NSG 500 Exam 3 Actual Exam V2 | 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 the
right scapula. During the physical exam, the practitioner notes that the patient stops
breathing mid-inspiration when the gallbladder area is palpated. Which of the following is the
correct name for this finding?
A. Rovsing sign
B. Blumberg sign
C. McBurney sign
D. Murphy sign
Answer: D
Rationale: The Murphy sign is a specific physical examination finding associated with
acute cholecystitis. It is elicited by palpating the right upper quadrant while the patient
takes a deep breath, causing the inflamed gallbladder to contact the examining hand and
resulting in a sudden cessation of inspiration. This finding is highly suggestive of
gallbladder inflammation and warrants further imaging like an ultrasound.
2. When performing an abdominal assessment on a patient complaining of pain, in which
order should the physical examination techniques be conducted?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Percussion, Palpation, Auscultation
Answer: A
Rationale: The standard sequence for abdominal assessment is inspection, followed by
auscultation, percussion, and finally palpation. Auscultation is performed before
percussion and palpation because these latter maneuvers can alter the frequency and
intensity of bowel sounds. Adhering to this order ensures the most accurate assessment of
the patient’s baseline abdominal activity.
3. A practitioner is evaluating a patient for suspected appendicitis and performs a maneuver
where they apply pressure to the left lower quadrant, which results in pain in the right lower
quadrant. What is this sign called?
A. Psoas sign
B. Rovsing sign
,C. Obturator sign
D. Markle sign
Answer: B
Rationale: Rovsing sign is positive when pressure applied to the left lower quadrant
causes referred pain in the right lower quadrant. This occurs due to the displacement of gas
or the stretching of the peritoneum which irritates the inflamed appendix. It is a common
finding in clinical cases of acute appendicitis along with other signs like McBurney’s point
tenderness.
4. Which of the following descriptions best characterizes ‘borborygmi’ heard during
abdominal auscultation?
A. Hyperactive, prolonged bowel sounds often heard as stomach growling
B. High-pitched, tinkling sounds indicating obstruction
C. Soft, low-pitched vascular sounds indicating turbulence
D. Completely absent sounds for at least 5 minutes
Answer: A
Rationale: Borborygmi are hyperactive, loud, and prolonged bowel sounds that are often
described as stomach growling. They are typically heard in individuals who are hungry or
have increased intestinal motility. While they can be normal, frequent borborygmi may also
be associated with early intestinal obstruction or gastroenteritis.
5. While percussing the abdomen, the practitioner hears a dull note in the left midaxillary
line. What does this finding most likely indicate?
A. Gas in the stomach
B. A normal finding for the spleen
C. Splenomegaly
D. Fecal impaction in the descending colon
Answer: C
Rationale: A dull percussion note in the left midaxillary line, specifically in the area of the
Traube space or the splenic percussion sign, often suggests splenomegaly. Normally, this
area produces tympany due to the presence of the stomach and colon. If the dullness
extends significantly, the clinician must perform deeper palpation to confirm the size of the
spleen.
, 6. A 62-year-old male presents with urinary frequency, urgency, and a weak stream. During a
digital rectal exam, the practitioner notes a symmetrically enlarged, firm, and non-tender
prostate. These findings are most consistent with:
A. Prostate cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Acute prostatitis
D. Urolithiasis
Answer: B
Rationale: Benign Prostatic Hyperplasia (BPH) typically presents as a symmetrically
enlarged, smooth, and firm prostate gland without tenderness. The symptoms of frequency,
urgency, and weak stream are classic obstructive voiding symptoms caused by the
enlargement. In contrast, prostate cancer often presents with nodules or asymmetry, and
prostatitis is usually associated with significant tenderness.
7. A patient presents with ‘tearing’ abdominal pain that radiates to the back. On examination,
the practitioner notes a pulsatile mass in the periumbilical area. What is the most
appropriate next step?
A. Deeply palpate the mass to determine its size
B. Perform a fluid wave test to check for ascites
C. Auscultate for a bruit and then refer for urgent imaging
D. Place the patient in the Trendelenburg position
Answer: C
Rationale: A pulsatile mass in the periumbilical area is a hallmark sign of an abdominal
aortic aneurysm (AAA). Deep palpation should be avoided as it carries a risk of rupture.
The practitioner should auscultate for a bruit and immediately arrange for imaging and
vascular consultation to prevent a catastrophic event.
8. A practitioner is performing a thyroid assessment. Which approach is considered most
effective for palpating the thyroid gland?
A. Standing behind the patient and using the finger pads of both hands
B. Standing in front of the patient and using the thumbs
C. Asking the patient to lie supine and hyperextend the neck
D. Using only one hand while the patient coughs
Answer: A
Assessment (NSG500 Exam 3) [PDF] | Wilkes University
1. A 45-year-old female presents with sharp right upper quadrant pain that radiates to the
right scapula. During the physical exam, the practitioner notes that the patient stops
breathing mid-inspiration when the gallbladder area is palpated. Which of the following is the
correct name for this finding?
