Nurs 612 Final Exam Study Guide | Updated, Fall 2026 | Maryville University

NURS 612 FINAL EXAM STUDY GUIDE

ABDOMEN / GI
Order of Assessment
o Inspection, auscultation, percussion, palpation.


Percussion: What should you hear where & why
o Tympany (High-pitched drum-like hollow sound): Most of the GI tract, due to air-
filled intestines.
o Dullness (Soft, quiet, thud): Over solid organs such as liver and spleen.


Organ location
Quadrant Organs
Liver and gallbladder, pylorus, duodenum, head of
pancreas, right adrenal gland, portion of right kidney,
Right upper (RUQ)
hepatic flexure of colon, portions of ascending and
transverse colon.
Left lobe of liver, spleen, stomach, body of pancreas, left
Left upper (LUQ) adrenal gland, portion of left kidney, splenic flexure of
colon, portions of transverse and descending colon.
Lower pole of right kidney, cecum and appendix, portion of
Right lower (RLQ) ascending colon, bladder (if distended), ovary and salpinx,
uterus (if enlarged), right spermatic cord, right ureter.
Lower pole of left kidney, sigmoid colon, portion of
Left lower (LLQ) descending colon, bladder (if distended), ovary and salpinx,
uterus (if enlarged), left spermatic cord, left ureter.



Assessment techniques
Technique Findings and association
McBurney's RLQ rebound tenderness and sharp pain on palpation (Appendicitis).
Point
Rovsing sign RLQ pain intensified by LLQ abdominal palpation (Appendicitis/ Peritoneal irritation).
Pain while patient is lying down, raising right leg, flexing hip, while examiner pushes
Psoas sign
down on lower right thigh (Appendicitis).
Pain in the right hypogastric region with internal rotation of flexed right hip
Obturator sign
(Appendicitis).
Murphy's sign Abrupt cessation of inspiration with RUQ palpation (Cholecystitis).



Know the presenting symptoms and assessment techniques for the following:
Appendicitis
Presenting Symptoms Physical Exam & Assessment
Techniques
 Acute onset abdominal pain: starts  RLQ rebound tenderness and sharp pain
periumbilical, migrates to right lower (McBurney's point)
quadrant (RLQ, McBurney's point)  Rovsing's sign (RLQ pain with LLQ
 Pain becomes sharp and localized palpation)
 Nausea, vomiting, anorexia, low-grade  Psoas sign (pain with right hip
fever
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, NURS 612 FINAL EXAM STUDY GUIDE
 In children: pain may be diffuse; in elderly: extension/flexion)
symptoms may be vague or less severe  Obturator sign (pain with internal rotation
of flexed right hip)




Cholecystitis
Presenting Symptoms Physical Exam & Assessment
Techniques
 Acute, persistent RUQ pain, may start  Murphy's sign (inspiratory arrest with
epigastric and localize to RUQ, deep RUQ palpation)
abrupt/severe lasting 2-4 hrs  Sonographic Murphy's sign (maximal
 Pain may radiate to right shoulder/scapula tenderness with US probe)
 Nausea, vomiting, fever, anorexia,  Boas' sign: increased skin sensitivity
sometimes jaundice (hyperesthesia) or pain below the right
 W/ chronic, may exhibit fat intolerance, scapula.
flatulence, nausea, anorexia, & nonspecific  RUQ tenderness, palpable gallbladder,
abd pain fever, tachycardia
 Elderly/pediatric: may lack classic findings  Involuntary guarding/rebound tenderness
 May have full palpable gallbladder RUQ




Pancreatitis
Presenting Symptoms Physical Exam & Assessment
Techniques
~Acute~
 Mild to severe sudden onset persistent  diffuse abdominal tenderness to
epigastric pain, may radiate to the back; palpation. Involuntary guarding and
typically constant and dull abdominal distension can occur.
 N/V, abd distention, fever, anorexia  Decreased bowel sounds may be
appreciated as a result of an ileus.
 Cullen (Echymosis around umbilicus) and
Gray Turner sign (Ecchymosis of flanks)
may be appreciated on examination,
severe necrotizing pancreatitis.
 Fever and tachycardia. Dyspnea due to
diaphragm irritation. Elevated pancreatic
enzymes (amylase and lipase).

~Chronic~
 Constant unremitting abdominal pain.  Similar to acute pancreatitis, however,
 Weight loss. greater likelihood of pseudocyst
 Steatorrhea (Excessive fat in stool) formation.
 With advanced, may exhibit signs of
malnutrition, with decreased

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, NURS 612 FINAL EXAM STUDY GUIDE
subcutaneous fat and temporal wasting.
 Elevated pancreatic enzymes and glucose
intolerance.




Crohn's disease
Presenting Symptoms Physical Exam & Assessment
Techniques
 chronic diarrhea with compromised
 Right lower quadrant tenderness.
nutritional status.
 May include arthritis, iritis (Inflammation of  Possible palpable abdominal mass
iris), and erythema nodosum (Inflammatory (Secondary to thickened/inflamed bowel).
skin condition causing tender red bumps
 Possible perianal skin tags, fistulae, and
that usually appear on the shins).
 Course characterized by unpredictable abscesses.
flares/remissions.  Extra-intestinal: Erythema nodosum,
pyoderma gangrenosum (Rare non-
infectious inflammatory skin condition
characterized by painful, rapidly growing
open ulcers with purple or red edges), and
arthritis involving the large joints.
 Colonoscopy/pathology: Cobblestone
appearance of the mucosa.
 Fistula/abscess formation, sometimes
extending to the skin.



IBS
Presenting Symptoms Physical Exam & Assessment
Techniques
 cluster of symptoms consisting of
 generally unremarkable.
abdominal pain, bloating, constipation, or
abdominal pain, urgency, and diarrhea, or  Rome IV diagnostic criteria: abdominal
mixed constipation and diarrhea pain on average at least one day a week
in the past three months, associated with
two or more of the following:
o Related to defecation.
o Associated with change in stool
frequency.
o Associated with change in stool
consistency.
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o Symptoms must have started at
least six months ago.



GERD
Presenting Symptoms Physical Exam & Assessment
Techniques
 heartburn or acid indigestion.
 Generally no physical findings
 Bitter or sour taste in back of throat.
 Horseness.  With severe disease, may have erythema
 Infants/ Toddlers: Back-arching fussiness of the posterior pharynx and edematous
with feeding, or regurgitation and vomiting,
vocal cords.
can be severe enough to cause weight loss
and failure to thrive.
 Can precipitate acute asthma exacerbation
or cause chronic respiratory problems
(Aspiration/esophageal bleeding).




Pyloric stenosis
Presenting Symptoms Physical Exam & Assessment
Techniques
 symptoms typically develop after several
 Epigastric distension 2/2 obstructed
weeks of age and include regurgitation
progressing to projectile vomiting, feeding stomach.
eagerly (even after vomiting episode), and  Possible visible wave of peristalsis (left to
failure to gain weight.
right).
 Small, round, olive-shaped mass,
sometimes palpable in the right upper
quadrant, particularly after vomiting
(Infant).
 Ultrasound and/or surgical consult should
be obtained with suspected cases.




Hernias- infancy also
Presenting Symptoms Physical Exam & Assessment
Techniques
~Diaphragmatic~
 Degree of respiratory stress can be slight
 Bowel sounds heard in chest with a flat or
or very severe, depending on the extent to
which the bowel has invaded the chest scaphoid abdomen/ Abdominal distension.
 Heart is usually displaced to the right.
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