W I L K ES U N I V ER S I T Y PA S S A N S C H OOL OF
NURSING
NSG 500 Advanced
Health Assessment
Exam 2
A comprehensive 100-question examination covering
abdominal, musculoskeletal, neurological, breast, axillae,
and genitourinary assessment, plus clinical decision-
making and integrated scenarios for the 2026-2027
curriculum.
100 Questions | Verified Answers
Latest Edition
C O M P L E T E R E V I E W | G R A D E A P R E P A R AT I O N
, NSG 500 Advanced Health Assessment Exam 2 | Wilkes University
Section 1: Abdominal and Gastrointestinal Assessment
1. A nurse practitioner is performing an abdominal assessment on a 45-year-old patient. According to the
IAPP examination sequence, which technique should be performed first?
A. A. Auscultation
B. B. Palpation
C. C. Percussion
D. D. Inspection [CORRECT]
Answer: D
Rationale: The IAPP sequence stands for Inspection, Auscultation, Percussion, Palpation. Inspection is always performed first
to observe the abdomen for contours, scars, lesions, and distension before any physical manipulation that could alter findings.
2. During an abdominal assessment, a nurse practitioner auscultates the abdomen of a fasting adult
patient and notes bowel sounds occurring approximately every 10 seconds in all four quadrants. How
should these findings be documented?
A. A. Hyperactive bowel sounds
B. B. Hypoactive bowel sounds
C. C. Normal bowel sounds [CORRECT]
D. D. Absent bowel sounds
Answer: C
Rationale: Normal bowel sounds occur 5 to 30 times per minute. Bowel sounds every 10 seconds equal approximately 6 per
minute, which falls within the normal range. Hyperactive sounds are more frequent, and hypoactive sounds are fewer than 5
per minute.
3. A 38-year-old female presents with right upper quadrant pain, fever, and nausea after eating a fatty
meal. When the nurse practitioner performs Murphy's sign assessment, the patient abruptly stops
breathing during deep inspiration when the examiner's fingers are positioned at the midclavicular line
below the costal margin. What condition is most likely indicated by a positive Murphy's sign?
A. A. Acute pancreatitis
B. B. Acute cholecystitis [CORRECT]
C. C. Hepatitis
D. D. Peptic ulcer disease
Answer: B
Rationale: Murphy's sign is positive when inspiration is arrested due to pain as the inflamed gallbladder contacts the examiner's
fingers during deep palpation in the right upper quadrant. This is a classic finding in acute cholecystitis, which is commonly
triggered by fatty meals.
4. A 22-year-old male presents to the emergency department with periumbilical pain that has migrated to
the right lower quadrant over the past 12 hours. The nurse practitioner palpates the area at McBurney's
point and the patient reports significant tenderness. Which condition is most strongly suggested by pain at
McBurney's point?
A. A. Diverticulitis
B. B. Acute appendicitis [CORRECT]
C. C. Ovarian torsion
D. D. Cholecystitis
Answer: B
Rationale: McBurney's point is located one-third the distance from the anterior superior iliac spine to the umbilicus in the right
lower quadrant. Tenderness at this point is the classic hallmark of acute appendicitis, especially when the pain has migrated
from the periumbilical region.
5. A nurse practitioner is assessing a patient with suspected ascites. Which percussion technique is used to
detect the presence of ascitic fluid in the abdominal cavity?
A. A. Liver span assessment
1
, NSG 500 Advanced Health Assessment Exam 2 | Wilkes University
B. B. Shifting dullness [CORRECT]
C. C. Tympanic percussion
D. D. Costovertebral angle percussion
Answer: B
Rationale: Shifting dullness is performed by percussing the abdomen with the patient supine to identify dullness, then having the
patient roll to one side and percussing again. If the area of dullness shifts to the dependent side, ascites is present. Liver span
and CVA percussion assess different conditions.
6. During a routine physical examination, the nurse practitioner percusses the liver span at the
midclavicular line. The upper border is at the fifth intercostal space and the lower border is at the costal
margin. The total span measures 14 cm. How should this finding be interpreted?
