NR 509 WEEK 8 ADVANCED
HEALTH ASSESSMENT FINAL
EXAM QUESTIONS AND VERIFIED
SOLUTION LATEST GUIDE 2026
GRADED A+ .
,1. : Abdomen
An overweight 26-year-old public servant presents to the Emergency Depart- ment with 12 hours of intense abdominal pain, light-
headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of
gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel
movement this morning. Her β-human chorionic gonadotropin (β-hCG) is positive at triage.
She reports that her last periterm-12od was 10 weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory
rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her
pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely
diagnosis?: Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension, positive β-hCG, and findings suggestive of peritoneal inflammation/irritation strongly
suggest a ruptured ectopic pregnancy with significant in- tra-abdominal bleeding leading to peritoneal signs. This case is emergent and requires immediate treatment of
her hypotension and presumed blood loss as well as gynecological consult for emergent surgery. Ruptured ectopic
pregnancies can lead to life-threatening intra-abdominal bleeding. Although acute cholecystitis, ruptured appendix, bowel wall perforation, and ruptured ovarian cyst are all
possibilities, the positive β-hCG testing and her unstable vital signs make ruptured ectopic pregnancy more likely.
2. : 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 dys- lipidemia. 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?: 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.
3. : 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?: 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.
4. : 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
subse- quently 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?: 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.
5. : 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 suffi- cient 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?: Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of irritable bowel syndrome (IBS). IBS is character- ized 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.
6. : 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
HEALTH ASSESSMENT FINAL
EXAM QUESTIONS AND VERIFIED
SOLUTION LATEST GUIDE 2026
GRADED A+ .
,1. : Abdomen
An overweight 26-year-old public servant presents to the Emergency Depart- ment with 12 hours of intense abdominal pain, light-
headedness, and a fainting episode that finally prompted her to seek medical attention. She has a strong family history of
gallstones and is concerned about this possibility. She has not had any vomiting or diarrhea. She had a normal bowel
movement this morning. Her β-human chorionic gonadotropin (β-hCG) is positive at triage.
She reports that her last periterm-12od was 10 weeks ago. Her vital signs at triage are pulse, 118; blood pressure, 86/68; respiratory
rate, 20/min; oxygen saturation, 99%; and temperature, 37.3ºC orally. The clinician performs an abdominal exam prior to her
pelvic exam and, on palpation of her abdomen, finds involuntary rigidity and rebound tenderness. What is the most likely
diagnosis?: Ruptured tubal (or ectopic) pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia, hypotension, positive β-hCG, and findings suggestive of peritoneal inflammation/irritation strongly
suggest a ruptured ectopic pregnancy with significant in- tra-abdominal bleeding leading to peritoneal signs. This case is emergent and requires immediate treatment of
her hypotension and presumed blood loss as well as gynecological consult for emergent surgery. Ruptured ectopic
pregnancies can lead to life-threatening intra-abdominal bleeding. Although acute cholecystitis, ruptured appendix, bowel wall perforation, and ruptured ovarian cyst are all
possibilities, the positive β-hCG testing and her unstable vital signs make ruptured ectopic pregnancy more likely.
2. : 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 dys- lipidemia. 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?: 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.
3. : 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?: 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.
4. : 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
subse- quently 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?: 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.
5. : 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 suffi- cient 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?: Functional change in bowel movement
Rationale: Functional change in bowel movement is characteristic of irritable bowel syndrome (IBS). IBS is character- ized 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.
6. : 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
