NR509 Advanced Health Assessment Final Exam
Questions and Correct Answers, Complete
Solution.
1) Regions of the abdomen
-right hypochondriac, epigastric, left hypochondriac
-right lumbar, umbilical, left lumbar
-right iliac/inguinal, hypogastric, left iliac/inguinal
2) Structures in RUQ
liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, and head of pancreas
3) Structures in LUQ
Spleen, splenic flexure of colon, stomach, and body and tail of pancreas
4) Structures in LLQ
Sigmoid colon, descending colon, left ovary
5) Structures in RLQ
Cecum, appendix, ascending colon, terminal ileum, and right ovary
6) Bone in the abdomen that protects the stomach
Xiphoid process
7) Ribs that protect most of the spleen
Left 9th, 10th, 11th
8) Palpating the pancreas in healthy adults
Cannot be detected
9) Where do you check for kidney tenderness?
At the costovertebral angle (CVA)
10) Where is the costovertebral angle?
Formed by the lower border of the 12th rib, and the transverse process of the upper lumbar
vertebrae
11) What can be palpated above the symphysis pubis?
A distended bladder
12) Key info to obtain for someone with abdominal pain: Onset
The timing as to when the patient's symptoms occurred and it's progression can help determine
the likelihood of an emergent cause
13) Key info to obtain for someone with abdominal pain: location
The knowledge of where the viscera are positioned in the abdominal cavity is a key part in
narrowing the differential diagnosis to the potential affected organs
14) Key info to obtain for someone with abdominal pain: character
Determining underlying pathophysiologic process of the patient's pain (visceral vs somatic) may
help in elucidating the cause
15) Key info to obtain for someone with abdominal pain: radiation
,Presence or absence of the pain migration can help determine the cause, especially in disease,
processes involving the liver, biliary, tract, and appendix.
16) Key info to obtain for someone with abdominal pain: palliative, provoking, or
associated factors
These may provide insight into the differential diagnosis. Examples include relief of pain by
vomiting, increased pain with eating, anorexia, fever, diarrhea, and constipation.
17) Key info to obtain for someone with abdominal pain: Past medical, surgical, and social
history
Can help provide clues to possible causes. Examples include prior similar pain episodes in the
past; Presence of comorbid conditions, such as diabetes or atrial fibrillation; medication use like
NSAIDs; history of previous abdominal surgery; smoking and illicit drug use, history of STI's, and
infertility.
18) visceral pain
-Occurs when hollow abdominal organs, such as the intestines or biliary tree contract unusually
forcefully, or are distended or stretched.
-solid organs, such as the liver, can also become painful when they're capsules are stretched
-Pain is typically nonspecific and difficult to localize
-Palpable near the midline at levels that vary according to the structure involved
-ischemia can stimulate these pain fibers
-Pain varies in quality and may be gnawing, cramping, or aching. As the pain, progressive,
systemic symptoms, such a sweating, pallor, nausea, vomiting, and restlessness can follow.
19) Visceral pain in the right upper quadrant suggests
Liver distention against its capsule from various causes of hepatitis, including alcoholic
hepatitis, or biliary pathology
20) Visceral periumbilical pain can be suggestive of...
Early acute appendicitis from distention of an inflamed appendix.
It gradually changes to parietal pain in the right lower quadrant from inflammation of the
adjacent parietal peritoneum to
21) Pain disproportionate to physical findings in the abdomen
22) Suspicious for intestinal mesenteric ischemia
somatic pain (parietal)
-Originates from inflammation of the parietal, peritoneum, a.k.a. peritonitis, which can be
localized or diffuse
-steady, aching pain that is usually more severe than visceral pain and more precisely located
over and involves structure.
-Typically aggravated by movement or coughing
, 23) -Patients with this type of pain prefer to lie still patients
with colicky pain from renal stone tend to..... Move
around frequently, trying to find a comfortable position
referred pain
-Felt in more distant sites that are innervated at approximately the same spinal levels as the
disorder structures
-often develops as the initial pain becomes more intense, and seems to radiate or travel from
the initial site.
24) -Palpation at the site of referred pain often does not result in tenderness
Pain of duodenal or pancreatic origin may be referred to....
The back
25) Pain from the biliary tree may radiate to
The rate scapular region or the right person thorax
26) Pain from pleurisy or inferior wall MI may be referred to
Epigastric reason
27) Pain may also be referred to the abdomen from the….
Chest, spine, or pelvis discomfort
Subjective negative feeling that is non-painful. Can include various symptoms, such as bloating,
nausea, upper abdominal fullness, and heartburn.
28) Dyspepsia
29) Chronic or recurrent discomfort or pain centered in the upper abdomen, characterized
by epigastric pain or burning (or both) parentheses and postprandial fullness or early
satiety (or both)
30) Functional, or non-ulcer, dyspepsia
Three month history of nonspecific, upper abdominal discomfort or nausea, not attributed to
structural abnormalities or peptic also disease.
Symptoms usually recurring and present for more than six months
Multifactoral causes include delayed gastric emptying, PUD with or without H. pylori, PUD, IBS,
and psychosocial factors.
31) If a patient reports heartburn and ever let us regurgitation together more than once a
week...
The accuracy of diagnosing GERD is over 90% RUQ pain
is associated with...
...pathology with the biliary tree and the liver
32) Risk factor for GERD
reduced salivary flow, which increases mucosal acid exposure by dampening the actions
of the bicarbonate buffer; obesity; delayed gastric emptying; selected medications;
hiatal hernia and increased intraabdominal pressure heartburn
33) rising retrosternal burning pain or discomfort occurring weekly or more often
what aggravates heartburn
Questions and Correct Answers, Complete
Solution.
