FINAL EXAM NR509 ACTUAL ASSESSMENT
2026 COMPLETE SOLVED QUESTIONS
◉ Kidney assessment LEFT. Answer: Retroperitoneal and
nonpalpable.
Palpation: lay on left side.
Place R hand behind the pt, just below and parallel to the 12th rib,
with fingertips just reaching the CVA. Lift, trying to displace the
kidney anteriorly. Place your left hand gently in the LUQ, lateral and
parallel to the rectus muscle. Ask the patient to take a deep breath.
At the peak of inspiration, press your left hand firmly and deeply
into the LUQ, just below the costal margin. Try to "capture" the
kidney between your two hands. Ask the patient to breathe out and
then to stop breathing briefly. Slowly release the pressure of your
left hand, feel-ing at the same time for the kidney to slide back into
its expiratory position. If the kidney is palpable, describe its size,
contour, and any tenderness.
OR Deep palpation: Stand on pt right side, use left hand, reach over
and around pt to lift up beneath the left kidney, and with right hand,
feel deep in the LUQ. Have pt to take deep breath, feel for a mass.
Abnormal: Splenomegaly (if palpable notch on medial border, edge
extends beyond midline, percussion is dull, and fingers can prode
deep to the medial and lateral borders but NOT btwn mass and
costal margin)
,Large kidney if: normal tympany in LUQ and can probe with fingers
between mass and costal margin but not deep to its medial and
lower borders.
◉ Kidney assessment: RIGHT. Answer: A normal right kidney may be
palpable, especially when the patient is thin and the abdominal
muscles are relaxed. To capture the right kidney, return to the
patient's right side. Use your left hand to lift up from the back, and
your right hand to feel deep in the RUQ. Proceed as before. The
kidney may be slightly tender. The patient is usually aware of a
capture and release.
Causes of kidney enlargement include hydronephrosis, cysts, and
tumors. Bilateral enlargement suggests poly-cystic kidney disease.
◉ Kidney Percussion. Answer: assess percussion tenderness over
the CVAs. Pressure from your fingertips may be enough to elicit
tenderness; if not, use fist percussion. Place the ball of one hand in
the CVA and strike it with the ulnar surface of your fist (Fig. 11-29).
Use enough force to cause a perceptible but painless jar or thud.
Pain with pressure or fist percussion supports pyelonephritis if
associated with fever and dysuria, but may also be musculoskeletal.
◉ Bladder assessment. Answer: Percussion dullness: bladder must
be 400-600ml full for dullness to appear.
Palpation: dome of distended bladder feels smooth, round,
nontender.
, Causes of bladder distention: outlet obstruction from a urethral
stricture or prostatic hyperplasia, medication side effects, and
neurologic disorders such as stroke or multiple sclerosis.
Suprapubic tenderness is common in bladder infection.
◉ Aorta assessment. Answer: Press firmly deep in the epigastrium,
slightly to the left of the midline, and identify the aortic pulsations
Adults over age 50 years, assess the width of the aorta by pressing
deeply in the upper abdomen with one hand on each side of the
aorta (normally no more than 3cm wide).
◉ Aorta abnormalities. Answer: A periumbilical or upper abdominal
mass with expansile pulsations that is ≥3 cm in diameter suggests an
AAA. Sensitivity of palpation increases as AAAs enlarge.
◉ Risk factors for AAA. Answer: 1. Age ≥65 years
2. history of smoking
3. male gender
4. first-degree relative with a history of AAA repair
◉ Ascites assessment. Answer: A protuberant abdomen with bulging
flanks is suspicious for ascites
dullness appears in the dependent areas of the abdomen.
2026 COMPLETE SOLVED QUESTIONS
◉ Kidney assessment LEFT. Answer: Retroperitoneal and
nonpalpable.
Palpation: lay on left side.
Place R hand behind the pt, just below and parallel to the 12th rib,
with fingertips just reaching the CVA. Lift, trying to displace the
kidney anteriorly. Place your left hand gently in the LUQ, lateral and
parallel to the rectus muscle. Ask the patient to take a deep breath.
At the peak of inspiration, press your left hand firmly and deeply
into the LUQ, just below the costal margin. Try to "capture" the
kidney between your two hands. Ask the patient to breathe out and
then to stop breathing briefly. Slowly release the pressure of your
left hand, feel-ing at the same time for the kidney to slide back into
its expiratory position. If the kidney is palpable, describe its size,
contour, and any tenderness.
OR Deep palpation: Stand on pt right side, use left hand, reach over
and around pt to lift up beneath the left kidney, and with right hand,
feel deep in the LUQ. Have pt to take deep breath, feel for a mass.
Abnormal: Splenomegaly (if palpable notch on medial border, edge
extends beyond midline, percussion is dull, and fingers can prode
deep to the medial and lateral borders but NOT btwn mass and
costal margin)
,Large kidney if: normal tympany in LUQ and can probe with fingers
between mass and costal margin but not deep to its medial and
lower borders.
◉ Kidney assessment: RIGHT. Answer: A normal right kidney may be
palpable, especially when the patient is thin and the abdominal
muscles are relaxed. To capture the right kidney, return to the
patient's right side. Use your left hand to lift up from the back, and
your right hand to feel deep in the RUQ. Proceed as before. The
kidney may be slightly tender. The patient is usually aware of a
capture and release.
Causes of kidney enlargement include hydronephrosis, cysts, and
tumors. Bilateral enlargement suggests poly-cystic kidney disease.
◉ Kidney Percussion. Answer: assess percussion tenderness over
the CVAs. Pressure from your fingertips may be enough to elicit
tenderness; if not, use fist percussion. Place the ball of one hand in
the CVA and strike it with the ulnar surface of your fist (Fig. 11-29).
Use enough force to cause a perceptible but painless jar or thud.
Pain with pressure or fist percussion supports pyelonephritis if
associated with fever and dysuria, but may also be musculoskeletal.
◉ Bladder assessment. Answer: Percussion dullness: bladder must
be 400-600ml full for dullness to appear.
Palpation: dome of distended bladder feels smooth, round,
nontender.
, Causes of bladder distention: outlet obstruction from a urethral
stricture or prostatic hyperplasia, medication side effects, and
neurologic disorders such as stroke or multiple sclerosis.
Suprapubic tenderness is common in bladder infection.
◉ Aorta assessment. Answer: Press firmly deep in the epigastrium,
slightly to the left of the midline, and identify the aortic pulsations
Adults over age 50 years, assess the width of the aorta by pressing
deeply in the upper abdomen with one hand on each side of the
aorta (normally no more than 3cm wide).
◉ Aorta abnormalities. Answer: A periumbilical or upper abdominal
mass with expansile pulsations that is ≥3 cm in diameter suggests an
AAA. Sensitivity of palpation increases as AAAs enlarge.
◉ Risk factors for AAA. Answer: 1. Age ≥65 years
2. history of smoking
3. male gender
4. first-degree relative with a history of AAA repair
◉ Ascites assessment. Answer: A protuberant abdomen with bulging
flanks is suspicious for ascites
dullness appears in the dependent areas of the abdomen.
