NR 509 Week 5 Quiz| Chamberlain University|
Actual Exam Questions and Correct Answers
A 19-year-old African American female presents with moderate to severe right lower quadrant
abdominal pain for 2 days, nausea, vomiting, unsure about fever. Which is a possible differential
diagnosis?
A) Ovarian cyst
B) Appendicitis
C) Gastroenteritis
D) All of the above
Correct Answer: D) All of the above
Explanation: Right lower quadrant pain with nausea and vomiting in a young female suggests
multiple possibilities: appendicitis (acute, localized pain), ovarian cyst (e.g., torsion or rupture),
and gastroenteritis (diffuse symptoms). All are plausible and should be considered in the
differential.
A 30-year-old female presents to the ED with a 1-day history of severe abdominal pain. The NP
suspects appendicitis and notes signs of peritonitis. Which physical exam finding supports
peritonitis?
A) Hypoactive bowel sounds
B) Rebound tenderness
C) Soft, non-tender abdomen
D) Tympanic percussion
Correct Answer: B) Rebound tenderness
Explanation: Rebound tenderness (pain on release of pressure) is a hallmark of peritonitis,
indicating peritoneal inflammation often associated with appendicitis. Hypoactive bowel sounds
are non-specific, a soft abdomen contradicts peritonitis, and tympanic percussion suggests air,
not inflammation.
A 44-year-old female presents with nausea and right upper quadrant pain. The NP notes wincing
and cessation of inspiration with RUQ palpation. Which is a positive exam finding?
, A) Rovsing’s sign
B) Murphy’s sign
C) Psoas sign
D) Obturator sign
Correct Answer: B) Murphy’s sign
Explanation: Murphy’s sign (pain and inspiratory arrest on RUQ palpation) is positive in
cholecystitis, indicated by nausea and RUQ pain. Rovsing’s, psoas, and obturator signs are
associated with appendicitis.
Which is the proper sequence of examination for the abdomen?
A) Auscultation, inspection, percussion, palpation
B) Inspection, palpation, percussion, auscultation
C) Inspection, auscultation, percussion, palpation
D) Palpation, percussion, auscultation, inspection
Correct Answer: C) Inspection, auscultation, percussion, palpation
Explanation: The abdominal exam sequence is inspection (visual), auscultation (bowel sounds
before manipulation), percussion (assess organ size), and palpation (last to avoid altering
findings). This order prevents distortion of bowel sounds or tenderness.
Dawn, a 55-year-old woman, undergoes a rectal exam in the lithotomy position during her
wellness visit. The NP feels a firm, immobile, irregular mass against the bowel wall. Which is
most likely?
A) Hemorrhoid
B) Rectal prolapse
C) Rectal carcinoma
D) Fecal impaction
Correct Answer: C) Rectal carcinoma
Explanation: A firm, immobile, irregular mass suggests rectal carcinoma, especially in a 55-
year-old. Hemorrhoids are soft and mobile, prolapse is external and soft, and impaction is
typically softer and movable.
Actual Exam Questions and Correct Answers
A 19-year-old African American female presents with moderate to severe right lower quadrant
abdominal pain for 2 days, nausea, vomiting, unsure about fever. Which is a possible differential
diagnosis?
A) Ovarian cyst
B) Appendicitis
C) Gastroenteritis
D) All of the above
Correct Answer: D) All of the above
Explanation: Right lower quadrant pain with nausea and vomiting in a young female suggests
multiple possibilities: appendicitis (acute, localized pain), ovarian cyst (e.g., torsion or rupture),
and gastroenteritis (diffuse symptoms). All are plausible and should be considered in the
differential.
A 30-year-old female presents to the ED with a 1-day history of severe abdominal pain. The NP
suspects appendicitis and notes signs of peritonitis. Which physical exam finding supports
peritonitis?
A) Hypoactive bowel sounds
B) Rebound tenderness
C) Soft, non-tender abdomen
D) Tympanic percussion
Correct Answer: B) Rebound tenderness
Explanation: Rebound tenderness (pain on release of pressure) is a hallmark of peritonitis,
indicating peritoneal inflammation often associated with appendicitis. Hypoactive bowel sounds
are non-specific, a soft abdomen contradicts peritonitis, and tympanic percussion suggests air,
not inflammation.
A 44-year-old female presents with nausea and right upper quadrant pain. The NP notes wincing
and cessation of inspiration with RUQ palpation. Which is a positive exam finding?
, A) Rovsing’s sign
B) Murphy’s sign
C) Psoas sign
D) Obturator sign
Correct Answer: B) Murphy’s sign
Explanation: Murphy’s sign (pain and inspiratory arrest on RUQ palpation) is positive in
cholecystitis, indicated by nausea and RUQ pain. Rovsing’s, psoas, and obturator signs are
associated with appendicitis.
Which is the proper sequence of examination for the abdomen?
A) Auscultation, inspection, percussion, palpation
B) Inspection, palpation, percussion, auscultation
C) Inspection, auscultation, percussion, palpation
D) Palpation, percussion, auscultation, inspection
Correct Answer: C) Inspection, auscultation, percussion, palpation
Explanation: The abdominal exam sequence is inspection (visual), auscultation (bowel sounds
before manipulation), percussion (assess organ size), and palpation (last to avoid altering
findings). This order prevents distortion of bowel sounds or tenderness.
Dawn, a 55-year-old woman, undergoes a rectal exam in the lithotomy position during her
wellness visit. The NP feels a firm, immobile, irregular mass against the bowel wall. Which is
most likely?
A) Hemorrhoid
B) Rectal prolapse
C) Rectal carcinoma
D) Fecal impaction
Correct Answer: C) Rectal carcinoma
Explanation: A firm, immobile, irregular mass suggests rectal carcinoma, especially in a 55-
year-old. Hemorrhoids are soft and mobile, prolapse is external and soft, and impaction is
typically softer and movable.
