NU 216 Exam 4 | Adult Health I (2026) Q&A | Herzing University
1. Which quadrant of the abdomen contains the appendix?
A) Right upper quadrant
B) Left upper quadrant
C) Right lower quadrant
D) Left lower quadrant
Correct Answer: Right lower quadrant
Rationale: The appendix is located in the right lower quadrant (RLQ) of the abdomen. The right
upper quadrant contains the liver and gallbladder, the left upper quadrant contains the stomach
and spleen, and the left lower quadrant contains the sigmoid colon. RLQ pain with rebound
tenderness is classic for appendicitis.
2. Which organ is located in the left upper quadrant of the abdomen?
A) Liver
B) Gallbladder
C) Spleen
D) Appendix
Correct Answer: Spleen
Rationale: The spleen is located in the left upper quadrant (LUQ), along with the stomach, left
lobe of the liver, body of the pancreas, and splenic flexure of the colon. The liver and gallbladder
are in the right upper quadrant, and the appendix is in the right lower quadrant. The spleen is
normally not palpable unless enlarged.
3. Which sequence is correct for abdominal assessment?
,A) Inspection, palpation, percussion, auscultation
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Palpation, percussion, auscultation, inspection
Correct Answer: Inspection, auscultation, percussion, palpation
Rationale: For abdominal assessment, auscultation is performed before percussion and
palpation because manipulating the abdomen can alter bowel sounds. The correct sequence is
inspection, auscultation, percussion, and palpation. This modified order ensures accurate
assessment of bowel sounds.
4. Which finding during abdominal assessment suggests ascites?
A) Hyperresonance
B) Shifting dullness
C) Tympany
D) Absent bowel sounds
Correct Answer: Shifting dullness
Rationale: Ascites causes shifting dullness, in which the area of dullness changes with patient
repositioning due to free fluid in the peritoneal cavity. Hyperresonance suggests excess gas,
tympany is normal over gas-filled structures, and absent bowel sounds suggest ileus or
obstruction. Shifting dullness and a fluid wave are key signs of ascites.
5. Which finding during abdominal assessment is abnormal and requires immediate evaluation?
A) Five to ten bowel sounds per minute
B) High-pitched tinkling sounds
,C) Absent bowel sounds
D) Borborygmi after eating
Correct Answer: Absent bowel sounds
Rationale: Absent bowel sounds are abnormal and suggest paralytic ileus or peritonitis,
requiring immediate evaluation. Five to ten sounds per minute is normal, high-pitched tinkling
sounds may indicate early obstruction, and borborygmi after eating is a normal hyperactive
response. Auscultate for 5 minutes before documenting absent sounds.
6. Which symptom is most characteristic of gastroesophageal reflux disease (GERD)?
A) Epigastric pain that improves with eating
B) Heartburn and regurgitation, especially after meals and when lying down
C) Bloody diarrhea
D) Right lower quadrant pain
Correct Answer: Heartburn and regurgitation, especially after meals and when lying down
Rationale: GERD causes heartburn (pyrosis) and regurgitation of gastric contents, often
worsening after meals, when lying down, or with bending. Epigastric pain that improves with
eating suggests peptic ulcer disease, bloody diarrhea suggests inflammatory bowel disease, and
RLQ pain suggests appendicitis. Lifestyle changes and proton pump inhibitors are mainstays of
therapy.
7. Which instruction should the nurse include when teaching a patient with GERD?
A) Lie down immediately after eating
B) Eat large meals before bedtime
C) Elevate the head of the bed and avoid food close to bedtime
, D) Wear tight clothing to prevent reflux
Correct Answer: Elevate the head of the bed and avoid food close to bedtime
Rationale: Elevating the head of the bed and avoiding food close to bedtime reduce nocturnal
reflux by using gravity to keep gastric contents down. Lying down immediately after eating,
eating large meals before bedtime, and wearing tight clothing increase intra-abdominal
pressure and worsen reflux. Lifestyle modification is essential in GERD management.
8. Which medication class is first-line for suppressing gastric acid in GERD?
A) Antacids
B) Histamine H2 receptor antagonists
C) Proton pump inhibitors
D) Antibiotics
Correct Answer: Proton pump inhibitors
Rationale: Proton pump inhibitors (PPIs) irreversibly inhibit the hydrogen-potassium ATPase
pump in gastric parietal cells, providing the most potent acid suppression and promoting
healing of erosive esophagitis. Antacids neutralize existing acid but do not suppress secretion,
H2 blockers are less potent, and antibiotics are not used for GERD. PPIs are first-line for
moderate to severe GERD.
