NUR 242 EXAM 3 – QUESTIONS AND ANSWERS |
2026/2027 LATEST UPDATE
Unit 7 — Gastrointestinal Elimination & Thoracic/Abdominal Assessment
1. Which assessment technique should the nurse perform first when examining a
client's abdomen?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation
Correct Answer: Inspection
Rationale: Abdominal assessment follows a different sequence from most physical
examinations because palpation and percussion can alter bowel sounds. The recommended
sequence is inspection, auscultation, percussion, and palpation. Inspection allows the nurse
to observe contour, symmetry, skin changes, scars, distention, visible peristalsis, and other
abnormalities before manipulating the abdomen.
2. A client reports severe right-lower-quadrant abdominal pain that began near the
umbilicus. Which condition should the nurse suspect?
A) Cholecystitis
B) Appendicitis
C) Pancreatitis
D) Diverticulitis
Correct Answer: Appendicitis
Rationale: Appendicitis commonly begins with vague periumbilical discomfort that later
localizes to the right lower quadrant as inflammation progresses. Pain often worsens with
movement or coughing. Associated findings can include nausea, vomiting, anorexia, and low-
grade fever. A worsening acute abdomen requires prompt evaluation because perforation
and peritonitis can occur.
3. Which finding is most concerning in a client with suspected intestinal obstruction?
A) Mild nausea
B) Decreased appetite
,C) Absent bowel sounds with severe distention
D) Occasional belching
Correct Answer: Absent bowel sounds with severe distention
Rationale: Severe abdominal distention combined with absent bowel sounds may indicate an
advanced obstruction or compromised intestinal function. Obstruction can prevent passage
of intestinal contents and lead to fluid shifts, vomiting, ischemia, perforation, and peritonitis.
This finding requires prompt assessment and notification of the healthcare provider.
4. Which characteristic is most consistent with Crohn's disease?
A) Continuous inflammation beginning at the rectum
B) Disease limited exclusively to the colon
C) Transmural inflammation with skip lesions
D) Absence of abdominal pain
Correct Answer: Transmural inflammation with skip lesions
Rationale: Crohn's disease can affect any portion of the gastrointestinal tract and
characteristically produces transmural inflammation with skip lesions, meaning diseased
areas are separated by relatively normal tissue. Ulcerative colitis typically produces
continuous mucosal inflammation beginning in the rectum. These differences are important
when interpreting symptoms, complications, and treatment.
5. Which complication is particularly associated with ulcerative colitis?
A) Toxic megacolon
B) Renal failure
C) Esophageal varices
D) Pyloric stenosis
Correct Answer: Toxic megacolon
Rationale: Toxic megacolon is a potentially life-threatening complication of severe
inflammatory bowel disease, particularly ulcerative colitis. The colon becomes markedly
dilated and systemic toxicity may develop, including fever, tachycardia, abdominal
tenderness, and hypotension. Rapid recognition is essential because perforation, sepsis, and
circulatory collapse may occur.
6. A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which additional finding would the nurse expect?
A) Bradycardia
,B) Elevated pancreatic enzymes
C) Increased bowel sounds
D) Hypothermia
Correct Answer: Elevated pancreatic enzymes
Rationale: Acute pancreatitis commonly causes severe epigastric pain that may radiate to
the back, nausea, vomiting, and elevated pancreatic enzymes such as lipase. The
inflammatory process can produce significant fluid shifts and systemic complications. Nursing
priorities include pain management, monitoring hemodynamic status, assessing respiratory
function, and watching for complications.
7. Which symptom is most characteristic of gastroesophageal reflux disease?
A) Heartburn after meals
B) Bloody diarrhea
C) Right-lower-quadrant rigidity
D) Clay-colored stool
Correct Answer: Heartburn after meals
Rationale: Gastroesophageal reflux disease commonly produces retrosternal burning or
heartburn, particularly after meals or when lying down. Regurgitation may also occur.
Lifestyle interventions include avoiding trigger foods, remaining upright after meals, weight
management when appropriate, and elevating the head of the bed for nighttime symptoms.
