history of alcohol use disorder presents with a protuberant
abdomen and yellowing of the sclera. Upon percussion of the abdomen, the practitioner
notes dullness in the flanks while the patient is supine. When the patient turns to his side, the
area of dullness shifts. This technique identifies:
A. Ascites
B. Splenomegaly
C. Bowel obstruction
D. Hepatomegaly
Answer: A
Rationale: The shifting dullness test is used to assess for the presence of free fluid in the
peritoneal cavity, known as ascites. Fluid will naturally gravitate to the dependent areas of
the abdomen. Changing the patient’s position allows the practitioner to see if the level of
dullness moves with gravity.
6. A patient reports unintended weight loss, heat intolerance, and palpitations. On physical
exam, the practitioner notes a fine tremor of the hands and exophthalmos. Which endocrine
disorder is most likely?
A. Hypothyroidism
, B. Cushing’s Syndrome
C. Addison’s Disease
D. Hyperthyroidism
Answer: D
Rationale: Hyperthyroidism, or an overactive thyroid, increases the metabolic rate, leading
to weight loss and heat intolerance. Exophthalmos, or bulging eyes, is a specific sign often
seen in Graves’ disease, the most common cause of hyperthyroidism. Palpitations and
tremors are results of increased sympathetic nervous system activity.
7. Which physical finding is most indicative of severe dehydration in an elderly patient?
A. Skin turgor assessed on the back of the hand
B. Dry mucous membranes and a furrowed tongue
C. Moist axilla
D. Hypertension
Answer: B
Rationale: Dry mucous membranes and a furrowed tongue are reliable signs of
dehydration across age groups. In elderly patients, skin turgor on the hand is often
unreliable due to the natural loss of skin elasticity. Therefore, assessing the moisture level
of the mouth and checking for longitudinal furrows on the tongue is more clinically
significant.
8. A patient presents with ‘tearing’ mid-back pain and a pulsating mass in the epigastric area.
What should the nurse practitioner’s next step be?
A. Auscultate for a bruit and avoid deep palpation
B. Deeply palpate the mass to determine its size
C. Perform vigorous percussion to check for dullness
D. Ask the patient to perform a Valsalva maneuver
Answer: A
Rationale: A pulsating abdominal mass combined with tearing back pain is highly
suspicious for an abdominal aortic aneurysm (AAA). Deep palpation is contraindicated
because it could potentially rupture the aneurysm. Auscultating for a bruit is a safer
physical exam step while preparing for emergency imaging.
9. During a nutritional assessment, a practitioner notes that a patient has a Body Mass Index
(BMI) of 28.5 kg/m². How is this BMI categorized?
A. Underweight
Assessment (NSG500 Exam 3) [PDF] | Wilkes University
1. A 45-year-old female presents with sharp right upper quadrant pain that radiates to her
right scapula. During the physical examination, the practitioner asks the patient to take a
deep breath while deeply palpating under the right costal margin, causing the patient to
abruptly stop her inspiration. This finding is known as:
A. McBurney’s sign
B. Murphy’s sign
C. Rovsing’s sign
D. Grey Turner’s sign
Answer: B
Rationale: Murphy’s sign is highly suggestive of acute cholecystitis. It occurs when the
inflamed gallbladder comes into contact with the examiner’s hand during deep inspiration.
The resulting pain causes a sudden cessation of the inspiratory effort.
2. When performing an abdominal assessment, in which order should the nurse practitioner
perform the following techniques?
A. Inspection, Palpation, Percussion, Auscultation
B. Inspection, Auscultation, Percussion, Palpation
C. Auscultation, Inspection, Percussion, Palpation
D. Percussion, Palpation, Auscultation, Inspection
Answer: B
Rationale: The correct sequence for abdominal assessment is inspection followed by
auscultation. This is done because percussion and palpation can increase peristalsis, which
would alter the bowel sounds heard during auscultation. By auscultating first, the
practitioner gets a more accurate representation of the patient’s bowel activity.