A. A. Normal liver span
B. B. Hepatomegaly [CORRECT]
C. C. Hepatic atrophy
D. D. Inconclusive measurement
Answer: B
Rationale: Normal liver span at the midclavicular line is 6 to 12 cm in adults. A span of 14 cm exceeds the upper limit of
normal, indicating hepatomegaly, which may be caused by conditions such as hepatitis, fatty liver, congestive heart failure, or
malignancy.
7. A 50-year-old patient with a history of alcohol abuse presents for a physical examination. The nurse
practitioner palpates the left upper quadrant and feels a mass that descends on inspiration. The patient
reports early satiety and fullness in the left upper abdomen. Which organ is most likely enlarged?
A. A. Liver
B. B. Spleen [CORRECT]
C. C. Kidney
D. D. Stomach
Answer: B
Rationale: An enlarged spleen (splenomegaly) descends inferiorly and medially on inspiration and can be palpated in the left
upper quadrant. In a patient with alcohol abuse, splenomegaly may be associated with portal hypertension and cirrhosis. The
liver is in the right upper quadrant.
8. A patient with known cirrhosis presents with dilated, tortuous veins radiating from the umbilicus. The
nurse practitioner recognizes this finding as caput medusae. What pathophysiological mechanism
explains this finding?
A. A. Increased central venous pressure
B. B. Portal hypertension with collateral venous circulation [CORRECT]
C. C. Inferior vena cava obstruction
D. D. Hepatic artery dilation
Answer: B
Rationale: Caput medusae occurs when portal hypertension develops secondary to liver cirrhosis, causing blood to be shunted
through collateral veins around the umbilicus (paraumbilical veins) to reach the systemic circulation. This creates the
characteristic radiating pattern of dilated abdominal wall veins.
9. A 52-year-old patient reports chronic heartburn that worsens when lying down after meals and
occasionally wakes him from sleep. He has tried over-the-counter antacids with partial relief. Endoscopy
reveals columnar epithelium replacing the normal squamous epithelium in the distal esophagus. What is
the most likely diagnosis?
A. A. Esophageal varices
B. B. Barrett esophagus [CORRECT]
C. C. Esophageal spasm
D. D. Achalasia
Answer: B
2
NURSING
NSG 500 Advanced
Health Assessment
Exam 2
A comprehensive 100-question examination covering
abdominal, musculoskeletal, neurological, breast, axillae,
and genitourinary assessment, plus clinical decision-
making and integrated scenarios for the 2026-2027
curriculum.
100 Questions | Verified Answers
Latest Edition
C O M P L E T E R E V I E W | G R A D E A P R E P A R AT I O N
, NSG 500 Advanced Health Assessment Exam 2 | Wilkes University
Section 1: Abdominal and Gastrointestinal Assessment
1. A nurse practitioner is performing an abdominal assessment on a 45-year-old patient. According to the
IAPP examination sequence, which technique should be performed first?
A. A. Auscultation
B. B. Palpation
C. C. Percussion
D. D. Inspection [CORRECT]
Answer: D
Rationale: The IAPP sequence stands for Inspection, Auscultation, Percussion, Palpation. Inspection is always performed first
to observe the abdomen for contours, scars, lesions, and distension before any physical manipulation that could alter findings.
2. During an abdominal assessment, a nurse practitioner auscultates the abdomen of a fasting adult
patient and notes bowel sounds occurring approximately every 10 seconds in all four quadrants. How
should these findings be documented?
A. A. Hyperactive bowel sounds
B. B. Hypoactive bowel sounds
C. C. Normal bowel sounds [CORRECT]
D. D. Absent bowel sounds
Answer: C
Rationale: Normal bowel sounds occur 5 to 30 times per minute. Bowel sounds every 10 seconds equal approximately 6 per
minute, which falls within the normal range. Hyperactive sounds are more frequent, and hypoactive sounds are fewer than 5
per minute.
3. A 38-year-old female presents with right upper quadrant pain, fever, and nausea after eating a fatty
meal. When the nurse practitioner performs Murphy's sign assessment, the patient abruptly stops
breathing during deep inspiration when the examiner's fingers are positioned at the midclavicular line
below the costal margin. What condition is most likely indicated by a positive Murphy's sign?