8. Which teaching is appropriate for a client with a hiatal hernia?
A) Lie flat immediately after meals
B) Eat very large meals
C) Remain upright after eating
D) Increase alcohol consumption
Correct Answer: Remain upright after eating
Rationale: Remaining upright after meals helps reduce reflux associated with a hiatal hernia.
Clients may also benefit from smaller meals, avoiding foods that trigger symptoms, weight
management when appropriate, and elevating the head of the bed. Lying flat immediately
after eating can increase reflux by facilitating movement of gastric contents into the
esophagus.
9. Which stool characteristic should the nurse associate with an upper gastrointestinal
bleed?
, A) Clay-colored stool
B) Melena
C) Steatorrhea
D) Green stool
Correct Answer: Melena
Rationale: Melena refers to black, tarry, often foul-smelling stool caused by digested blood,
commonly from an upper gastrointestinal source. Hematemesis may also occur. Significant
gastrointestinal bleeding can lead to hypovolemia and shock, so the nurse should monitor
vital signs, mental status, urine output, hemoglobin, and signs of decreased perfusion.
10. A client with hematemesis becomes hypotensive and tachycardic. What is the
priority nursing concern?
A) Constipation
B) Fluid-volume deficit
C) Increased appetite
D) Mild nausea
Correct Answer: Fluid-volume deficit
Rationale: Hematemesis accompanied by hypotension and tachycardia suggests significant
blood loss and possible hypovolemic shock. The immediate priority is circulation and
restoration of adequate perfusion. The nurse should rapidly assess airway and breathing,
establish or maintain intravenous access as ordered, monitor hemodynamics, and prepare
for fluid or blood replacement.
11. Which assessment finding is most suggestive of peritonitis?
A) Soft, nontender abdomen
B) Board-like abdominal rigidity
C) Increased appetite
D) Normal bowel sounds
Correct Answer: Board-like abdominal rigidity
Rationale: Board-like rigidity is a classic sign of peritoneal irritation and may occur with
perforation, severe infection, or other acute abdominal emergencies. Peritonitis can progress
rapidly to sepsis and shock. The nurse should avoid unnecessary manipulation of the
abdomen and promptly report concerning findings while monitoring the client's overall
stability.
2026/2027 LATEST UPDATE
Unit 7 — Gastrointestinal Elimination & Thoracic/Abdominal Assessment
1. Which assessment technique should the nurse perform first when examining a
client's abdomen?
A) Inspection
B) Palpation
C) Percussion
D) Auscultation
Correct Answer: Inspection
Rationale: Abdominal assessment follows a different sequence from most physical
examinations because palpation and percussion can alter bowel sounds. The recommended
sequence is inspection, auscultation, percussion, and palpation. Inspection allows the nurse
to observe contour, symmetry, skin changes, scars, distention, visible peristalsis, and other
abnormalities before manipulating the abdomen.
2. A client reports severe right-lower-quadrant abdominal pain that began near the
umbilicus. Which condition should the nurse suspect?
A) Cholecystitis
B) Appendicitis
C) Pancreatitis
D) Diverticulitis
Correct Answer: Appendicitis
Rationale: Appendicitis commonly begins with vague periumbilical discomfort that later
localizes to the right lower quadrant as inflammation progresses. Pain often worsens with
movement or coughing. Associated findings can include nausea, vomiting, anorexia, and low-
grade fever. A worsening acute abdomen requires prompt evaluation because perforation
and peritonitis can occur.
3. Which finding is most concerning in a client with suspected intestinal obstruction?
A) Mild nausea
B) Decreased appetite
,C) Absent bowel sounds with severe distention
D) Occasional belching
Correct Answer: Absent bowel sounds with severe distention
Rationale: Severe abdominal distention combined with absent bowel sounds may indicate an
advanced obstruction or compromised intestinal function. Obstruction can prevent passage
of intestinal contents and lead to fluid shifts, vomiting, ischemia, perforation, and peritonitis.
This finding requires prompt assessment and notification of the healthcare provider.
4. Which characteristic is most consistent with Crohn's disease?
A) Continuous inflammation beginning at the rectum
B) Disease limited exclusively to the colon
C) Transmural inflammation with skip lesions
D) Absence of abdominal pain
Correct Answer: Transmural inflammation with skip lesions
Rationale: Crohn's disease can affect any portion of the gastrointestinal tract and
characteristically produces transmural inflammation with skip lesions, meaning diseased
areas are separated by relatively normal tissue. Ulcerative colitis typically produces
continuous mucosal inflammation beginning in the rectum. These differences are important
when interpreting symptoms, complications, and treatment.
