NR 509 Final Exam: (Latest 2026/2027 Update) Advanced Health Assessment
Comprehensive Review | Q&A | Grade A | 100% Correct (Verified Answers) –
Chamberlain University
Subject: Advanced Health Assessment – Appendicitis, Cholecystitis, Pancreatitis, PUD, GERD,
Diverticulitis, Hepatitis, IBS, Incontinence, Cancer Screening, Breast/Prostate/Testicular Exam, Pediatric
Milestones, Tanner Staging, Geriatrics
Source: NR 509 Final Exam / Chamberlain University / Bates' Guide to Physical Examination (2026/2027
Update)
Format: Q&A Guide with Clinical Rationales | Grade A Guaranteed
1. What is McBurney point and its significance in appendicitis?
Correct Answer: McBurney point lies 2 inches from the anterior superior iliac spine on a line drawn
from that process to the umbilicus. Tenderness at McBurney point makes appendicitis three times more
likely.
1. McBurney point corresponds to the base of the appendix. Classic tenderness here is highly
suggestive of appendicitis.
2. The pain of appendicitis classically begins near the umbilicus then migrates to the RLQ. Older
adults are less likely to report this pattern.
2. What is Rovsing sign and how is it performed?
Correct Answer: Press deeply and evenly in the LLQ, then quickly withdraw fingers. Pain in the RLQ
during left-sided pressure is a positive Rovsing sign.
1. Rovsing sign is positive when palpation of the LLQ causes referred pain in the RLQ,
suggesting peritoneal irritation from appendicitis.
2. This maneuver stretches the peritoneum and inflamed appendix indirectly.
3. What is the psoas sign and how is it elicited?
Correct Answer: Place hand just above patient's right knee and ask patient to raise thigh against your
hand, or ask patient to turn onto left side then extend right leg at hip. Increased abdominal pain on either
maneuver is a positive psoas sign, suggesting irritation of psoas muscle by an inflamed appendix.
1. The psoas sign tests for retrocecal appendicitis where the inflamed appendix irritates the
iliopsoas muscle.
2. Flexion contracts the psoas; extension stretches it; both cause pain if inflamed.
4. What is the obturator sign?
Correct Answer: Flex the patient's right thigh at the hip with knee bent, and rotate the leg internally.
Right hypogastric pain is a positive obturator sign, from irritation of the obturator muscle by an
inflamed appendix. This sign has very low sensitivity.
1. The obturator sign tests for pelvic appendicitis where the appendix lies near the obturator
internus muscle.
2. Less helpful than other signs; low sensitivity but may be specific when positive.
, 5. What is Murphy sign and how is it performed?
Correct Answer: Hook fingers under the costal margin at the lateral border of the rectus muscle. Ask
patient to take a deep breath. A sharp increase in tenderness with inspiratory effort is a positive Murphy
sign, tripling the likelihood of acute cholecystitis.
1. During inspiration, the descending gallbladder contacts inflamed peritoneum, causing pain and
inspiratory arrest.
2. Highly sensitive and specific for acute cholecystitis when present.
6. What are the characteristic features of pain in acute pancreatitis?
Correct Answer: Epigastric pain radiating straight to the back, steady quality, acute onset persistent,
aggravated by lying supine, relieved by leaning forward with trunk flexed. Associated with nausea,
vomiting, abdominal distention, fever. 80% have history of alcohol abuse or gallstones.
1. Pancreatitis is autodigestion of the pancreas by activated trypsin.
2. Leaning forward reduces pain by relieving tension on the retroperitoneum.
7. What are the key features of peptic ulcer disease?
Correct Answer: Epigastric gnawing or burning pain that may radiate to back; intermittent; duodenal
ulcer often wakes patient at night and occurs in cycles; food and antacids bring relief (less so in gastric
ulcers). H. pylori present in 90%. Gastric ulcer in >50 yrs; duodenal ulcer 30-60 yrs.
1. DU pain occurs when stomach empty; relieved by food. GU pain may be worsened by food.
2. No symptoms in up to 20% of patients.
8. What are the classic features of GERD?
Correct Answer: Heartburn (retrosternal burning) and regurgitation after meals, especially spicy foods;
aggravated by lying down, bending over; relieved by antacids, PPIs, avoiding alcohol, smoking, fatty
meals. Associated with wheezing, chronic cough, hoarseness, dysphagia.
1. GERD results from impaired LES tone or excessive relaxations, causing acid exposure to
esophagus.
2. Increases risk of Barrett esophagus and esophageal adenocarcinoma.
9. What are the findings in acute diverticulitis?
Correct Answer: Left lower quadrant pain, often gradual onset, may be cramping then steady;
associated with fever, constipation, nausea, vomiting, abdominal mass with rebound tenderness.
1. Diverticulitis is inflammation of colonic diverticula, usually sigmoid colon.
2. Treatment includes antibiotics, bowel rest, and analgesia; surgery for complications.
10. What are prevention methods for Hepatitis A and B?
Correct Answer: Hepatitis A and B are preventable by vaccination. Hep A spreads through fecal
matter; Hep B has 1% fatality, 15-25% of chronic infections die from cirrhosis or liver cancer. Hep C is
mainly percutaneous exposure.
1. Hep B vaccine is recommended for all high-risk adults: sexual contacts, healthcare workers,
dialysis, IV drug users, travelers to endemic areas.