A. A. Acute pancreatitis
B. B. Acute cholecystitis [CORRECT]
C. C. Hepatitis
D. D. Peptic ulcer disease
Answer: B
Rationale: Murphy's sign is positive when inspiration is arrested due to pain as the inflamed gallbladder contacts the examiner's
fingers during deep palpation in the right upper quadrant. This is a classic finding in acute cholecystitis, which is commonly
triggered by fatty meals.
4. A 22-year-old male presents to the emergency department with periumbilical pain that has migrated to
the right lower quadrant over the past 12 hours. The nurse practitioner palpates the area at McBurney's
point and the patient reports significant tenderness. Which condition is most strongly suggested by pain at
McBurney's point?
A. A. Diverticulitis
B. B. Acute appendicitis [CORRECT]
C. C. Ovarian torsion
D. D. Cholecystitis
Answer: B
Rationale: McBurney's point is located one-third the distance from the anterior superior iliac spine to the umbilicus in the right
lower quadrant. Tenderness at this point is the classic hallmark of acute appendicitis, especially when the pain has migrated
from the periumbilical region.
5. A nurse practitioner is assessing a patient with suspected ascites. Which percussion technique is used to
detect the presence of ascitic fluid in the abdominal cavity?
A. A. Liver span assessment
1
, NSG 500 Advanced Health Assessment Exam 2 | Wilkes University
B. B. Shifting dullness [CORRECT]
C. C. Tympanic percussion
D. D. Costovertebral angle percussion
Answer: B
Rationale: Shifting dullness is performed by percussing the abdomen with the patient supine to identify dullness, then having the
patient roll to one side and percussing again. If the area of dullness shifts to the dependent side, ascites is present. Liver span
and CVA percussion assess different conditions.
6. During a routine physical examination, the nurse practitioner percusses the liver span at the
midclavicular line. The upper border is at the fifth intercostal space and the lower border is at the costal
margin. The total span measures 14 cm. How should this finding be interpreted?
A. A. Normal liver span
B. B. Hepatomegaly [CORRECT]
C. C. Hepatic atrophy
D. D. Inconclusive measurement
Answer: B
Rationale: Normal liver span at the midclavicular line is 6 to 12 cm in adults. A span of 14 cm exceeds the upper limit of
normal, indicating hepatomegaly, which may be caused by conditions such as hepatitis, fatty liver, congestive heart failure, or
malignancy.
7. A 50-year-old patient with a history of alcohol abuse presents for a physical examination. The nurse
practitioner palpates the left upper quadrant and feels a mass that descends on inspiration. The patient
reports early satiety and fullness in the left upper abdomen. Which organ is most likely enlarged?
A. A. Liver
B. B. Spleen [CORRECT]
C. C. Kidney
D. D. Stomach
Answer: B
Rationale: An enlarged spleen (splenomegaly) descends inferiorly and medially on inspiration and can be palpated in the left
upper quadrant. In a patient with alcohol abuse, splenomegaly may be associated with portal hypertension and cirrhosis. The
liver is in the right upper quadrant.
8. A patient with known cirrhosis presents with dilated, tortuous veins radiating from the umbilicus. The
nurse practitioner recognizes this finding as caput medusae. What pathophysiological mechanism
explains this finding?
A. A. Increased central venous pressure
B. B. Portal hypertension with collateral venous circulation [CORRECT]
C. C. Inferior vena cava obstruction
D. D. Hepatic artery dilation
Answer: B
Rationale: Caput medusae occurs when portal hypertension develops secondary to liver cirrhosis, causing blood to be shunted
through collateral veins around the umbilicus (paraumbilical veins) to reach the systemic circulation. This creates the
characteristic radiating pattern of dilated abdominal wall veins.
9. A 52-year-old patient reports chronic heartburn that worsens when lying down after meals and
occasionally wakes him from sleep. He has tried over-the-counter antacids with partial relief. Endoscopy
reveals columnar epithelium replacing the normal squamous epithelium in the distal esophagus. What is
the most likely diagnosis?
A. A. Esophageal varices
B. B. Barrett esophagus [CORRECT]
C. C. Esophageal spasm
D. D. Achalasia
Answer: B
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