NR 509 WEEK 8 ADVANCED HEALTH
ASSESSMENT FINAL 2026 STUDY
GUIDE COMPREHENSIVE
QUESTIONS ANSWERS VERIFIED A+
◉ CHAPTER 19: Abdomen
A 63-year-old janitor with a history of adenomatous colonic polyps
presents for a well visit. Basic labs are performed to screen for diabetes
mellitus and dyslipidemia. Electrolytes and liver enzymes were also
measured. His labs are all normal expect for moderate elevations of
aspartate aminotransferase, alanine aminotransferase, γ-glutamyl
transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician
performs an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?.
Answer: Liver palpable 3 cm below the right costal margin, mid
clavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular line, would be considered normal on inspiration when the
liver is pushed down into the abdominal cavity on inspiration, but is
abnormal on expiration. Findings to support hepatomegaly would be
more convincing if, by percussion, the liver span was >12 cm at the
midclavicular line. For patients with obstructive lung disease, air
trapping in the lungs may displace the liver downwards into the
abdominal cavity. The liver span and dullness to percussion refer to the
same measurement. Measurements of 6-12 cm at the mid-clavicular line
and 4-8 cm at the midsternal line are considered normal.
,◉ CHAPTER 19: Abdomen
A 63-year-old underweight administrative clerk with a 50-pack-year
smoking history presents with a several month history of recurrent
epigastric abdominal discomfort. She feels fairly well otherwise and
denies any nausea, vomiting, diarrhea, or constipation. She reports that a
first cousin died from a ruptured aneurysm at age 68 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen
saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6.
On exam, her abdominal aorta is prominent, which is concerning for an
abdominal aortic aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA?.
Answer: History of smoking
Rationale: History of smoking is her most significant risk factor for an
AAA. Male gender, not female gender, is considered as risk factor.
Underweight is not a risk factor for AAA. Family history of ruptured
aneurysm is vague and could be a cerebral aneurysm. Further, her family
history is in a first-degree cousin not a first-degree relative (biologic
parents, siblings, and children). Hypertension could contribute to
atherosclerosis, which is a risk factor. Further, a diagnosis of
hypertension is not based on one elevated blood pressure reading.
◉ CHAPTER 19: Abdomen
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using high
sensitivity fecal occult blood testing (FOBT). He presents for follow-up
of his hypertension, during which the clinician scans his chart to ensure
he is up to date with his preventive health care. He has a positive FOBT
on one occasion at age 66 years and subsequently went for a
,colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found
on colonoscopy. He has no first-degree relatives with a history of
colorectal cancer or adenomatous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening recommendations for this
patient?.
Answer: Do not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most
adults ages 76-85 years, the gain in life years is small compared to
colonoscopy risks. It is advised to discuss individualized risks and
benefits with the patient. Annual FOBT screening may continue until
age 80-85 years if benefits to doing so outweigh risks for the individual
patient; however, screening should not be routinely continued. In
general, a life expectancy >7 years is necessary for screening to be
potentially beneficial. There is no indication to repeat a colonoscopy
given the absence of any cancerous or precancerous findings on his
colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT
every 3 years is a valid screening option, but again screening is not
routinely recommended for patients age >75 years.
◉ CHAPTER 19: Abdomen
An otherwise healthy 31-year-old accountant presents to an outpatient
clinic with a 3-year history of recurrent crampy abdominal pain that lasts
for about 1-2 weeks each episode and is associated with onset of
constipation. She describes infrequent, small hard stool that she finds
very difficult to pass. She has tried to increase dietary fiber and water
intake, but usually this is not sufficient and she resorts to over-the-
counter laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel
, movements. Which of the following is the most likely physiological
mechanism for her constipation?.
Answer: Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of
irritable bowel syndrome (IBS). IBS is characterized by three patterns:
diarrhea predominant, constipation predominant, or mixed. Other
functional causes for her constipation should be excluded prior to
making this diagnosis. A large firm fecal mass in the rectum is
characteristic of fecal impaction, which is common in debilitated,
bedridden individuals. Decreased fecal bulk is characteristic of a diet
low in fiber. This patient had not found that increasing fiber helps her
constipation. Spasm of the external sphincter is associated with painful
anal lesions, which this patient does not report. Impairment of
autonomic innervations is characteristic of patients with multiple
sclerosis, spinal cord injuries, and Hirschsprung disease. She has no
known diagnosis that would increase suspicion of neurological
impairment.
◉ CHAPTER 19: Abdomen
A 23-year-old woman comes to the respirology clinic for follow-up of
her chronic sinusitis and bronchiectasis that is associated with a rare
congenital condition called Kartagener syndrome. The preceptor notes
that she has situs inversus and asks for a physical exam. Which of the
following descriptions best fits with findings on the abdominal exam?.
Answer: Tympany to percussion in the right upper quadrant, dullness to
percussion of the left upper quadrant
ASSESSMENT FINAL 2026 STUDY
GUIDE COMPREHENSIVE
QUESTIONS ANSWERS VERIFIED A+
◉ CHAPTER 19: Abdomen
A 63-year-old janitor with a history of adenomatous colonic polyps
presents for a well visit. Basic labs are performed to screen for diabetes
mellitus and dyslipidemia. Electrolytes and liver enzymes were also
measured. His labs are all normal expect for moderate elevations of
aspartate aminotransferase, alanine aminotransferase, γ-glutamyl
transferase, and alkaline phosphatase as well as a mildly elevated total
bilirubin. He presents for a follow-up appointment and the clinician
performs an abdominal exam to assess his liver. Which of the following
findings would be most consistent with hepatomegaly?.
