NR 509 Final Exam Questions With Accurate
Answers 2025\2026 A+ Grade
Appendicitis
- accurate answers-1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing
sign, and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates
to the RLQ. Older adults are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests
appendicitis.
McBurney Point
- accurate answers-1. McBurney point lies 2 inches from the anterior superior
spinous process of ilium on a line drawn from that process to the umbilicus
2. Appendicitis is three times more likely if there is McBurney point
tenderness.
Rovsing sign
- accurate answers-Press deeply and evenly in the LLQ. Then quickly
withdraw your fingers.
Pain in the RLQ during left-sided pressure is a positive Rovsing sign.
Psoas Sign
- accurate answers---Place your hand just above the patient's right knee and
ask the patient to raise that thigh against your hand. Alternatively, ask the
patient to turn onto the left side. Then extend the patient's right leg at the hip.
Flexion of the leg at the hip makes the psoas muscle contract; extension
stretches it.
--Increased abdominal pain on either maneuver is a positive psoas sign, sug-
gesting irritation of the psoas muscle by an inflamed appendix.
Obturator Sign
- accurate answers---Less helpful
--Flex the patient's right thigh at the hip, with the knee bent, and rotate the leg
internally at the hip. This maneuver stretches the internal obturator muscle.
,--Right hypogastric pain is a positive obturator sign, from irritation of the
obturator muscle by an inflamed appendix. This sign has very low sensitivity.
Acute Cholecystits
- accurate answers-RUQ pain
Murphy Sign
Murphy Sign
- accurate answers-Hook your left thumb or the fingers of your right hand
under the costal margin at the point where the lateral border of the rectus
muscle intersects with the costal margin. Alternatively, palpate the RUQ with
the fingers of your right hand near the costal margin. If the liver is enlarged,
hook your thumb or fingers under the liver edge at a comparable point. Ask
the patient to take a deep breath, which forces the liver and gallbladder down
toward the examining fingers. Watch the patient's breathing and note the
degree of tenderness.
--A sharp increase in tenderness with inspiratory effort is a positive Murphy
sign. When positive, Murphy sign triples the likelihood of acute cholecystitis.
Acute Pancreatitis Process
- accurate answers-Intrapancreatic trypsinogen activation to trypsin and
other enzymes, result-ing in autodigestion and inflammation of the pancreas
Acute Pancreatitis Location
- accurate answers-Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality
- accurate answers-Usually steady
Acute PancreatitisTiming
- accurate answers-Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors
- accurate answers-Lying supine; dyspnea if pleural effusions from capillary
leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors
- accurate answers-Leaning forward with trunk flexed
, Acute Pancreatitis Associated Symptoms and Setting
- accurate answers-Nausea, vomiting, abdominal dis-tention, fever; often
recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process
- accurate answers-Mucosal ulcer in stomach or duode-num >5 mm, covered
with fibrin, ex-tending through the muscularis mu-cosa; H. pylori infection
present in 90% of peptic ulcers
Peptic Ulcer Disease Location
- accurate answers-Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality
- accurate answers-Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
Peptic Ulcer Disease Timing
- accurate answers-Intermittent; duodenal ulcer is more likely than gastric
ulcer or dyspepsia to cause pain that (1) wakes the patient at night, and (2)
occurs intermittently over a few wks, disappears for months, then recurs
Peptic Ulcer Disease aggravating factors
- accurate answers-Variable
Peptic Ulcer Disease relieving factors
- accurate answers-Food and antacids may bring re-lief (less likely in gastric
ulcers)
Peptic Ulcer Disease associated symptoms and setting
- accurate answers-Nausea, vomiting, belching, bloating; heartburn (more
common in duodenal ulcer); weight loss (more common in gastric ulcer);
dyspepsia is more com-mon in the young (20-29 yrs), gastric ulcer in those
over 50 yrs, and duodenal ulcer in those 30-60 yrs
GERD Process
- accurate answers-Prolonged exposure of esophagus to gastric acid due to
Answers 2025\2026 A+ Grade
Appendicitis
- accurate answers-1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the presence of RLQ tenderness, Rovsing
sign, and the psoas sign
--The pain of appendicitis classically begins near the umbilicus, then migrates
to the RLQ. Older adults are less likely to report this pattern.
