,NR 509 Advanced Physical Assessment Final Exam – 180
Questions with Answers & Rationales
,1. The clinician performs an abdominal exam on a patient and finds
involuntary rigidity and rebound tenderness. The patient is hypotensive,
tachycardic, and has a positive β-hCG. What is the most likely diagnosis?
A. Acute cholecystitis
B. Ruptured appendicitis
C. Ruptured ectopic pregnancy
D. Bowel wall perforation
✅ Correct Answer: C. Ruptured ectopic pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and peritoneal signs (rigidity, rebound)
strongly suggests a ruptured ectopic pregnancy with intra-abdominal
bleeding. Pregnancy of unknown location with hemodynamic instability is a
surgical emergency.
2. A 63-year-old patient has elevated liver enzymes and bilirubin. Which
abdominal exam finding would be most consistent with hepatomegaly?
A. Liver span of 8 cm at the midclavicular line
B. Liver palpable 3 cm below the right costal margin on expiration
C. Liver palpable 2 cm below the right costal margin on inspiration
D. Liver span of 10 cm at the midsternal line
✅ Correct Answer: B. Liver palpable 3 cm below the right costal margin on
expiration
Rationale: The liver is normally palpable on inspiration (when pushed down
by the diaphragm) but NOT on expiration. A liver palpable on expiration
suggests true hepatomegaly. Normal liver span is 6–12 cm at the
midclavicular line and 4–8 cm at the midsternal line.
, 3. In a patient with chronic pancreatitis, chronic diarrhea, and weight loss,
what is the mechanism of the most likely diagnosis?
A. Inflammation of colonic diverticulum
B. Reduced blood supply to the bowel
C. Fibrosis of the pancreas
D. H. pylori infection
✅ Correct Answer: C. Fibrosis of the pancreas
Rationale: Chronic pancreatitis leads to pancreatic fibrosis and decreased
exocrine function, causing pancreatic enzyme insufficiency, malabsorption,
diarrhea, and weight loss.
4. A positive Murphy's sign is best described as:
A. Pain upon release of pressure in the left lower quadrant
B. Pain when the right hip is internally rotated
C. Arrest of inspiration during palpation of the gallbladder
D. Pain when dropping from toes to heels
✅ Correct Answer: C. Arrest of inspiration during palpation of the
gallbladder
Rationale: Murphy's sign is elicited by palpating the right subcostal area
during inspiration. The patient abruptly stops inhaling due to pain from the
inflamed gallbladder contacting the examiner's hand. This indicates acute
cholecystitis.
5. A positive Obturator sign is a physical finding of:
A. Gallstones
B. Ruptured spleen
C. Appendicitis
Questions with Answers & Rationales
,1. The clinician performs an abdominal exam on a patient and finds
involuntary rigidity and rebound tenderness. The patient is hypotensive,
tachycardic, and has a positive β-hCG. What is the most likely diagnosis?
A. Acute cholecystitis
B. Ruptured appendicitis
C. Ruptured ectopic pregnancy
D. Bowel wall perforation
✅ Correct Answer: C. Ruptured ectopic pregnancy
Rationale: The constellation of abdominal pain, syncope, tachycardia,
hypotension, positive β-hCG, and peritoneal signs (rigidity, rebound)
strongly suggests a ruptured ectopic pregnancy with intra-abdominal
bleeding. Pregnancy of unknown location with hemodynamic instability is a
surgical emergency.
2. A 63-year-old patient has elevated liver enzymes and bilirubin. Which
abdominal exam finding would be most consistent with hepatomegaly?
A. Liver span of 8 cm at the midclavicular line
B. Liver palpable 3 cm below the right costal margin on expiration
C. Liver palpable 2 cm below the right costal margin on inspiration
D. Liver span of 10 cm at the midsternal line
✅ Correct Answer: B. Liver palpable 3 cm below the right costal margin on
expiration
Rationale: The liver is normally palpable on inspiration (when pushed down
by the diaphragm) but NOT on expiration. A liver palpable on expiration
suggests true hepatomegaly. Normal liver span is 6–12 cm at the
midclavicular line and 4–8 cm at the midsternal line.
, 3. In a patient with chronic pancreatitis, chronic diarrhea, and weight loss,
what is the mechanism of the most likely diagnosis?
A. Inflammation of colonic diverticulum
B. Reduced blood supply to the bowel
C. Fibrosis of the pancreas
D. H. pylori infection
✅ Correct Answer: C. Fibrosis of the pancreas
Rationale: Chronic pancreatitis leads to pancreatic fibrosis and decreased
exocrine function, causing pancreatic enzyme insufficiency, malabsorption,
diarrhea, and weight loss.
4. A positive Murphy's sign is best described as:
A. Pain upon release of pressure in the left lower quadrant
B. Pain when the right hip is internally rotated
C. Arrest of inspiration during palpation of the gallbladder
D. Pain when dropping from toes to heels
✅ Correct Answer: C. Arrest of inspiration during palpation of the
gallbladder
Rationale: Murphy's sign is elicited by palpating the right subcostal area
during inspiration. The patient abruptly stops inhaling due to pain from the
inflamed gallbladder contacting the examiner's hand. This indicates acute
cholecystitis.
5. A positive Obturator sign is a physical finding of:
A. Gallstones
B. Ruptured spleen
C. Appendicitis