1) Regions of the abdomen
-right hypochondriac, epigastric, left hypochondriac
-right lumbar, umbilical, left lumbar
-right iliac/inguinal, hypogastric, left iliac/inguinal
2) Structures in RUQ
liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, and head of pancreas
3) Structures in LUQ
Spleen, splenic flexure of colon, stomach, and body and tail of pancreas
4) Structures in LLQ
Sigmoid colon, descending colon, left ovary
5) Structures in RLQ
Cecum, appendix, ascending colon, terminal ileum, and right ovary
6) Bone in the abdomen that protects the stomach
Xiphoid process
7) Ribs that protect most of the spleen
Left 9th, 10th, 11th
8) Palpating the pancreas in healthy adults
Cannot be detected
9) Where do you check for kidney tenderness?
At the costovertebral angle (CVA)
10) Where is the costovertebral angle?
Formed by the lower border of the 12th rib, and the transverse process of the upper lumbar
vertebrae
11) What can be palpated above the symphysis pubis?
A distended bladder
12) Key info to obtain for someone with abdominal pain: Onset
The timing as to when the patient's symptoms occurred and it's progression can help determine
the likelihood of an emergent cause
13) Key info to obtain for someone with abdominal pain: location
The knowledge of where the viscera are positioned in the abdominal cavity is a key part in
narrowing the differential diagnosis to the potential affected organs
14) Key info to obtain for someone with abdominal pain: character
Determining underlying pathophysiologic process of the patient's pain (visceral vs somatic) may
help in elucidating the cause
15) Key info to obtain for someone with abdominal pain: radiation
,Presence or absence of the pain migration can help determine the cause, especially in disease,
processes involving the liver, biliary, tract, and appendix.
16) Key info to obtain for someone with abdominal pain: palliative, provoking, or
associated factors
These may provide insight into the differential diagnosis. Examples include relief of pain by
vomiting, increased pain with eating, anorexia, fever, diarrhea, and constipation.
17) Key info to obtain for someone with abdominal pain: Past medical, surgical, and social
history
Can help provide clues to possible causes. Examples include prior similar pain episodes in the
past; Presence of comorbid conditions, such as diabetes or atrial fibrillation; medication use like
NSAIDs; history of previous abdominal surgery; smoking and illicit drug use, history of STI's, and
infertility.
18) visceral pain
-Occurs when hollow abdominal organs, such as the intestines or biliary tree contract unusually
forcefully, or are distended or stretched.
-solid organs, such as the liver, can also become painful when they're capsules are stretched
-Pain is typically nonspecific and difficult to localize
-Palpable near the midline at levels that vary according to the structure involved
-ischemia can stimulate these pain fibers
-Pain varies in quality and may be gnawing, cramping, or aching. As the pain, progressive,
systemic symptoms, such a sweating, pallor, nausea, vomiting, and restlessness can follow.
19) Visceral pain in the right upper quadrant suggests
Liver distention against its capsule from various causes of hepatitis, including alcoholic
hepatitis, or biliary pathology
20) Visceral periumbilical pain can be suggestive of...
Early acute appendicitis from distention of an inflamed appendix.
It gradually changes to parietal pain in the right lower quadrant from inflammation of the
adjacent parietal peritoneum to
21) Pain disproportionate to physical findings in the abdomen
22) Suspicious for intestinal mesenteric ischemia
somatic pain (parietal)
-Originates from inflammation of the parietal, peritoneum, a.k.a. peritonitis, which can be
localized or diffuse
-steady, aching pain that is usually more severe than visceral pain and more precisely located
over and involves structure.
-Typically aggravated by movement or coughing
, 23) -Patients with this type of pain prefer to lie still patients
with colicky pain from renal stone tend to..... Move
around frequently, trying to find a comfortable position
referred pain
-Felt in more distant sites that are innervated at approximately the same spinal levels as the
disorder structures
-often develops as the initial pain becomes more intense, and seems to radiate or travel from
the initial site.
24) -Palpation at the site of referred pain often does not result in tenderness
Pain of duodenal or pancreatic origin may be referred to....
The back
25) Pain from the biliary tree may radiate to
The rate scapular region or the right person thorax
26) Pain from pleurisy or inferior wall MI may be referred to
Epigastric reason
27) Pain may also be referred to the abdomen from the….
Chest, spine, or pelvis discomfort
Subjective negative feeling that is non-painful. Can include various symptoms, such as bloating,
nausea, upper abdominal fullness, and heartburn.
28) Dyspepsia
29) Chronic or recurrent discomfort or pain centered in the upper abdomen, characterized
by epigastric pain or burning (or both) parentheses and postprandial fullness or early
satiety (or both)
30) Functional, or non-ulcer, dyspepsia
Three month history of nonspecific, upper abdominal discomfort or nausea, not attributed to
structural abnormalities or peptic also disease.
Symptoms usually recurring and present for more than six months
Multifactoral causes include delayed gastric emptying, PUD with or without H. pylori, PUD, IBS,
and psychosocial factors.
31) If a patient reports heartburn and ever let us regurgitation together more than once a
week...
The accuracy of diagnosing GERD is over 90% RUQ pain
is associated with...
...pathology with the biliary tree and the liver
32) Risk factor for GERD
reduced salivary flow, which increases mucosal acid exposure by dampening the actions
of the bicarbonate buffer; obesity; delayed gastric emptying; selected medications;
hiatal hernia and increased intraabdominal pressure heartburn
33) rising retrosternal burning pain or discomfort occurring weekly or more often
what aggravates heartburn
