Name
University of Phoenix
NSG/507 Social Justice and Information Systems for Population Health
Prof. Name
Date
This NSG 507 Week 5 abdomen test bank reviews high-yield concepts related to abdominal assessment, gastrointestinal and urinary disorders, physical examination techniques, and common clinical findings. Each question includes the correct answer and a concise explanation to support exam preparation.
Question: While percussing the 7th right intercostal space along the midclavicular line, which percussion note should the nurse expect?
Options:
A. Dullness
B. Tympany
C. Resonance
D. Hyperresonance
Correct Answer: A. Dullness
Key Points:
The liver is a solid organ, so percussion over the liver normally produces a dull percussion note. The liver is primarily located in the right upper quadrant (RUQ) of the abdomen.
Question: Which structure is normally located in the left lower quadrant (LLQ) of the abdomen?
Options:
A. Liver
B. Duodenum
C. Gallbladder
D. Sigmoid colon
Correct Answer: D. Sigmoid colon
Key Points:
Important LLQ structures include the sigmoid and descending colon, left ovary and fallopian tube, and the left ureter.
Question: Difficulty swallowing food, liquids, or medications is known as:
Options:
A. Aphasia
B. Dysphasia
C. Dysphagia
D. Anorexia
Correct Answer: C. Dysphagia
Key Points:
Dysphagia refers to impaired or difficult swallowing. Aphasia and dysphasia involve language impairment, while anorexia refers to loss of appetite.
Question: Which area should the nurse assess when urinary bladder distention is suspected?
Options:
A. Lumbar area
B. Epigastric region
C. Inguinal region
D. Midline area above the pubic bone
Correct Answer: D. Midline area above the pubic bone
Key Points:
The bladder is assessed in the suprapubic or hypogastric region. A distended bladder may feel firm and rounded on palpation and produce dullness on percussion.
Question: Which gastrointestinal change is commonly associated with normal aging?
Options:
A. Increased saliva production
B. Enlarged liver
C. Faster esophageal emptying
D. Reduced gastric acid secretion
Correct Answer: D. Reduced gastric acid secretion
Key Points:
Normal aging can be associated with decreased gastric acid and saliva production, reduced liver size, and slower esophageal motility.
Question: What should the nurse do when an enlarged spleen is suspected?
Options:
A. Assume trauma is the cause
B. Continue palpating because the spleen is normally palpable
C. Palpate the spleen thoroughly
D. Stop palpating because of the risk of rupture
Correct Answer: D. Stop palpating because of the risk of rupture
Key Points:
A normal spleen is generally not palpable. When the spleen is enlarged, it may become fragile, and excessive palpation can increase the risk of splenic injury or rupture.
Question: How should a rounded, outwardly protruding abdomen be documented?
Options:
A. Obese
B. Herniated
C. Scaphoid
D. Protuberant
Correct Answer: D. Protuberant
Key Points:
A protuberant abdomen has a rounded or outward appearance. In contrast, a scaphoid abdomen appears sunken or concave.
Question: A scaphoid abdomen appears:
Options:
A. Flat
B. Convex
C. Bulging
D. Concave
Correct Answer: D. Concave
Key Points:
A scaphoid abdomen is sunken or concave. It may be seen in very thin individuals and can occur with significant malnutrition.
Question: A visible pulsation between the xiphoid process and umbilicus most likely represents:
Options:
A. Renal artery pulsation
B. Inferior vena cava
C. Abdominal aorta
D. Increased peristalsis
Correct Answer: C. Abdominal aorta
Key Points:
Visible aortic pulsations can be a normal finding, particularly in thin adults or individuals with relaxed abdominal muscles. A new or prominent pulsatile mass, however, requires further evaluation.
Question: Hypoactive bowel sounds may be associated with:
Options:
A. Diarrhea
B. Peritonitis
C. Laxative use
D. Gastroenteritis
Correct Answer: B. Peritonitis
Key Points:
Decreased or absent bowel sounds may occur with peritonitis, paralytic ileus, or advanced bowel obstruction.
Question: Why should the nurse auscultate the abdomen before percussion and palpation?