5. Which complication is particularly associated with ulcerative colitis?
A) Toxic megacolon
B) Renal failure
C) Esophageal varices
D) Pyloric stenosis
Correct Answer: Toxic megacolon
Rationale: Toxic megacolon is a potentially life-threatening complication of severe
inflammatory bowel disease, particularly ulcerative colitis. The colon becomes markedly
dilated and systemic toxicity may develop, including fever, tachycardia, abdominal
tenderness, and hypotension. Rapid recognition is essential because perforation, sepsis, and
circulatory collapse may occur.
6. A client with acute pancreatitis reports severe epigastric pain radiating to the back.
Which additional finding would the nurse expect?
A) Bradycardia
,B) Elevated pancreatic enzymes
C) Increased bowel sounds
D) Hypothermia
Correct Answer: Elevated pancreatic enzymes
Rationale: Acute pancreatitis commonly causes severe epigastric pain that may radiate to
the back, nausea, vomiting, and elevated pancreatic enzymes such as lipase. The
inflammatory process can produce significant fluid shifts and systemic complications. Nursing
priorities include pain management, monitoring hemodynamic status, assessing respiratory
function, and watching for complications.
7. Which symptom is most characteristic of gastroesophageal reflux disease?
A) Heartburn after meals
B) Bloody diarrhea
C) Right-lower-quadrant rigidity
D) Clay-colored stool
Correct Answer: Heartburn after meals
Rationale: Gastroesophageal reflux disease commonly produces retrosternal burning or
heartburn, particularly after meals or when lying down. Regurgitation may also occur.
Lifestyle interventions include avoiding trigger foods, remaining upright after meals, weight
management when appropriate, and elevating the head of the bed for nighttime symptoms.
8. Which teaching is appropriate for a client with a hiatal hernia?
A) Lie flat immediately after meals
B) Eat very large meals
C) Remain upright after eating
D) Increase alcohol consumption
Correct Answer: Remain upright after eating
Rationale: Remaining upright after meals helps reduce reflux associated with a hiatal hernia.
Clients may also benefit from smaller meals, avoiding foods that trigger symptoms, weight
management when appropriate, and elevating the head of the bed. Lying flat immediately
after eating can increase reflux by facilitating movement of gastric contents into the
esophagus.
9. Which stool characteristic should the nurse associate with an upper gastrointestinal
bleed?
, A) Clay-colored stool
B) Melena
C) Steatorrhea
D) Green stool
Correct Answer: Melena
Rationale: Melena refers to black, tarry, often foul-smelling stool caused by digested blood,
commonly from an upper gastrointestinal source. Hematemesis may also occur. Significant
gastrointestinal bleeding can lead to hypovolemia and shock, so the nurse should monitor
vital signs, mental status, urine output, hemoglobin, and signs of decreased perfusion.
10. A client with hematemesis becomes hypotensive and tachycardic. What is the
priority nursing concern?
A) Constipation
B) Fluid-volume deficit
C) Increased appetite
D) Mild nausea
Correct Answer: Fluid-volume deficit
Rationale: Hematemesis accompanied by hypotension and tachycardia suggests significant
blood loss and possible hypovolemic shock. The immediate priority is circulation and
restoration of adequate perfusion. The nurse should rapidly assess airway and breathing,
establish or maintain intravenous access as ordered, monitor hemodynamics, and prepare
for fluid or blood replacement.
11. Which assessment finding is most suggestive of peritonitis?
A) Soft, nontender abdomen
B) Board-like abdominal rigidity
C) Increased appetite
D) Normal bowel sounds
Correct Answer: Board-like abdominal rigidity
Rationale: Board-like rigidity is a classic sign of peritoneal irritation and may occur with
perforation, severe infection, or other acute abdominal emergencies. Peritonitis can progress
rapidly to sepsis and shock. The nurse should avoid unnecessary manipulation of the
abdomen and promptly report concerning findings while monitoring the client's overall
stability.