A. Rovsing sign
B. Blumberg sign
C. McBurney sign
D. Murphy sign
Answer: D
Rationale: The Murphy sign is a specific physical examination finding associated with
acute cholecystitis. It is elicited by palpating the right upper quadrant while the patient
takes a deep breath, causing the inflamed gallbladder to contact the examining hand and
resulting in a sudden cessation of inspiration. This finding is highly suggestive of
gallbladder inflammation and warrants further imaging like an ultrasound.
2. When performing an abdominal assessment on a patient complaining of pain, in which
order should the physical examination techniques be conducted?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
D. Inspection, Percussion, Palpation, Auscultation
Answer: A
Rationale: The standard sequence for abdominal assessment is inspection, followed by
auscultation, percussion, and finally palpation. Auscultation is performed before
percussion and palpation because these latter maneuvers can alter the frequency and
intensity of bowel sounds. Adhering to this order ensures the most accurate assessment of
the patient’s baseline abdominal activity.
3. A practitioner is evaluating a patient for suspected appendicitis and performs a maneuver
where they apply pressure to the left lower quadrant, which results in pain in the right lower
quadrant. What is this sign called?
A. Psoas sign
B. Rovsing sign
,C. Obturator sign
D. Markle sign
Answer: B
Rationale: Rovsing sign is positive when pressure applied to the left lower quadrant
causes referred pain in the right lower quadrant. This occurs due to the displacement of gas
or the stretching of the peritoneum which irritates the inflamed appendix. It is a common
finding in clinical cases of acute appendicitis along with other signs like McBurney’s point
tenderness.
4. Which of the following descriptions best characterizes ‘borborygmi’ heard during
abdominal auscultation?
A. Hyperactive, prolonged bowel sounds often heard as stomach growling
B. High-pitched, tinkling sounds indicating obstruction
C. Soft, low-pitched vascular sounds indicating turbulence
D. Completely absent sounds for at least 5 minutes
Answer: A
Rationale: Borborygmi are hyperactive, loud, and prolonged bowel sounds that are often
described as stomach growling. They are typically heard in individuals who are hungry or
have increased intestinal motility. While they can be normal, frequent borborygmi may also
be associated with early intestinal obstruction or gastroenteritis.
5. While percussing the abdomen, the practitioner hears a dull note in the left midaxillary
line. What does this finding most likely indicate?
A. Gas in the stomach
B. A normal finding for the spleen
C. Splenomegaly
D. Fecal impaction in the descending colon
Answer: C
Rationale: A dull percussion note in the left midaxillary line, specifically in the area of the
Traube space or the splenic percussion sign, often suggests splenomegaly. Normally, this
area produces tympany due to the presence of the stomach and colon. If the dullness
extends significantly, the clinician must perform deeper palpation to confirm the size of the
spleen.
, 6. A 62-year-old male presents with urinary frequency, urgency, and a weak stream. During a
digital rectal exam, the practitioner notes a symmetrically enlarged, firm, and non-tender
prostate. These findings are most consistent with:
A. Prostate cancer
B. Benign Prostatic Hyperplasia (BPH)
C. Acute prostatitis
D. Urolithiasis
Answer: B
Rationale: Benign Prostatic Hyperplasia (BPH) typically presents as a symmetrically
enlarged, smooth, and firm prostate gland without tenderness. The symptoms of frequency,
urgency, and weak stream are classic obstructive voiding symptoms caused by the
enlargement. In contrast, prostate cancer often presents with nodules or asymmetry, and
prostatitis is usually associated with significant tenderness.
7. A patient presents with ‘tearing’ abdominal pain that radiates to the back. On examination,
the practitioner notes a pulsatile mass in the periumbilical area. What is the most
appropriate next step?
A. Deeply palpate the mass to determine its size
B. Perform a fluid wave test to check for ascites
C. Auscultate for a bruit and then refer for urgent imaging
D. Place the patient in the Trendelenburg position
Answer: C
Rationale: A pulsatile mass in the periumbilical area is a hallmark sign of an abdominal
aortic aneurysm (AAA). Deep palpation should be avoided as it carries a risk of rupture.
The practitioner should auscultate for a bruit and immediately arrange for imaging and
vascular consultation to prevent a catastrophic event.
8. A practitioner is performing a thyroid assessment. Which approach is considered most
effective for palpating the thyroid gland?
A. Standing behind the patient and using the finger pads of both hands
B. Standing in front of the patient and using the thumbs
C. Asking the patient to lie supine and hyperextend the neck
D. Using only one hand while the patient coughs
Answer: A
