Abdomen Questions

Question 1

The nurse is percussing the seventh right intercostal space at the midclavicular line over the liver. Which sound should the nurse expect to hear?

a. Tympany
b. Dullness
c. Resonance
d. Hyperresonance

Answer 1

ANS: B
Abdominal percussion is performed to assess the relative density of abdominal contents, locate organs, and screen for abnormal fluid or masses in the abdomen. The liver is a solid organ which is located in the right upper quadrant and would elicit a dull
percussion note. Tympany is heard over air-filled organs such as the stomach and intestines. It is the predominant sound that should be heard over the intestines because air in the intestines rises to the surface when the person is supine. Resonance is a low-pitched, clear, hollow sound that predominates in health lung tissue. Hyperresonance is a lower-pitched, booming sound found when too
much air is present such as with gaseous distention of the intestines in the abdomen or emphysema in the lungs. Since the liver is a
solid organ located in the right upper quadrant, it should elicit a dull sound when percussed.

Question 2

Which structure is located in the left lower quadrant of the abdomen?

a. Liver
b. Duodenum
c. Gallbladder
d. Sigmoid colon

Answer 2

ANS: D

The sigmoid colon is located in the left lower quadrant of the abdomen. The duodenum, or first part of the small intestine, and the
gallbladder are located in the right upper abdominal quadrant. The sigmoid colon then is the structure that is located in the left
lower abdominal quadrant.

Question 3

A patient is having difficulty swallowing medications and food. How should the nurse document this?

a. Aphasia
b. Anorexia
c. Dysphasia
d. Dysphagia

Answer 3

ANS: D

Dysphagia is a condition that occurs with disorders of the throat or esophagus and results in difficulty swallowing. Aphasia and
dysphasia are speech disorders. Anorexia is a loss of appetite.

Question 4

The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?

a. Percuss and palpate in the lumbar region
b. Inspect and palpate in the epigastric region
c. Auscultate and percuss in the inguinal region
d. Percuss and palpate the midline area above the suprapubic bone

Answer 4

ANS: D

The bladder is located in the suprapubic area (above the pubic bone) and if distended would elicit a dull sound when percussed and
feel firm to palpation. However, this technique has been found to be unreliable and bedside bladder scanning with ultrasound is
commonly used to estimate bladder volume.

Question 5

The nurse is aware that what change may occur in the gastrointestinal system with aging?

a. Increased salivation
b. Increased liver size
c. Increased esophageal emptying
d. Decreased gastric acid secretion

Answer 5

ANS: D

Gastric acid secretion decreases with aging. As one ages, salivation decreases, esophageal emptying is delayed, and liver size
decreases.

Question 6

A 22-year-old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handle
bars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of the spleen
in this situation?
a. The spleen can be enlarged as a result of trauma.
b. The spleen is normally felt on routine palpation.
c. If an enlarged spleen is noted, then the nurse should thoroughly palpate to
determine its size.
d. An enlarged spleen should not be palpated because it can easily rupture.

Answer 6

ANS: D

If an enlarged spleen is felt, then the nurse should not continue to palpate it but refer the patient to a physician. An enlarged spleen
is friable and can easily rupture with overpalpation.

Question 7

A patient’s abdomen is bulging and stretched in appearance. How should the nurse document this finding?

a. Obese
b. Scaphoid
c. Herniated
d. Protuberant

Answer 7

ANS: D

A bulging and stretched abdomen is described as protuberant. A protuberant abdomen is rounded, bulging, and stretched. A
scaphoid abdomen caves inward. An obese abdomen appears uniformly rounded with a sunken umbilicus. A hernia is a protrusion
of the abdominal viscera through an abnormal opening in the abdominal muscle wall.

Question 8

The nurse is describing a scaphoid abdomen. When assessing the contour of the abdomen from the rib margin to the pubic bone,
what would the contour look like?
a. Flat
b. Convex
c. Bulging
d. Concave

Answer 8

ANS: D
Contour describes the profile of the abdomen from the rib margin to the pubic bone; a scaphoid contour is one that is concave from
a horizontal plane. The contour describes the nutritional state and normally ranges from flat to round.

