3 MAXE • 152 SRUN
Penn State University
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment
E X A M I N AT I O N I I I • A B D O M E N , N U T R I T I O N , M U S CU LO S K E L E TA L & I N T E G U M E N TA R Y SYST E M S
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Exam III TOTAL QUESTIONS 40 Questions
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover abdominal assessment (quadrant anatomy, bowel sounds, special tests), nutritional assessment,
musculoskeletal assessment (range of motion, joint types, muscle strength grading), and integumentary system (skin lesions,
pressure injuries, malignant vs. benign lesions).
▸ Pay close attention to the correct order of abdominal assessment, the characteristics that distinguish rheumatoid arthritis from
osteoarthritis, and the ABCDEF skin assessment rule.
▸ Correct answers and detailed rationales appear below each question for exam preparation.
SECTION I — ABDOMEN, NUTRITION, MUSCULOSKELETAL & Questions 1
INTEGUMENTARY ASSESSMENT – 40
1. What are the GI changes in the older adult?
A. Increased salivation, increased gastric acid secretion, and increased liver size
B. Abdominal wall musculature relaxes; decreased motility; salivation decreases leading to dry mouth and decreased
sense of taste; incidence of gallstones increases; gastric acid secretion decreases; liver size decreases; drug
metabolism slows; constipation
C. Increased motility, increased liver size, and decreased incidence of gallstones
D. No changes occur in the GI system with aging
CORRECT ANSWER B — Abdominal wall musculature relaxes; decreased motility; decreased salivation; increased
gallstone incidence; decreased gastric acid; decreased liver size; slowed drug metabolism;
constipation
RATIONALE Aging produces predictable GI changes: the abdominal wall musculature relaxes (less tone), GI motility
decreases, salivary production decreases leading to dry mouth (xerostomia) and diminished taste, the
incidence of gallstones increases, gastric acid secretion decreases, the liver size decreases with corresponding
reduction in drug metabolism capacity, and constipation becomes more common. These changes have
clinical implications — for example, decreased liver metabolism means drugs may remain active longer in
elderly patients, requiring dose adjustments. The thinner abdominal wall in older adults makes the liver and
kidneys easier to palpate. Common causes of constipation in the elderly include decreased physical activity,
inadequate water intake, low-fiber diet, medication side effects, irritable bowel syndrome, bowel obstruction,
and hypothyroidism.
,2. Why is auscultation performed BEFORE percussion and palpation in an abdominal assessment?
A. Because it is the easiest technique to perform first
B. Because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
C. Because the stethoscope must be warmed before use
D. Because the patient expects this order
CORRECT ANSWER B — Because percussion and palpation can increase peristalsis, which would give a false interpretation
of bowel sounds
RATIONALE The abdominal assessment follows a unique order — Inspection, Auscultation, Percussion, Palpation —
instead of the standard order (Inspection, Palpation, Percussion, Auscultation) used for other body systems.
The reason: percussion and palpation can stimulate peristalsis (involuntary intestinal contractions), which
would alter bowel sounds. If auscultation were performed after palpation, the nurse might hear hyperactive
bowel sounds caused by the palpation itself rather than the patient's true baseline. This would lead to a false
interpretation. Bowel sounds should be auscultated using the DIAPHRAGM of the stethoscope (best for high-
pitched sounds), starting in the RLQ (right lower quadrant — near the ileocecal valve, where bowel sounds are
typically most active) and proceeding systematically through all four quadrants. Normal bowel sounds are
high-pitched, gurgling, irregular, 5–30 per minute.
3. What organs are located in the Right Upper Quadrant (RUQ)?
A. Stomach, spleen, body of pancreas, part of transverse & descending colon
B. Cecum, appendix, right ovary & tube, right ureter, right spermatic cord
C. Liver, gallbladder, duodenum, head of pancreas, part of ascending and transverse colon
D. Part of descending colon, sigmoid colon, left ovary & tube, left ureter, left spermatic cord
CORRECT ANSWER C — Liver, gallbladder, duodenum, head of pancreas, part of ascending and transverse colon
RATIONALE The abdomen is divided into four quadrants for systematic assessment. RUQ: Liver, Gallbladder, Duodenum,
Head of pancreas, Part of ascending and transverse colon. LUQ: Stomach, Spleen, Body of pancreas, Part of
transverse & descending colon. RLQ: Cecum, Appendix, Right ovary & tube, Right ureter, Right spermatic cord.