Options:
A. To identify tender areas
B. Percussion and palpation can alter bowel sounds
C. To help the patient relax
D. To prevent vascular changes
Correct Answer: B. Percussion and palpation can alter bowel sounds
Key Points:
The standard abdominal assessment sequence is:
Inspection
Auscultation
Percussion
Palpation
This sequence prevents manipulation of the abdomen from changing bowel sounds before they are assessed.
Question: Which finding is most consistent with normal bowel sounds?
Options:
A. Loud, continuous tinkling
B. Irregular, high-pitched gurgling sounds
C. Friction rub
D. Large-intestine sounds only
Correct Answer: B. Irregular, high-pitched gurgling sounds
Key Points:
Normal bowel sounds are typically intermittent, relatively high-pitched gurgling or clicking sounds produced by intestinal movement. They are commonly heard several times per minute, particularly over the small intestine.
Question: Borborygmi are most accurately described as:
Options:
A. Vascular bruits
B. Friction rubs
C. Reduced intestinal activity
D. Loud, increased bowel activity
Correct Answer: D. Loud, increased bowel activity
Key Points:
Borborygmi are loud, prolonged rumbling or growling sounds caused by increased movement of gas and fluid through the intestines. They may occur with hyperperistalsis.
Question: Which percussion finding is expected during a normal abdominal assessment?
Options:
A. Femoral bruit
B. Tympany around the umbilical area
C. Palpable spleen
D. LUQ dullness caused by an enlarged spleen
Correct Answer: B. Tympany around the umbilical area
Key Points:
The abdomen is normally predominantly tympanic because of intestinal gas. Dullness is normally expected over solid organs such as the liver.
Question: The medical term for heartburn is:
Options:
A. Diarrhea
B. Pyrosis
C. Dysphagia
D. Constipation
Correct Answer: B. Pyrosis
Key Points:
Pyrosis means heartburn. Pregnancy can increase heartburn because hormonal changes relax the lower esophageal sphincter and the growing uterus increases intra-abdominal pressure.
Question: Which combination represents percussion notes that may be encountered during an abdominal assessment?
Options:
A. Flatness, resonance, dullness
B. Resonance, dullness, tympany
C. Tympany, hyperresonance, dullness
D. Resonance, hyperresonance, flatness
Correct Answer: C. Tympany, hyperresonance, dullness
Key Points:
Tympany: commonly associated with gas-filled bowel.
Hyperresonance: may occur with excessive gas.
Dullness: occurs over solid organs, fluid, fecal masses, or a distended bladder.
Question: Which gastric change is associated with pernicious anemia?
Options:
A. Increased gastric acid secretion
B. Decreased gastric acid secretion
C. Delayed gastric emptying
D. Accelerated gastric emptying
Correct Answer: B. Decreased gastric acid secretion
Key Points:
Autoimmune atrophic gastritis associated with pernicious anemia can cause decreased gastric acid and impaired intrinsic-factor production. The resulting vitamin B12 malabsorption can lead to vitamin B12 deficiency and megaloblastic anemia.
Question: Costovertebral angle (CVA) tenderness is most suggestive of:
Options:
A. Ovarian infection
B. Enlarged liver
C. Kidney inflammation or infection
D. Enlarged spleen
Correct Answer: C. Kidney inflammation or infection
Key Points:
CVA tenderness can occur with pyelonephritis or other renal conditions. In the appropriate clinical setting, it is an important finding associated with kidney infection.
Question: Ascites is best defined as:
Options:
A. Abnormal accumulation of fluid in the peritoneal cavity
B. Fecal retention
C. Excess intestinal gas
D. Uterine fibroids
Correct Answer: A. Abnormal accumulation of fluid in the peritoneal cavity
Key Points:
Common causes of ascites include cirrhosis and portal hypertension. It can also occur with heart failure, malignancy, pancreatitis, and other conditions.
Question: What is the primary purpose of deep abdominal palpation?
Options:
A. Assess intestinal motility
B. Identify organs, masses, and deeper tenderness
C. Assess superficial tenderness only
D. Evaluate the skin
Correct Answer: B. Identify organs, masses, and deeper tenderness
Key Points:
Deep palpation helps evaluate organ size, masses, consistency, mobility, and tenderness.