Question 9

While examining a patient, the nurse observes abdominal pulsations between the xiphoid process and umbilicus. What does the
nurse suspect?
a. Pulsations of the renal arteries
b. Normal abdominal aortic pulsations
c. Pulsations of the inferior vena cava
d. Increased peristalsis from a bowel obstruction

Answer 9

ANS: B
Pulsations from the aorta are normally observed beneath the skin in the epigastric area, particularly in thin people who have good
muscle wall relaxation. Pulsations of the renal arteries are not visible. The vena cava is a vein, not an artery, and does not have
pulsations. Waves of peristalsis are sometimes visible in very thin people and appear as a slow ripple moving obliquely across the
abdomen.

Question 10

A patient has hypoactive bowel sounds. What is a possible cause of this finding?

a. Diarrhea
b. Peritonitis
c. Laxative use
d. Gastroenteritis

Answer 10

ANS: B
Diminished or absent bowel sounds signal decreased gastrointestinal motility which can be caused from inflammation from
peritonitis, a paralytic ileus after abdominal surgery, or with a bowel obstruction. Diarrhea, laxative use, and gastroenteritis cause
hyperactive, not hypoactive, bowel sounds.

Question 11

The nurse is watching a new graduate nurse perform auscultation of a patient’s abdomen. Which statement by the new graduate
shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?
a. “We need to determine the areas of tenderness before using percussion and
palpation.”
b. “Auscultation prevents distortion of bowel sounds that might occur after
percussion and palpation.”
c. “Auscultation allows the patient more time to relax and therefore be more
comfortable with the physical examination.”
d. “Auscultation prevents distortion of vascular sounds, such as bruits and hums,
that might occur after percussion and palpation.”

Answer 11

ANS: B
Auscultation is performed first (after inspection) because percussion and palpation can increase peristalsis, which would give a
false interpretation of bowel sounds.

Question 12

The nurse is listening to bowel sounds. Which of these statements is true of bowel sounds?

a. Sound like two pieces of leather being rubbed together
b. Are usually high-pitched, gurgling, and irregular sounds
c. Are usually loud, high-pitched, rushing, and tinkling sounds
d. Originate from the movement of air and fluid through the large intestine

Answer 12

ANS: B
Bowel sounds are high-pitched, gurgling, and cascading sounds that irregularly occur from 5 to 30 times per minute. They originate
from the movement of air and fluid through the small intestine.

Question 13

The physician comments that a patient has abdominal borborygmi. What is the best description of this term?

a. Hypoactive bowel sounds
b. A peritoneal friction rub
c. Loud gurgling bowel sounds
d. Loud continual humming bowel sounds

Answer 13

ANS: C
Borborygmi is the term used for hyperperistalsis when the person actually feels his or her stomach growling. Upon auscultation
borborygmi sounds like loud gurgling bowel sounds

Question 14

During an abdominal assessment, the nurse would consider which of these findings as normal?

a. Presence of a bruit in the femoral area
b. Tympanic percussion note in the umbilical region
c. Dull percussion note in the left upper quadrant at the midclavicular line
d. Palpable spleen between the ninth and eleventh ribs in the left midaxillary line

Answer 14

ANS: B
Tympany should predominate in all four quadrants of the abdomen because air in the intestines rises to the surface when the person
is supine. Vascular bruits are not usually present. Normally the spleen is not palpable. Dullness would not be found in the area of
lung resonance (left upper quadrant at the midclavicular line).

Question 15

The nurse is assessing the abdomen of a pregnant woman who states she has been having “acid indigestion” all the time. What does
the nurse know that esophageal reflux during pregnancy can cause?
a. Diarrhea
b. Pyrosis
c. Dysphagia
d. Constipation

Answer 15

ANS: B

Pyrosis, or heartburn, is caused by esophageal reflux during pregnancy. The other options are not correct.

Question 16

The nurse is performing an abdominal assessment. What types of percussion notes can be heard during abdominal assessment?

a. Flatness, resonance, and dullness
b. Resonance, dullness, and tympany
c. Tympany, hyperresonance, and dullness
d. Resonance, hyperresonance, and flatness

Answer 16

ANS: C
Percussion notes normally heard during the abdominal assessment may include tympany, which should predominate because air in
the intestines rises to the surface when the person is supine; hyperresonance, which may be present with gaseous distention; and
dullness, which may be found over a distended bladder, adipose tissue, fluid, or a mass. Flatness is not a term used to describe a
percussed sound. Resonance is a low-pitched, clear, hollow sound that predominates in healthy lung tissue but not in the abdomen.