--Localized tenderness anywhere in the RLQ, even in the right flank, suggests
appendicitis.
McBurney Point
- accurate answers-1. McBurney point lies 2 inches from the anterior superior
spinous process of ilium on a line drawn from that process to the umbilicus
2. Appendicitis is three times more likely if there is McBurney point
tenderness.
Rovsing sign
- accurate answers-Press deeply and evenly in the LLQ. Then quickly
withdraw your fingers.
Pain in the RLQ during left-sided pressure is a positive Rovsing sign.
Psoas Sign
- accurate answers---Place your hand just above the patient's right knee and
ask the patient to raise that thigh against your hand. Alternatively, ask the
patient to turn onto the left side. Then extend the patient's right leg at the hip.
Flexion of the leg at the hip makes the psoas muscle contract; extension
stretches it.
--Increased abdominal pain on either maneuver is a positive psoas sign, sug-
gesting irritation of the psoas muscle by an inflamed appendix.
Obturator Sign
- accurate answers---Less helpful
--Flex the patient's right thigh at the hip, with the knee bent, and rotate the leg
internally at the hip. This maneuver stretches the internal obturator muscle.
,--Right hypogastric pain is a positive obturator sign, from irritation of the
obturator muscle by an inflamed appendix. This sign has very low sensitivity.
Acute Cholecystits
- accurate answers-RUQ pain
Murphy Sign
Murphy Sign
- accurate answers-Hook your left thumb or the fingers of your right hand
under the costal margin at the point where the lateral border of the rectus
muscle intersects with the costal margin. Alternatively, palpate the RUQ with
the fingers of your right hand near the costal margin. If the liver is enlarged,
hook your thumb or fingers under the liver edge at a comparable point. Ask
the patient to take a deep breath, which forces the liver and gallbladder down
toward the examining fingers. Watch the patient's breathing and note the
degree of tenderness.
--A sharp increase in tenderness with inspiratory effort is a positive Murphy
sign. When positive, Murphy sign triples the likelihood of acute cholecystitis.
Acute Pancreatitis Process
- accurate answers-Intrapancreatic trypsinogen activation to trypsin and
other enzymes, result-ing in autodigestion and inflammation of the pancreas
Acute Pancreatitis Location
- accurate answers-Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality
- accurate answers-Usually steady
Acute PancreatitisTiming
- accurate answers-Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors
- accurate answers-Lying supine; dyspnea if pleural effusions from capillary
leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors
- accurate answers-Leaning forward with trunk flexed
, Acute Pancreatitis Associated Symptoms and Setting
- accurate answers-Nausea, vomiting, abdominal dis-tention, fever; often
recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process
- accurate answers-Mucosal ulcer in stomach or duode-num >5 mm, covered
with fibrin, ex-tending through the muscularis mu-cosa; H. pylori infection
present in 90% of peptic ulcers
Peptic Ulcer Disease Location
- accurate answers-Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality
- accurate answers-Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
Peptic Ulcer Disease Timing
- accurate answers-Intermittent; duodenal ulcer is more likely than gastric
ulcer or dyspepsia to cause pain that (1) wakes the patient at night, and (2)
occurs intermittently over a few wks, disappears for months, then recurs
Peptic Ulcer Disease aggravating factors
- accurate answers-Variable
Peptic Ulcer Disease relieving factors
- accurate answers-Food and antacids may bring re-lief (less likely in gastric
ulcers)
Peptic Ulcer Disease associated symptoms and setting
- accurate answers-Nausea, vomiting, belching, bloating; heartburn (more
common in duodenal ulcer); weight loss (more common in gastric ulcer);
dyspepsia is more com-mon in the young (20-29 yrs), gastric ulcer in those
over 50 yrs, and duodenal ulcer in those 30-60 yrs
GERD Process
- accurate answers-Prolonged exposure of esophagus to gastric acid due to