Question: Black, tarry stool is known as:
Options:
A. Gallbladder disease
B. Laxative-related stool
C. Melena caused by gastrointestinal bleeding
D. Hemorrhoidal bleeding
Correct Answer: C. Melena caused by gastrointestinal bleeding
Key Points:
Melena refers to black, tarry, often sticky stool caused by digested blood, commonly from an upper gastrointestinal bleed. Bright red blood per rectum is more commonly associated with lower GI or anorectal bleeding.
Question: Which structure should be considered when a patient has localized right lower quadrant tenderness?
Options:
A. Spleen
B. Sigmoid colon
C. Appendix
D. Gallbladder
Correct Answer: C. Appendix
Key Points:
Localized RLQ pain and tenderness may indicate appendicitis. Tenderness near McBurney’s point is a classic finding.
Question: Which abdominal change commonly occurs with aging?
Options:
A. Increased abdominal muscle tone
B. Thinner and weaker abdominal muscles
C. Increased rigidity
D. Greater pain sensitivity
Correct Answer: B. Thinner and weaker abdominal muscles
Key Points:
Older adults commonly experience decreased abdominal muscle mass and tone. Because pain responses can be less pronounced, significant abdominal disease may occasionally present with relatively mild tenderness.
Question: Which finding is classically associated with infantile hypertrophic pyloric stenosis?
Options:
A. Projectile vomiting
B. Hypoactive bowel sounds
C. Olive-shaped mass in the RLQ
D. Right-to-left peristalsis
Correct Answer: A. Projectile vomiting
Key Points:
Classic findings include forceful, nonbilious projectile vomiting, a palpable olive-shaped mass in the right upper quadrant/epigastric region, and visible gastric peristalsis moving from left to right.
Question: Which finding should raise concern for an abdominal aortic aneurysm (AAA)?
Options:
A. Absence of an abdominal bruit
B. Strong femoral pulses
C. Pulsatile abdominal mass
D. Mass located specifically below the umbilicus
Correct Answer: C. Pulsatile abdominal mass
Key Points:
A pulsatile abdominal mass can indicate an AAA and requires prompt medical evaluation. A bruit may or may not be present, and peripheral pulses can vary depending on the patient’s vascular status.
Question: A patient reports abdominal pain that began around the umbilicus and later localized to McBurney’s point in the RLQ. Which condition is most likely?
Answer: A. Acute appendicitis
Key Points:
Pain may begin as vague periumbilical visceral pain.
It may later localize to the right lower quadrant.
Rebound tenderness and guarding may indicate peritoneal irritation.
Nausea and vomiting may occur.
Bowel habits may remain relatively unchanged.
Question: A patient develops watery diarrhea, abdominal cramping, bloating, and gas after consuming dairy products. Which type of diarrhea is most likely?
Answer: B. Osmotic diarrhea
Key Points:
Lactose intolerance is a common cause of osmotic diarrhea. Symptoms generally improve when lactose-containing foods are avoided.
Question: A patient experiences sudden, severe flank pain that radiates toward the groin. What is the most likely cause?
Answer: B. Ureteral pain caused by a kidney stone
Key Points:
Pain is often sudden and colicky.
It may begin in the flank and move toward the groin.
Hematuria is common.
Nausea and vomiting may occur.
Fever is not a typical feature of an uncomplicated stone.
Question: A patient initially develops periumbilical pain that later shifts to the RLQ. Which diagnosis should the nurse suspect?
Answer: D. Appendicitis
Key Points:
Appendicitis classically begins with poorly localized visceral pain near the umbilicus. As inflammation involves the parietal peritoneum, the pain often becomes localized to the RLQ and may worsen with movement.
Question: Which conditions can cause epigastric pain?
Options:
A. Peptic ulcer disease
B. Pancreatitis
C. Myocardial ischemia
D. All of the above
Correct Answer: D. All of the above
Key Points:
Epigastric pain has several possible causes, including peptic ulcer disease, pancreatitis, and myocardial ischemia. Gallbladder disease and some pulmonary conditions can also produce upper abdominal discomfort.
Question: Abdominal pain that improves after a bowel movement is a common feature of:
Options:
A. Appendicitis
B. Cholecystitis
C. Peptic ulcer disease
D. Irritable bowel syndrome (IBS)
Correct Answer: D. Irritable bowel syndrome (IBS)
Key Points:
IBS commonly involves recurrent abdominal pain associated with defecation and changes in stool frequency or consistency. Symptoms may be influenced by certain foods, stress, or other triggers.