LLQ: Part of descending colon, Sigmoid colon, Left ovary & tube, Left ureter, Left spermatic cord. Knowing
organ locations is essential for interpreting abnormal assessment findings — for example, pain and rebound
tenderness at McBurney's point (RLQ) suggests appendicitis; Murphy's sign (inspiratory arrest with RUQ
palpation) suggests cholecystitis (gallbladder inflammation). The liver is normally not palpable >1–2 cm
below the costal margin; a palpable liver indicates hepatomegaly. The spleen (LUQ) can rupture easily with
over-palpation.
4. What is the normal percussion sound over an air-filled viscus (hollow organ) in the abdomen?
A. Dullness
B. Resonance
C. Tympany
D. Hyperresonance
CORRECT ANSWER C — Tympany
RATIONALE Tympany is the normal, expected percussion sound over air-filled organs (stomach, intestines). It is a high-
pitched, drum-like sound produced by air in a hollow cavity. Dullness is heard over solid organs (liver, spleen,
full bladder, gravid uterus) or fluid-filled areas. Resonance is the normal percussion sound over healthy lung
tissue. Hyperresonance over the abdomen may indicate excessive gas (distention). This distinction is clinically
useful: shifting from tympany to dullness as the patient changes position may indicate ascites (free fluid in
the peritoneal cavity). A protuberant, tympanic abdomen suggests intestinal distention; a protuberant, dull
abdomen suggests fluid, mass, or organ enlargement.
, 5. What does Blumberg's sign test for and how is it assessed?
A. Gallbladder inflammation — assessed by deep palpation under the right costal margin during inspiration
B. Rebound tenderness — assessed by pressing deeply in the LLQ and quickly releasing; pain upon release may indicate
appendicitis
C. Liver enlargement — assessed by percussion from resonance to dullness
D. Splenic enlargement — assessed by palpating the LUQ
CORRECT ANSWER B — Rebound tenderness — assessed by pressing deeply in the LLQ and quickly releasing; pain upon
release may indicate appendicitis
RATIONALE Blumberg's sign tests for rebound tenderness — a sign of peritoneal inflammation. The nurse presses deeply
and slowly into the abdomen (typically the LLQ, away from the suspected area of inflammation), then quickly
releases the pressure. If the patient experiences pain upon release (not during pressure), the test is positive,
indicating peritoneal irritation. In appendicitis, rebound tenderness may be present at McBurney's point
(RLQ, located by drawing a line from the anterior superior iliac spine to the umbilicus — the point one-third of
the distance from the iliac spine). Murphy's sign tests for gallbladder inflammation: the nurse presses under
the right costal margin during deep inspiration; inspiratory arrest (sudden cessation of breathing due to pain)
is a positive sign. These special tests are used when specific pathology is suspected based on the history and
initial examination.
6. What is the difference between marasmus and kwashiorkor?
A. Marasmus is protein malnutrition; kwashiorkor is calorie malnutrition
B. Marasmus is protein-calorie malnutrition with weight ≤80% standard for height; kwashiorkor is protein malnutrition
caused by diets high in calories but little/no protein
C. Both are identical conditions
D. Marasmus is vitamin deficiency; kwashiorkor is mineral deficiency
CORRECT ANSWER B — Marasmus is protein-calorie malnutrition with weight ≤80% standard; kwashiorkor is protein
malnutrition from high-calorie, low-protein diets
RATIONALE Marasmus and kwashiorkor are two distinct forms of protein-energy malnutrition. Marasmus (protein-calorie
malnutrition) results from inadequate intake of both protein and calories — the patient is severely
underweight (weight ≤80% of standard for height), with marked wasting of muscle and subcutaneous fat, but
typically no edema. Kwashiorkor results from diets adequate in calories but severely deficient in protein —
the patient may have a normal weight or even be overweight but exhibits edema (especially abdominal
distention/"pot belly"), fatty liver, skin lesions, and hair changes. Both conditions are serious and require
medical intervention. Vulnerable groups for undernutrition: infants <1 year, children, pregnant women, recent
immigrants, people with low incomes, hospitalized patients, and aging adults (6 major risk factors: poor
physical/mental health, social isolation, alcoholism, limited functional ability, poverty, polypharmacy).