Answer: Liver palpable 3 cm below the right costal margin, mid
clavicular line, on expiration
Rationale: The liver being palpable 3 cm below the right costal margin,
midclavicular line, would be considered normal on inspiration when the
liver is pushed down into the abdominal cavity on inspiration, but is
abnormal on expiration. Findings to support hepatomegaly would be
more convincing if, by percussion, the liver span was >12 cm at the
midclavicular line. For patients with obstructive lung disease, air
trapping in the lungs may displace the liver downwards into the
abdominal cavity. The liver span and dullness to percussion refer to the
same measurement. Measurements of 6-12 cm at the mid-clavicular line
and 4-8 cm at the midsternal line are considered normal.
,◉ CHAPTER 19: Abdomen
A 63-year-old underweight administrative clerk with a 50-pack-year
smoking history presents with a several month history of recurrent
epigastric abdominal discomfort. She feels fairly well otherwise and
denies any nausea, vomiting, diarrhea, or constipation. She reports that a
first cousin died from a ruptured aneurysm at age 68 years. Her vital
signs are pulse, 86; blood pressure, 148/92; respiratory rate, 16; oxygen
saturation, 95%; and temperature, 36.2ºC. Her body mass index is 17.6.
On exam, her abdominal aorta is prominent, which is concerning for an
abdominal aortic aneurysm (AAA). Which of the following is her most
significant risk factor for an AAA?.
Answer: History of smoking
Rationale: History of smoking is her most significant risk factor for an
AAA. Male gender, not female gender, is considered as risk factor.
Underweight is not a risk factor for AAA. Family history of ruptured
aneurysm is vague and could be a cerebral aneurysm. Further, her family
history is in a first-degree cousin not a first-degree relative (biologic
parents, siblings, and children). Hypertension could contribute to
atherosclerosis, which is a risk factor. Further, a diagnosis of
hypertension is not based on one elevated blood pressure reading.
◉ CHAPTER 19: Abdomen
A 76-year-old retired man with a history of prostate cancer and
hypertension has been screened annually for colon cancer using high
sensitivity fecal occult blood testing (FOBT). He presents for follow-up
of his hypertension, during which the clinician scans his chart to ensure
he is up to date with his preventive health care. He has a positive FOBT
on one occasion at age 66 years and subsequently went for a
,colonoscopy. Internal hemorrhoids and sigmoid diverticuli were found
on colonoscopy. He has no first-degree relatives with a history of
colorectal cancer or adenomatous polyps. What are the U.S. Preventive
Services Task Force (USPSTF) screening recommendations for this
patient?.
Answer: Do not screen routinely
Rationale: The USPSTF recommends not screening routinely. For most
adults ages 76-85 years, the gain in life years is small compared to
colonoscopy risks. It is advised to discuss individualized risks and
benefits with the patient. Annual FOBT screening may continue until
age 80-85 years if benefits to doing so outweigh risks for the individual
patient; however, screening should not be routinely continued. In
general, a life expectancy >7 years is necessary for screening to be
potentially beneficial. There is no indication to repeat a colonoscopy
given the absence of any cancerous or precancerous findings on his
colonoscopy 10 years ago. Sigmoidoscopy every 5 years with FOBT
every 3 years is a valid screening option, but again screening is not
routinely recommended for patients age >75 years.
◉ CHAPTER 19: Abdomen
An otherwise healthy 31-year-old accountant presents to an outpatient
clinic with a 3-year history of recurrent crampy abdominal pain that lasts
for about 1-2 weeks each episode and is associated with onset of
constipation. She describes infrequent, small hard stool that she finds
very difficult to pass. She has tried to increase dietary fiber and water
intake, but usually this is not sufficient and she resorts to over-the-
counter laxatives, which she finds upset her stomach but do resolve the
constipation. Symptoms typically gradually resolve with bowel
, movements. Which of the following is the most likely physiological
mechanism for her constipation?.
Answer: Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of
irritable bowel syndrome (IBS). IBS is characterized by three patterns:
diarrhea predominant, constipation predominant, or mixed. Other
functional causes for her constipation should be excluded prior to
making this diagnosis. A large firm fecal mass in the rectum is
characteristic of fecal impaction, which is common in debilitated,
bedridden individuals. Decreased fecal bulk is characteristic of a diet
low in fiber. This patient had not found that increasing fiber helps her
constipation. Spasm of the external sphincter is associated with painful
anal lesions, which this patient does not report. Impairment of
autonomic innervations is characteristic of patients with multiple
sclerosis, spinal cord injuries, and Hirschsprung disease. She has no
known diagnosis that would increase suspicion of neurological
impairment.
◉ CHAPTER 19: Abdomen
A 23-year-old woman comes to the respirology clinic for follow-up of
her chronic sinusitis and bronchiectasis that is associated with a rare
congenital condition called Kartagener syndrome. The preceptor notes
that she has situs inversus and asks for a physical exam. Which of the
following descriptions best fits with findings on the abdominal exam?.
Answer: Tympany to percussion in the right upper quadrant, dullness to
percussion of the left upper quadrant