Question: Coffee-ground emesis most strongly suggests:
Options:
A. Lower GI bleeding
B. Upper GI bleeding, such as peptic ulcer bleeding
C. Gallbladder disease
D. Hemorrhoids
Correct Answer: B. Upper GI bleeding
Key Points:
Coffee-ground vomitus contains blood that has been altered by exposure to gastric acid. It is associated with upper GI bleeding and may occur along with melena.
Question: A daycare worker develops jaundice after a possible fecal-oral exposure. Which type of viral hepatitis is most likely?
Options:
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
Correct Answer: A. Hepatitis A
Key Points:
Hepatitis A is transmitted primarily through the fecal-oral route. Close-contact environments such as daycare settings can facilitate transmission. Vaccination is an important prevention strategy.
Question: Pain that begins in the flank and moves downward toward the groin is most characteristic of:
Options:
A. Splenic enlargement
B. Appendicitis
C. Ureteral stone
D. Gastritis
Correct Answer: C. Ureteral stone
Key Points:
Ureteral stones can cause severe, colicky pain that follows the path of the ureter. Hematuria is also a common finding.
Question: A patient experiences a sudden, strong urge to urinate followed by involuntary urine leakage. Which type of incontinence is this?
Options:
A. Stress incontinence
B. Urge incontinence
C. Overflow incontinence
D. Functional incontinence
Correct Answer: B. Urge incontinence
Key Points:
Urge incontinence is commonly associated with detrusor overactivity. The patient experiences an intense urinary urge that may be followed by involuntary leakage.
Question: What is the correct sequence for performing a routine abdominal assessment?
Options:
A. Palpation → Percussion → Auscultation → Inspection
B. Auscultation → Inspection → Palpation → Percussion
C. Inspection → Auscultation → Percussion → Palpation
D. Percussion → Palpation → Inspection → Auscultation
Correct Answer: C. Inspection → Auscultation → Percussion → Palpation
Memory Tip: IAPP
Remember the sequence as IAPP:
Inspection → Auscultation → Percussion → Palpation.
Question: What abdominal assessment is particularly important in a patient with resistant hypertension?
Answer: D. Carefully auscultate the abdomen
Key Points:
The nurse should listen for an abdominal bruit, which may suggest turbulent blood flow associated with renal artery stenosis. This finding requires further clinical evaluation.
Question: If the liver edge is palpable, which additional assessment is useful for determining liver size?
Answer: C. Measure the liver span by percussion
Key Points:
A palpable liver edge does not automatically indicate hepatomegaly. Liver size can be estimated by measuring the liver span, typically using percussion along the right midclavicular line.
Question: A grating sound heard over the spleen is most consistent with:
Answer: A. Splenic friction rub
Key Points:
A splenic friction rub may occur when the splenic capsule becomes inflamed, such as with splenic infarction or other inflammatory processes.
Question: A small abdominal mass is detected during examination. Which technique may help determine whether the mass originates from the abdominal wall?
Answer: B. Repeat the examination while the patient contracts the abdominal muscles
Key Points:
Assessing the mass while the abdominal muscles are contracted can help distinguish an abdominal wall mass from an intra-abdominal mass.
Question: A positive Castell’s sign may suggest:
Options:
A. Enlarged liver
B. Splenic enlargement
C. Ascites
D. Distended bladder
Correct Answer: B. Splenic enlargement
Key Points:
Castell’s sign is assessed at the left lower anterior axillary line. A change from tympany to dullness during inspiration can suggest splenomegaly.
Question: Which finding can help distinguish an enlarged kidney from an enlarged spleen?
Answer: C. Tympany may remain over an enlarged kidney
Key Points:
The kidney lies posteriorly and may be partially covered by bowel. Therefore, tympany may remain over the mass. An enlarged spleen typically produces a more pronounced area of dullness.
Question: A smooth, midline, dull mass is palpated above the pubic bone. Which condition is most likely?
Answer: D. Distended urinary bladder
Key Points:
A distended bladder can produce a smooth, rounded, midline suprapubic mass that is dull to percussion. Urinary retention, including retention associated with benign prostatic hyperplasia (BPH), can contribute to bladder distention.