Question 17

An older patient has been diagnosed with pernicious anemia. This disorder could be r/t what condition?

a. Increased gastric acid secretion
b. Decreased gastric acid secretion
c. Delayed gastrointestinal emptying time
d. Increased gastrointestinal emptying time

Answer 17

ANS: B
Gastric acid secretion decreases with aging and may cause pernicious anemia (because it interferes with vitamin B12 absorption),
iron deficiency anemia, and malabsorption of calcium.

Question 18

A patient is reporting sharp pain along the costovertebral angles. What does this symptom most often indicate?

a. Ovarian infection
b. Liver enlargement
c. Spleen enlargement
d. Kidney inflammation

Answer 18

ANS: D
Sharp pain along the costovertebral angles occurs with inflammation of the kidney or paranephric area. The other options are not
correct. Ovarian infection and liver or spleen enlargement do not cause pain along the costovertebral angles.

Question 19

A nurse notices that a patient has abdominal ascites. What does this finding indicate?

a. Flatus
b. Fibroid tumors
c. Presence of feces
d. Presence of fluid

Answer 19

ANS: D
Ascites is free fluid in the peritoneal cavity and occurs with heart failure, portal hypertension, cirrhosis, hepatitis, pancreatitis, and
cancer.

Question 20

The nurse notices that a patient has had a black, tarry stool. What should the nurse recognize may cause this finding?

a. Gallbladder disease
b. Overuse of laxatives
c. Gastrointestinal bleeding
d. Localized bleeding around the anus

Answer 20

ANS: C
Stools may be black and tarry (melena) as a result of bleeding in the upper gastrointestinal tract. Red blood in stools occurs with
localized bleeding in the rectal or anal areas.

Question 21

During an abdominal assessment, the nurse elicits tenderness on light palpation in the right lower quadrant. The nurse recognizes
this finding could indicate a problem with what structure?
a. Spleen
b. Sigmoid
c. Appendix
d. Gallbladder

Answer 21

ANS: C
The appendix is located in the right lower quadrant. When the iliopsoas muscle is inflamed, which occurs with an inflamed or
perforated appendix, pain is felt in the right lower quadrant. The spleen is in the left upper quadrant; the sigmoid is in the left lower
quadrant; and the gallbladder is in the right upper quadrant.

Question 22

The nurse is assessing the abdomen of an older adult. Which statement regarding the older adult and abdominal assessment is true?
a. Abdominal tone is increased.
b. Abdominal musculature is thinner.
c. Abdominal rigidity with an acute abdominal condition is more common.
d. The older adult with an acute abdominal condition complains more about pain
than the younger person.

Answer 22

ANS: B
In the older adult, the abdominal musculature is thinner and has less tone than that of the younger adult, and abdominal rigidity
with an acute abdominal condition is less common in the aging person. The older adult with an acute abdominal condition often
complains less about pain than the younger person.

Question 23

During an assessment of a newborn infant, the nurse suspects the infant has pyloric stenosis. What finding would cause the nurse to
suspect this?
a. Projectile vomiting
b. Hypoactive bowel activity
c. Palpable olive-sized mass in the right lower quadrant
d. Pronounced peristaltic waves crossing from right to left

Answer 23

ANS: A
Significant peristalsis, together with projectile vomiting, in the newborn suggests pyloric stenosis. After feeding, pronounced
peristaltic waves cross from left to right, leading to projectile vomiting. One can also palpate an olive-sized mass in the right upper
quadrant.

Question 24

The nurse is reviewing the assessment of an aortic aneurysm. Which of these statements is true regarding an aortic aneurysm?

a. A bruit is absent.
b. Femoral pulses are increased.
c. A pulsating mass is usually present.
d. Most are located below the umbilicus

Answer 24

ANS: C
Most aortic aneurysms are palpable during routine examination and feel like a pulsating mass. A bruit will be audible, and femoral
pulses are present but decreased. Such aneurysms are located in the upper abdomen just to the left of midline.

