NR-304 Health Assessment II - Set 2 - Part 3

Correct Answer: The spleen, in the left upper quadrant

The spleen occupies the left upper quadrant beneath ribs nine through eleven, so blunt trauma to that region threatens it directly. Splenic injury is the concern that makes left upper quadrant pain after a fall urgent. Option b is incorrect because the gallbladder sits on the patient's right beneath the liver, not on the left. Reversing these two upper organs is the most frequent quadrant error students make on this material. Option c is incorrect because the appendix lies low on the right, far below and across from the painful area described. Appendiceal pain migrates from the umbilicus toward the right hip, not toward the left ribs. Option d is incorrect because the bladder is a midline structure that rises only above the symphysis pubis when full. It could never account for pain located high under the left rib margin.

Correct Answer: Fever with tenderness over the inflamed segment

Diverticulitis produces left lower quadrant pain with fever and leukocytosis, and tenderness over the inflamed segment is almost always present because the inflamed diverticulum irritates the peritoneum lying directly over it. Option a is incorrect because inspiratory arrest is the Murphy sign of an inflamed gallbladder under the right costal margin, a right upper quadrant problem unrelated to a sigmoid diverticulum. Option b is incorrect because migration of pain from the umbilicus to the right lower quadrant describes appendicitis. This client's pain has stayed on the left, where the sigmoid colon lies. Option d is incorrect because steatorrhea reflects fat malabsorption in the small bowel and pancreas. Diverticular inflammation alters bowel habit toward constipation or diarrhea but does not impair the digestion of fat.

Correct Answer: "I will tell you where it hurts before you start."

Telling the nurse about painful areas before the examination begins lets those areas be examined last. Palpating a tender spot early produces pain and guarding that hides findings in every other quadrant. Option a is incorrect because arms raised overhead stretch the abdominal wall taut from above and tighten the muscles. The arms belong at the sides or folded across the chest. Option c is incorrect because legs extended flat keep the rectus muscles under tension. Bending the knees over a pillow slackens the abdominal wall and is part of the correct position for this examination. Option d is incorrect because breath holding tenses the wall and removes the slow breathing the nurse relies on to relax it. Clients are coached to breathe slowly and evenly during palpation.

Correct Answer: The head sits upper right and the body upper left

The course quadrant table splits the pancreas, placing the head in the right upper quadrant cradled by the duodenum and the body in the epigastrium and left upper quadrant, with the tail reaching the splenic hilum. Option a is incorrect because the sides are reversed. The head is cradled in the duodenal C loop on the right, and the tail extends leftward toward the spleen, so this answer inverts the organ's actual orientation. Option b is incorrect because no part of the pancreas reaches the lower quadrants. It is an upper abdominal retroperitoneal organ, which is why its pain is felt in the epigastrium and bores through to the back. Option c is incorrect because the pancreas does not sit wholly on the left. Its head occupies the right upper quadrant, and charting the organ as a single quadrant structure misses why pancreatic pain crosses the midline.

Correct Answer: The enlarging uterus displaces the appendix upward

The enlarging uterus pushes the intestines upward and posteriorly and displaces the appendix upward and to the right, so appendicitis late in pregnancy presents in the right flank or right upper quadrant. Option b is incorrect because pregnancy offers no protection from an inflamed appendix. What changes is the location of the pain and the clarity of the signs, which makes the diagnosis harder rather than impossible. Option c is incorrect because assuming a urinary cause would miss an appendix that has been pushed into the flank. Pyelonephritis is one possibility among several, and costovertebral tenderness would help separate them. Option d is incorrect because the uterus separates the inflamed organ from the anterior abdominal wall, so peritoneal signs are blunted instead of exaggerated. That is why imaging is pursued sooner in pregnancy.