3. A patient presents with a complaint of periumbilical pain that has now shifted to the right
lower quadrant (RLQ). On examination, the practitioner applies pressure to the left lower
quadrant, and the patient feels pain in the right lower quadrant. This is an example of:
A. Rovsing’s sign
B. The Obturator sign
C. The Psoas sign
,D. Rebound tenderness
Answer: A
Rationale: Rovsing’s sign is a clinical indicator of peritoneal irritation, often associated
with appendicitis. By pressing on the left side, the gas is displaced toward the cecum,
causing pain in the inflamed right side. This maneuver helps confirm the presence of
localized inflammation in the RLQ.
4. During an assessment of the renal system, the practitioner uses blunt percussion over the
costovertebral angles (CVA). The patient winces and reports sharp pain. This finding most
likely indicates:
A. Acute pyelonephritis
B. Splenomegaly
C. Abdominal aortic aneurysm
D. Cholelithiasis
Answer: A
Rationale: CVA tenderness is a classic sign of kidney inflammation or infection, such as
pyelonephritis. The percussion vibrates the kidney and the surrounding capsule, which
elicits pain if the organ is inflamed. Other conditions like kidney stones may also cause this
type of discomfort.
5. A 60-year-old male with a history of alcohol use disorder presents with a protuberant
abdomen and yellowing of the sclera. Upon percussion of the abdomen, the practitioner
notes dullness in the flanks while the patient is supine. When the patient turns to his side, the
area of dullness shifts. This technique identifies:
A. Ascites
B. Splenomegaly
C. Bowel obstruction
D. Hepatomegaly
Answer: A
Rationale: The shifting dullness test is used to assess for the presence of free fluid in the
peritoneal cavity, known as ascites. Fluid will naturally gravitate to the dependent areas of
the abdomen. Changing the patient’s position allows the practitioner to see if the level of
dullness moves with gravity.
6. A patient reports unintended weight loss, heat intolerance, and palpitations. On physical
exam, the practitioner notes a fine tremor of the hands and exophthalmos. Which endocrine
disorder is most likely?
A. Hypothyroidism
, B. Cushing’s Syndrome
C. Addison’s Disease
D. Hyperthyroidism
Answer: D
Rationale: Hyperthyroidism, or an overactive thyroid, increases the metabolic rate, leading
to weight loss and heat intolerance. Exophthalmos, or bulging eyes, is a specific sign often
seen in Graves’ disease, the most common cause of hyperthyroidism. Palpitations and
tremors are results of increased sympathetic nervous system activity.
7. Which physical finding is most indicative of severe dehydration in an elderly patient?
A. Skin turgor assessed on the back of the hand
B. Dry mucous membranes and a furrowed tongue
C. Moist axilla
D. Hypertension
Answer: B
Rationale: Dry mucous membranes and a furrowed tongue are reliable signs of
dehydration across age groups. In elderly patients, skin turgor on the hand is often
unreliable due to the natural loss of skin elasticity. Therefore, assessing the moisture level
of the mouth and checking for longitudinal furrows on the tongue is more clinically
significant.
8. A patient presents with ‘tearing’ mid-back pain and a pulsating mass in the epigastric area.
What should the nurse practitioner’s next step be?
A. Auscultate for a bruit and avoid deep palpation
B. Deeply palpate the mass to determine its size
C. Perform vigorous percussion to check for dullness
D. Ask the patient to perform a Valsalva maneuver
Answer: A
Rationale: A pulsating abdominal mass combined with tearing back pain is highly
suspicious for an abdominal aortic aneurysm (AAA). Deep palpation is contraindicated
because it could potentially rupture the aneurysm. Auscultating for a bruit is a safer
physical exam step while preparing for emergency imaging.
9. During a nutritional assessment, a practitioner notes that a patient has a Body Mass Index
(BMI) of 28.5 kg/m². How is this BMI categorized?
A. Underweight
