NR509NP Final Exam Study Guide spring 2026 Chamberlain College of Nursing

NR509 Advanced Physical Assessment

Exam Study Guide – Final Exam



Exam Format: Non-Cumulative
Question Type: Multiple Choice
Number of Questions: 100
Time Allotted: 120 minutes
Testing Timeframe: The final exam will be available starting on
Wednesday of Week 8 at 12:01 am MT until Saturday of Week 8 at
11:59 pm MT.


1. Exam Coverage

Content Areas:

 Week 5: Abdominal Assessment
o Acute ABD Pain Assessment Findings
 Appendicitis: Pain typically starts around the umbilicus and
then localizes to the right lower quadrant (McBurney's
point).
 Pancreatitis: Often presents a severe epigastric pain that
may radiate to the back.
 Bowel obstruction: Crampy pain that may be associated
with distention and changes in bowel habits.
o Chronic ABD Pain Assessment Findings
 IBS: Often associated w/ changes in bowel habits and may
be relieved with defecation.
 PUD: “gnawing” or burning sensation; often occurring after
meals.
o ABD Assessment Techniques (and order)
 Inspection
 Auscultation
 Percussion
 Palpation
o Key Assessment findings for APPENDICITIS:
 Guarding: Involuntary tensing of ABD muscles in response
to pain.
 Psoas Sign: Pain with flexing right hip against resistance;
can indicate irritation of iliopsoas muscle d/t appendicitis,

,  Obturator Sign: Pain when right hip is flexes and
internally rotates; can indicate appendicitis.
 RLQ pain
 McBurney’s Point
 Rovsing’s Sign
 Blomberg’s Sign (rebound tenderness)
 Low grade fever
 N/V
o Key Assessment Findings for HEPATOMEGALY
 Inspection: Any s/s liver enlargement or distention as well
as s/s jaundice.
 Auscultate
 Palpation: Liver edge is usually at the right costal margin.
 If hepatomegaly, liver edge may be MORE THAN
1cm BELOW right costal margin.
 Assess for tenderness during palpation.
 Percussion: Should be normal tympanic sound over air-
filled structures.
 In hepatomegaly, you will hear DULLNESS.
 S/S:
 Pain in RUQ
 Fullness
 Jaundice
 Causes
 Liver disease (hepatitis, cirrhosis, fatty liver)
 CHF (from fluid overload  liver congestion and
enlargement)
 Cancer
 From Bates:
o Borborygmi = sounds of digestion (lol).
o Light palpation  then deep palpation.
o Percussion of liver
 Locate midclavicular line (start below umbilicus in RLQ
then move up; then start at nipple line and move down) 
Normal is 4-6cm in midsternal line; 6-12cm in R
midclavicular line.
o Palpation of liver
 Let hand behind lower thorax to lift 11th and 12th ribs; place
right hand over RLQ and press gently and patient INHALES.
 Hooking technique to press IN and UP during
inhalation.
o Palpation of spleen
 Reach over and around left side of patient with left hand;
place R hand below left costal margin and press IN towards
spleen. Try to feel when patient INHALES. (Not often
palpable).