Penn State University
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment
E X A M I N AT I O N I I I • A B D O M E N , N U T R I T I O N , M U S CU LO S K E L E TA L & I N T E G U M E N TA R Y SYST E M S
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Exam III TOTAL QUESTIONS 40 Questions
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover abdominal assessment (quadrant anatomy, bowel sounds, special tests), nutritional assessment,
musculoskeletal assessment (range of motion, joint types, muscle strength grading), and integumentary system (skin lesions,
pressure injuries, malignant vs. benign lesions).
▸ Pay close attention to the correct order of abdominal assessment, the characteristics that distinguish rheumatoid arthritis from
osteoarthritis, and the ABCDEF skin assessment rule.
▸ Correct answers and detailed rationales appear below each question for exam preparation.
SECTION I — ABDOMEN, NUTRITION, MUSCULOSKELETAL & Questions 1
INTEGUMENTARY ASSESSMENT – 40
1. What are the GI changes in the older adult?
A. Increased salivation, increased gastric acid secretion, and increased liver size
B. Abdominal wall musculature relaxes; decreased motility; salivation decreases leading to dry mouth and decreased
sense of taste; incidence of gallstones increases; gastric acid secretion decreases; liver size decreases; drug
metabolism slows; constipation
C. Increased motility, increased liver size, and decreased incidence of gallstones
D. No changes occur in the GI system with aging
CORRECT ANSWER B — Abdominal wall musculature relaxes; decreased motility; decreased salivation; increased
gallstone incidence; decreased gastric acid; decreased liver size; slowed drug metabolism;
constipation
RATIONALE Aging produces predictable GI changes: the abdominal wall musculature relaxes (less tone), GI motility
decreases, salivary production decreases leading to dry mouth (xerostomia) and diminished taste, the
incidence of gallstones increases, gastric acid secretion decreases, the liver size decreases with corresponding
reduction in drug metabolism capacity, and constipation becomes more common. These changes have
clinical implications — for example, decreased liver metabolism means drugs may remain active longer in
elderly patients, requiring dose adjustments. The thinner abdominal wall in older adults makes the liver and
kidneys easier to palpate. Common causes of constipation in the elderly include decreased physical activity,
inadequate water intake, low-fiber diet, medication side effects, irritable bowel syndrome, bowel obstruction,
and hypothyroidism.
,2. Why is auscultation performed BEFORE percussion and palpation in an abdominal assessment?
A. Because it is the easiest technique to perform first
B. Because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds
C. Because the stethoscope must be warmed before use
D. Because the patient expects this order
CORRECT ANSWER B — Because percussion and palpation can increase peristalsis, which would give a false interpretation
of bowel sounds
RATIONALE The abdominal assessment follows a unique order — Inspection, Auscultation, Percussion, Palpation —
instead of the standard order (Inspection, Palpation, Percussion, Auscultation) used for other body systems.
The reason: percussion and palpation can stimulate peristalsis (involuntary intestinal contractions), which
would alter bowel sounds. If auscultation were performed after palpation, the nurse might hear hyperactive
bowel sounds caused by the palpation itself rather than the patient's true baseline. This would lead to a false
interpretation. Bowel sounds should be auscultated using the DIAPHRAGM of the stethoscope (best for high-
pitched sounds), starting in the RLQ (right lower quadrant — near the ileocecal valve, where bowel sounds are
typically most active) and proceeding systematically through all four quadrants. Normal bowel sounds are
high-pitched, gurgling, irregular, 5–30 per minute.
3. What organs are located in the Right Upper Quadrant (RUQ)?
A. Stomach, spleen, body of pancreas, part of transverse & descending colon
B. Cecum, appendix, right ovary & tube, right ureter, right spermatic cord
C. Liver, gallbladder, duodenum, head of pancreas, part of ascending and transverse colon
D. Part of descending colon, sigmoid colon, left ovary & tube, left ureter, left spermatic cord
CORRECT ANSWER C — Liver, gallbladder, duodenum, head of pancreas, part of ascending and transverse colon
RATIONALE The abdomen is divided into four quadrants for systematic assessment. RUQ: Liver, Gallbladder, Duodenum,
Head of pancreas, Part of ascending and transverse colon. LUQ: Stomach, Spleen, Body of pancreas, Part of
transverse & descending colon. RLQ: Cecum, Appendix, Right ovary & tube, Right ureter, Right spermatic cord.