9. Which organism is the most common cause of peptic ulcer disease?
A) Escherichia coli
B) Helicobacter pylori
C) Staphylococcus aureus
D) Clostridioides difficile
1. Which quadrant of the abdomen contains the appendix?
A) Right upper quadrant
B) Left upper quadrant
C) Right lower quadrant
D) Left lower quadrant
Correct Answer: Right lower quadrant
Rationale: The appendix is located in the right lower quadrant (RLQ) of the abdomen. The right
upper quadrant contains the liver and gallbladder, the left upper quadrant contains the stomach
and spleen, and the left lower quadrant contains the sigmoid colon. RLQ pain with rebound
tenderness is classic for appendicitis.
2. Which organ is located in the left upper quadrant of the abdomen?
A) Liver
B) Gallbladder
C) Spleen
D) Appendix
Correct Answer: Spleen
Rationale: The spleen is located in the left upper quadrant (LUQ), along with the stomach, left
lobe of the liver, body of the pancreas, and splenic flexure of the colon. The liver and gallbladder
are in the right upper quadrant, and the appendix is in the right lower quadrant. The spleen is
normally not palpable unless enlarged.
3. Which sequence is correct for abdominal assessment?
,A) Inspection, palpation, percussion, auscultation
B) Inspection, auscultation, percussion, palpation
C) Auscultation, inspection, palpation, percussion
D) Palpation, percussion, auscultation, inspection
Correct Answer: Inspection, auscultation, percussion, palpation
Rationale: For abdominal assessment, auscultation is performed before percussion and
palpation because manipulating the abdomen can alter bowel sounds. The correct sequence is
inspection, auscultation, percussion, and palpation. This modified order ensures accurate
assessment of bowel sounds.
4. Which finding during abdominal assessment suggests ascites?
A) Hyperresonance
B) Shifting dullness
C) Tympany
D) Absent bowel sounds
Correct Answer: Shifting dullness
Rationale: Ascites causes shifting dullness, in which the area of dullness changes with patient
repositioning due to free fluid in the peritoneal cavity. Hyperresonance suggests excess gas,
tympany is normal over gas-filled structures, and absent bowel sounds suggest ileus or
obstruction. Shifting dullness and a fluid wave are key signs of ascites.
5. Which finding during abdominal assessment is abnormal and requires immediate evaluation?
A) Five to ten bowel sounds per minute
B) High-pitched tinkling sounds
,C) Absent bowel sounds
D) Borborygmi after eating
Correct Answer: Absent bowel sounds
Rationale: Absent bowel sounds are abnormal and suggest paralytic ileus or peritonitis,
requiring immediate evaluation. Five to ten sounds per minute is normal, high-pitched tinkling
sounds may indicate early obstruction, and borborygmi after eating is a normal hyperactive
response. Auscultate for 5 minutes before documenting absent sounds.
6. Which symptom is most characteristic of gastroesophageal reflux disease (GERD)?
A) Epigastric pain that improves with eating
B) Heartburn and regurgitation, especially after meals and when lying down
C) Bloody diarrhea
D) Right lower quadrant pain
Correct Answer: Heartburn and regurgitation, especially after meals and when lying down
Rationale: GERD causes heartburn (pyrosis) and regurgitation of gastric contents, often
worsening after meals, when lying down, or with bending. Epigastric pain that improves with
eating suggests peptic ulcer disease, bloody diarrhea suggests inflammatory bowel disease, and
RLQ pain suggests appendicitis. Lifestyle changes and proton pump inhibitors are mainstays of
therapy.
7. Which instruction should the nurse include when teaching a patient with GERD?
A) Lie down immediately after eating
B) Eat large meals before bedtime
C) Elevate the head of the bed and avoid food close to bedtime
, D) Wear tight clothing to prevent reflux
Correct Answer: Elevate the head of the bed and avoid food close to bedtime
Rationale: Elevating the head of the bed and avoiding food close to bedtime reduce nocturnal
reflux by using gravity to keep gastric contents down. Lying down immediately after eating,
eating large meals before bedtime, and wearing tight clothing increase intra-abdominal
pressure and worsen reflux. Lifestyle modification is essential in GERD management.
8. Which medication class is first-line for suppressing gastric acid in GERD?
A) Antacids
B) Histamine H2 receptor antagonists
C) Proton pump inhibitors
D) Antibiotics
Correct Answer: Proton pump inhibitors
Rationale: Proton pump inhibitors (PPIs) irreversibly inhibit the hydrogen-potassium ATPase
pump in gastric parietal cells, providing the most potent acid suppression and promoting
healing of erosive esophagitis. Antacids neutralize existing acid but do not suppress secretion,
H2 blockers are less potent, and antibiotics are not used for GERD. PPIs are first-line for
moderate to severe GERD.
9. Which organism is the most common cause of peptic ulcer disease?
A) Escherichia coli
B) Helicobacter pylori
C) Staphylococcus aureus
D) Clostridioides difficile