2. Hep A vaccine for travelers, men who have sex with men, drug users, chronic liver disease.
Comprehensive Review | Q&A | Grade A | 100% Correct (Verified Answers) –
Chamberlain University
Subject: Advanced Health Assessment – Appendicitis, Cholecystitis, Pancreatitis, PUD, GERD,
Diverticulitis, Hepatitis, IBS, Incontinence, Cancer Screening, Breast/Prostate/Testicular Exam, Pediatric
Milestones, Tanner Staging, Geriatrics
Source: NR 509 Final Exam / Chamberlain University / Bates' Guide to Physical Examination (2026/2027
Update)
Format: Q&A Guide with Clinical Rationales | Grade A Guaranteed
1. What is McBurney point and its significance in appendicitis?
Correct Answer: McBurney point lies 2 inches from the anterior superior iliac spine on a line drawn
from that process to the umbilicus. Tenderness at McBurney point makes appendicitis three times more
likely.
1. McBurney point corresponds to the base of the appendix. Classic tenderness here is highly
suggestive of appendicitis.
2. The pain of appendicitis classically begins near the umbilicus then migrates to the RLQ. Older
adults are less likely to report this pattern.
2. What is Rovsing sign and how is it performed?
Correct Answer: Press deeply and evenly in the LLQ, then quickly withdraw fingers. Pain in the RLQ
during left-sided pressure is a positive Rovsing sign.
1. Rovsing sign is positive when palpation of the LLQ causes referred pain in the RLQ,
suggesting peritoneal irritation from appendicitis.
2. This maneuver stretches the peritoneum and inflamed appendix indirectly.
3. What is the psoas sign and how is it elicited?
Correct Answer: Place hand just above patient's right knee and ask patient to raise thigh against your
hand, or ask patient to turn onto left side then extend right leg at hip. Increased abdominal pain on either
maneuver is a positive psoas sign, suggesting irritation of psoas muscle by an inflamed appendix.
1. The psoas sign tests for retrocecal appendicitis where the inflamed appendix irritates the
iliopsoas muscle.
2. Flexion contracts the psoas; extension stretches it; both cause pain if inflamed.
4. What is the obturator sign?
Correct Answer: Flex the patient's right thigh at the hip with knee bent, and rotate the leg internally.
Right hypogastric pain is a positive obturator sign, from irritation of the obturator muscle by an
inflamed appendix. This sign has very low sensitivity.
1. The obturator sign tests for pelvic appendicitis where the appendix lies near the obturator
internus muscle.
2. Less helpful than other signs; low sensitivity but may be specific when positive.
, 5. What is Murphy sign and how is it performed?
Correct Answer: Hook fingers under the costal margin at the lateral border of the rectus muscle. Ask
patient to take a deep breath. A sharp increase in tenderness with inspiratory effort is a positive Murphy
sign, tripling the likelihood of acute cholecystitis.
1. During inspiration, the descending gallbladder contacts inflamed peritoneum, causing pain and
inspiratory arrest.
2. Highly sensitive and specific for acute cholecystitis when present.
6. What are the characteristic features of pain in acute pancreatitis?
Correct Answer: Epigastric pain radiating straight to the back, steady quality, acute onset persistent,
aggravated by lying supine, relieved by leaning forward with trunk flexed. Associated with nausea,
vomiting, abdominal distention, fever. 80% have history of alcohol abuse or gallstones.
1. Pancreatitis is autodigestion of the pancreas by activated trypsin.
2. Leaning forward reduces pain by relieving tension on the retroperitoneum.
7. What are the key features of peptic ulcer disease?
Correct Answer: Epigastric gnawing or burning pain that may radiate to back; intermittent; duodenal
ulcer often wakes patient at night and occurs in cycles; food and antacids bring relief (less so in gastric
ulcers). H. pylori present in 90%. Gastric ulcer in >50 yrs; duodenal ulcer 30-60 yrs.
1. DU pain occurs when stomach empty; relieved by food. GU pain may be worsened by food.
2. No symptoms in up to 20% of patients.
8. What are the classic features of GERD?
Correct Answer: Heartburn (retrosternal burning) and regurgitation after meals, especially spicy foods;
aggravated by lying down, bending over; relieved by antacids, PPIs, avoiding alcohol, smoking, fatty
meals. Associated with wheezing, chronic cough, hoarseness, dysphagia.
1. GERD results from impaired LES tone or excessive relaxations, causing acid exposure to
esophagus.
2. Increases risk of Barrett esophagus and esophageal adenocarcinoma.
9. What are the findings in acute diverticulitis?
Correct Answer: Left lower quadrant pain, often gradual onset, may be cramping then steady;
associated with fever, constipation, nausea, vomiting, abdominal mass with rebound tenderness.
1. Diverticulitis is inflammation of colonic diverticula, usually sigmoid colon.
2. Treatment includes antibiotics, bowel rest, and analgesia; surgery for complications.
10. What are prevention methods for Hepatitis A and B?
Correct Answer: Hepatitis A and B are preventable by vaccination. Hep A spreads through fecal
matter; Hep B has 1% fatality, 15-25% of chronic infections die from cirrhosis or liver cancer. Hep C is
mainly percutaneous exposure.
1. Hep B vaccine is recommended for all high-risk adults: sexual contacts, healthcare workers,
dialysis, IV drug users, travelers to endemic areas.
2. Hep A vaccine for travelers, men who have sex with men, drug users, chronic liver disease.