LLQ: Part of descending colon, Sigmoid colon, Left ovary & tube, Left ureter, Left spermatic cord. Knowing
organ locations is essential for interpreting abnormal assessment findings — for example, pain and rebound
tenderness at McBurney's point (RLQ) suggests appendicitis; Murphy's sign (inspiratory arrest with RUQ
palpation) suggests cholecystitis (gallbladder inflammation). The liver is normally not palpable >1–2 cm
below the costal margin; a palpable liver indicates hepatomegaly. The spleen (LUQ) can rupture easily with
over-palpation.
4. What is the normal percussion sound over an air-filled viscus (hollow organ) in the abdomen?
A. Dullness
B. Resonance
C. Tympany
D. Hyperresonance
CORRECT ANSWER C — Tympany
RATIONALE Tympany is the normal, expected percussion sound over air-filled organs (stomach, intestines). It is a high-
pitched, drum-like sound produced by air in a hollow cavity. Dullness is heard over solid organs (liver, spleen,
full bladder, gravid uterus) or fluid-filled areas. Resonance is the normal percussion sound over healthy lung
tissue. Hyperresonance over the abdomen may indicate excessive gas (distention). This distinction is clinically
useful: shifting from tympany to dullness as the patient changes position may indicate ascites (free fluid in
the peritoneal cavity). A protuberant, tympanic abdomen suggests intestinal distention; a protuberant, dull
abdomen suggests fluid, mass, or organ enlargement.
, 5. What does Blumberg's sign test for and how is it assessed?
A. Gallbladder inflammation — assessed by deep palpation under the right costal margin during inspiration
B. Rebound tenderness — assessed by pressing deeply in the LLQ and quickly releasing; pain upon release may indicate
appendicitis
C. Liver enlargement — assessed by percussion from resonance to dullness
D. Splenic enlargement — assessed by palpating the LUQ
CORRECT ANSWER B — Rebound tenderness — assessed by pressing deeply in the LLQ and quickly releasing; pain upon
release may indicate appendicitis
RATIONALE Blumberg's sign tests for rebound tenderness — a sign of peritoneal inflammation. The nurse presses deeply
and slowly into the abdomen (typically the LLQ, away from the suspected area of inflammation), then quickly
releases the pressure. If the patient experiences pain upon release (not during pressure), the test is positive,
indicating peritoneal irritation. In appendicitis, rebound tenderness may be present at McBurney's point
(RLQ, located by drawing a line from the anterior superior iliac spine to the umbilicus — the point one-third of
the distance from the iliac spine). Murphy's sign tests for gallbladder inflammation: the nurse presses under
the right costal margin during deep inspiration; inspiratory arrest (sudden cessation of breathing due to pain)
is a positive sign. These special tests are used when specific pathology is suspected based on the history and
initial examination.
6. What is the difference between marasmus and kwashiorkor?
A. Marasmus is protein malnutrition; kwashiorkor is calorie malnutrition
B. Marasmus is protein-calorie malnutrition with weight ≤80% standard for height; kwashiorkor is protein malnutrition
caused by diets high in calories but little/no protein
C. Both are identical conditions
D. Marasmus is vitamin deficiency; kwashiorkor is mineral deficiency
CORRECT ANSWER B — Marasmus is protein-calorie malnutrition with weight ≤80% standard; kwashiorkor is protein
malnutrition from high-calorie, low-protein diets
RATIONALE Marasmus and kwashiorkor are two distinct forms of protein-energy malnutrition. Marasmus (protein-calorie
malnutrition) results from inadequate intake of both protein and calories — the patient is severely
underweight (weight ≤80% of standard for height), with marked wasting of muscle and subcutaneous fat, but
typically no edema. Kwashiorkor results from diets adequate in calories but severely deficient in protein —
the patient may have a normal weight or even be overweight but exhibits edema (especially abdominal
distention/"pot belly"), fatty liver, skin lesions, and hair changes. Both conditions are serious and require
medical intervention. Vulnerable groups for undernutrition: infants <1 year, children, pregnant women, recent
immigrants, people with low incomes, hospitalized patients, and aging adults (6 major risk factors: poor
physical/mental health, social isolation, alcoholism, limited functional ability, poverty, polypharmacy).