Correct Answer: Hold oral intake and notify the provider now

Coffee-ground emesis with melena and falling blood pressure is active upper gastrointestinal bleeding. The client is kept nothing by mouth for likely endoscopy or surgery, and the provider is notified immediately rather than after further observation. Option a is incorrect because anything by mouth risks aspiration if this client goes urgently to endoscopy or surgery, and oral fluid cannot replace circulating volume lost through the gastrointestinal tract. Option b is incorrect because waiting an hour while the pressure drops allows shock to develop. Visible bleeding with unstable vital signs is a finding that has already earned escalation, not further monitoring. Option d is incorrect because warmth over the abdomen increases local blood flow and can accelerate bleeding from an ulcer crater. Nothing about a warm pack addresses hypovolemia or the source of the hemorrhage.

Correct Answer: The client with a rigid abdomen and vomiting

A rigid abdomen with vomiting is a peritoneal picture and a surgical emergency that can progress to septic shock within hours. The other three describe findings that are expected, benign or non-urgent by themselves. Option a is incorrect because mild tenderness over the sigmoid colon in that quadrant is an expected finding in a healthy adult. It is documented as elicited and does not compete with a peritoneal sign. Option c is incorrect because a hernia that is soft and reduces easily has an intact blood supply and is repaired electively. The urgent hernia is tender, discoloured, irreducible and accompanied by vomiting. Option d is incorrect because loud gurgling sounds by themselves are not an emergency and occur with gastroenteritis, diarrhea and laxatives. Increased motility becomes worrying only when pain, distention and obstipation accompany it.

Correct Answer: Shoulder pain reflects diaphragmatic irritation from intra-abdominal bleeding

Kehr sign is referred shoulder pain from blood or air irritating the diaphragm, carried by the phrenic nerve. With a missed period and rising heart rate, a ruptured ectopic pregnancy must be assumed and escalated. Option b is incorrect because treating this as a strain delays recognition of an abdominal catastrophe. Heat is also contraindicated in an undiagnosed acute abdomen, and rest does nothing for blood under the diaphragm. Option c is incorrect because biliary pain refers to the right scapula and right shoulder, not the left, and it follows fatty meals rather than a missed period. The side alone argues against gallbladder disease. Option d is incorrect because attributing these findings to anxiety ignores hypovolemia announcing itself through a climbing pulse. Any woman of childbearing age with sudden pelvic pain is evaluated for pregnancy before anything else.

Correct Answer: Ask about aspirin and other NSAID use

Black tarry stool is melena, digested blood from an upper gastrointestinal source. Frequent NSAID and low dose aspirin use heads the risk list for peptic ulcer disease, so that history comes first. Option a is incorrect because travel history points toward infectious diarrhea, which produces loose or bloody stool rather than the black tarry stool of digested upper gastrointestinal blood. It does not explain the lightheadedness either. Option b is incorrect because fluid and fiber questions belong to a constipation history. Nothing in this presentation suggests hard stool or straining, and delaying the bleeding history risks missing an active upper gastrointestinal hemorrhage. Option d is incorrect because family cancer history matters for screening rather than for this acute episode. Colonic bleeding would show as red blood in the stool, not the tarry black of upper tract bleeding.

Correct Answer: You have described Rovsing sign; Blumberg sign is rebound tenderness

The described maneuver is Rovsing sign, which points to appendicitis. Blumberg sign is rebound tenderness, pain felt when deep pressure applied away from the tender area is released quickly, and it signals peritoneal inflammation. Option a is incorrect because confirming the student's error leaves two named signs merged into one. Blumberg is not left-sided pressure, and a positive Blumberg means peritoneal inflammation anywhere, not appendicitis alone. Option b is incorrect because Murphy sign is inspiratory arrest during deep palpation under the right costal margin. Nothing in the student's statement concerns the gallbladder or the client's breathing pattern. Option c is incorrect because the psoas test uses leg movement, either resisted hip flexion or passive hip extension, rather than quadrant pressure. It also suggests a retrocecal appendix only when leg motion reproduces pain.