Question 25

During an abdominal assessment, the nurse is unable to hear bowel sounds in a patient’s abdomen. How long should the nurse
listen before reporting absent bowel sounds?
a. 1 minute
b. 5 minutes
c. 10 minutes
d. 2 minutes in each quadrant

Answer 25

ANS: B
Absent bowel sounds are rare. The nurse must listen for 5 minutes before deciding that bowel sounds are completely absent.

Question 26

A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The nurse should conduct which of these
techniques to assess for this condition?
a. Obturator test
b. Test for Murphy sign
c. Iliopsoas muscle test
d. Assess for rebound tenderness

Answer 26

ANS: B
Normally palpating the liver causes no pain. In a person with inflammation of the gallbladder, or cholecystitis, pain occurs as the
descending liver pushes the inflamed gallbladder onto the examining hand during inspiration (Murphy test). The person feels sharp
pain and abruptly stops midway during inspiration. The obturator and iliopsoas muscle tests assess for an inflamed appendix.
Although a patient with cholecystitis may have rebound tenderness, the presence of rebound tenderness indicates peritoneal
inflammation which could be caused by several things so it is not specific to cholecystitis.

Question 27

Just before going home, a new mother asks the nurse about the infant’s umbilical cord. Which of these statements is correct?

a. “It should fall off in 10 to 14 days.”
b. “It will soften before it falls off.”
c. “It contains two veins and one artery.”
d. “Skin will cover the area within 1 week.”

Answer 27

ANS: A
At birth, the umbilical cord is white and contains two umbilical arteries and one vein inside the Wharton’s jelly. The umbilical
stump dries within a week, hardens, and falls off in 10 to 14 days. Skin will cover the area in 3 to 4 weeks.

Question 28

Which of these percussion findings would the nurse expect to find in a patient with a large amount of ascites?

a. Dullness across the abdomen
b. Flatness in the right upper quadrant
c. Hyperresonance in the left upper quadrant
d. Tympany in the right and left lower quadrants

Answer 28

ANS: A
A large amount of ascitic fluid produces a dull sound to percussion. Flatness is not a term used to describe a percussed sound.
Hyperresonance is a lower-pitched, booming sound found when too much air is present such as with gaseous distention of the
intestines in the abdomen, not with ascites or fluid. Tympany normally is the predominant sound heard on abdominal auscultation,
but it is not heard with ascites, or fluid, in the abdomen.

Question 29

A 40-year-old man states that his physician told him that he has a hernia. He asks the nurse to explain what a hernia is. Which
response by the nurse is appropriate?
a. “No need to worry. Most men your age develop hernias.”
b. “A hernia is a loop of bowel protruding through a weak spot in the abdominal
muscles.”
c. “A hernia is the result of prenatal growth abnormalities that are just now causing
problems.”
d. “I’ll have to have your physician explain this to you.”

Answer 29

ANS: B
The nurse should explain that a hernia is a protrusion of the abdominal viscera through an abnormal opening in the muscle wall.
The nurse should acknowledge the patient’s concerns and not tell him not to worry about it or refer him to his physician to explain
it. It is not a result of prenatal growth abnormalities.

Question 30

A 45-year-old man is in the clinic for a physical examination. During the abdominal assessment, the nurse percusses the abdomen
and notices an area of dullness above the right costal margin of approximately 11 cm. How should the nurse proceed?
a. Document the presence of hepatomegaly.
b. Ask additional health history questions regarding his alcohol intake.
c. Consider this finding as normal, and proceed with the examination.
d. Describe this dullness as indicative of an enlarged liver, and refer him to a

Answer 30

ANS: C
A liver span of 10.5 cm is the mean for males and 7 cm for females. Men and taller individuals are at the upper end of this range.
Women and shorter individuals are at the lower end of this range. A liver span of 11 cm is within normal limits for this individual

Question 31

When palpating the abdomen of a 20-year-old patient, the nurse notices the presence of tenderness in the left upper quadrant with
deep palpation. Which of these structures is most likely to be involved?
a. Spleen
b. Appendix
c. Gallbladder
d. Sigmoid colon

Answer 31

ANS: A
The spleen is located in the left upper quadrant of the abdomen. The gallbladder is in the right upper quadrant, the sigmoid colon is
in the left lower quadrant, and the appendix is in the right lower quadrant.