Question: What diagnostic study is commonly used to evaluate a suspected abdominal aortic aneurysm?
Answer: A. Abdominal ultrasound
Key Points:
A pulsatile abdominal mass should prompt appropriate medical evaluation. Abdominal ultrasonography is commonly used to detect and measure an AAA.
Question: Which physical examination finding may be associated with ascites?
Answer: D. Shifting dullness
Key Points:
Ascites can cause shifting dullness as free fluid moves within the abdominal cavity when the patient’s position changes. A fluid wave may also be present with larger volumes of ascitic fluid.
Question: Which finding is associated with a positive obturator sign?
Answer: B. RLQ pain when the flexed hip is internally rotated
Key Points:
Obturator sign: pain with internal rotation of the flexed hip.
Psoas sign: pain with hip extension or resisted hip flexion.
Murphy sign: RUQ pain or inspiratory arrest during palpation of the gallbladder area.
Rovsing sign: RLQ pain produced by palpation of the LLQ.
These signs can support clinical suspicion of appendicitis or other abdominal pathology but should be interpreted with the complete clinical picture.
Question: A patient reports severe abdominal pain, but the physical examination reveals relatively little tenderness. Which condition is classically associated with this presentation?
Options:
A. Gastroenteritis
B. Peritonitis
C. Mesenteric ischemia
D. Constipation
Correct Answer: C. Mesenteric ischemia
Key Points:
A classic warning sign of acute mesenteric ischemia is pain that appears out of proportion to the physical examination findings. This is a potentially life-threatening condition requiring urgent evaluation.
Question: Which finding would be expected in a patient with situs inversus?
Answer: A. Tympany in the RUQ with liver dullness in the LUQ
Key Points:
Situs inversus involves a mirror-image arrangement of the internal organs. Therefore, the liver may be located primarily on the left side rather than the right.
Question: Which physical finding indicates peritoneal irritation and may support a diagnosis of appendicitis?
Options:
A. Tympany
B. Rebound tenderness
C. Hyperactive bowel sounds
D. Abdominal bruit
Correct Answer: B. Rebound tenderness
Key Points:
Rebound tenderness can indicate peritoneal irritation. In a patient with compatible symptoms, it may support concern for appendicitis with localized peritonitis.
Question: Which pathological change is characteristic of chronic pancreatitis?
Options:
A. Increased bile production
B. Acute mucosal inflammation
C. Increased pancreatic regeneration
D. Gallbladder obstruction
E. Fibrosis of the pancreas
Correct Answer: E. Fibrosis of the pancreas
Key Points:
Chronic pancreatitis causes progressive fibrosis and permanent structural damage to pancreatic tissue. Common clinical features include chronic or recurrent epigastric pain that may radiate to the back, malabsorption, weight loss, and diabetes mellitus.
Question: Which symptom is particularly suggestive of biliary colic?
Options:
A. Left shoulder pain
B. Periumbilical pain
C. Suprapubic pain
D. Flank pain
E. Pain radiating to the right shoulder
Correct Answer: E. Pain radiating to the right shoulder
Key Points:
Gallbladder pain may refer to the right shoulder or right scapular region because of shared nerve pathways involving the phrenic nerve. Biliary colic commonly presents with RUQ or epigastric pain, often after eating a fatty meal.
For exam preparation, remember these core associations:
Liver → RUQ → dullness
Sigmoid colon → LLQ
Appendix → RLQ
Dysphagia → difficulty swallowing
Pyrosis → heartburn
Melena → black, tarry stool from GI bleeding
Ascites → fluid in the peritoneal cavity
CVA tenderness → possible renal inflammation/infection
McBurney’s point → appendicitis
Murphy sign → gallbladder inflammation
Obturator sign → pain with internal rotation of flexed hip
Rovsing sign → RLQ pain with LLQ palpation
Psoas sign → pain with hip extension/resisted flexion
AAA → pulsatile abdominal mass
Urge incontinence → sudden urge followed by leakage
Abdominal assessment → IAPP
Scaphoid → concave/sunken
Protuberant → rounded/outward
Borborygmi → loud intestinal rumbling
Mesenteric ischemia → pain out of proportion to examination