Question 32

The nurse is reviewing information on lactose intolerance and learned that in some racial groups lactase activity (ability to digest
and absorb lactose) is high at birth but declines to low levels by adulthood. Which ethnic group has the highest potential for
lactose-intolerance symptoms in adulthood?
a. Asians
b. African Americans
c. White Americans
d. American Indians

Answer 32

ANS: D
Millions of American adults have the potential for lactose-intolerance symptoms; while 70–80% of White Americans produce
lactase adequately into adulthood, only 30% of Mexican Americans, 20% of African Americans, and no American Indians will
maintain adequate ability to digest lactose without adverse symptoms.

Question 33

The nurse is assessing a patient for possible peptic ulcer disease. Which condition or history often causes this disorder?

a. Hypertension
b. Streptococcal infections
c. Recurrent constipation with frequent laxative use
d. Frequent use of nonsteroidal antiinflammatory drugs

Answer 33

ANS: D
Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can
create a painful open sore that may bleed. Peptic ulcers often occur with the frequent use of nonsteroidal antiinflammatory drugs,
alcohol use, smoking, and Helicobacter pylori infections all of which can cause inflammation and irritation to the stomach lining or
mucosa.

Question 34

During the change-of-shift report, the student nurse hears that a patient has hepatomegaly. What should the student recognizes that
this term means?
a. Enlarged liver
b. Enlarged spleen
c. Distended bowel
d. Excessive diarrhea

Answer 34

ANS: A
The term hepatomegaly refers to an enlarged liver. The term splenomegaly refers to an enlarged spleen. The other responses are not
correct.

Question 35

During an assessment, the nurse notices that a patient’s umbilicus is enlarged and everted. It is positioned midline with no change
in skin color. The nurse recognizes that the patient may have which condition?
a. Constipation
b. Abdominal tumor
c. Umbilical hernia
d. Intra-abdominal bleeding

Answer 35

ANS: C
The umbilicus is normally midline and inverted with no signs of discoloration. With an umbilical hernia, the mass is enlarged and
everted. The other responses are incorrect.

Question 36

During an abdominal assessment, the nurse tests for a fluid wave. What condition would produce a positive fluid wave test?

a. Ascites
b. Splenomegaly
c. Constipation
d. Distended bladder

Answer 36

ANS: A
If ascites (fluid in the abdomen) is present, then the examiner will feel a fluid wave when assessing the abdomen. A fluid wave is
not present with splenomegaly, a distended bladder, or constipation.

Question 37

The nurse is preparing to examine a patient who has been complaining of right lower quadrant pain. Which technique is correct
during the assessment?
a. Examine the tender area first.
b. Examine the tender area last.
c. Avoid palpating the tender area.
d. Palpate the tender area first, and then auscultate for bowel sounds.

Answer 37

ANS: B
The nurse should save the examination of any identified tender areas until last. This method avoids pain and the resulting muscle
rigidity that would obscure deep palpation later in the examination. Auscultation is performed before percussion and palpation
because percussion and palpation can increase peristalsis, which would give a false interpretation of bowel sounds.

Question 38

During a health history, the patient tells the nurse, “I have pain all the time in my stomach. It’s worse 2 hours after I eat, but it gets
better if I eat again!” Based on these symptoms, the nurse suspects that the patient has which condition?
a. Appendicitis
b. Gastric ulcer
c. Duodenal ulcer
d. Cholecystitis

Answer 38

ANS: C
Pain associated with duodenal ulcers occurs 2 to 3 hours after a meal; it may be relieved by eating more food. Chronic pain
associated with gastric ulcers usually occurs on an empty stomach. Severe, acute pain would occur with appendicitis and
cholecystitis.

Question 39

The nurse suspects that a patient has appendicitis. Which of these procedures are appropriate for use when assessing for
appendicitis or a perforated appendix? (Select all that apply.)
a. Test for fluid wave
b. Test for the Murphy sign
c. Test for the Blumberg sign
d. Test for shifting dullness
e. Perform the iliopsoas muscle test

Answer 39

ANS: C, E
Testing for the Blumberg sign (rebound tenderness) and performing the iliopsoas muscle test should be used when assessing for
appendicitis. The Murphy sign is used when assessing for an inflamed gallbladder or cholecystitis. Testing for a fluid wave and
shifting dullness is performed when assessing for ascites.