NR 509 Final Exam 2025/2026 Exam
Questions and Verified Answers |
Already Graded A+
Appendicitis - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔--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 - 🧠 ANSWER ✔✔--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 - 🧠 ANSWER ✔✔RUQ pain
Murphy Sign
Murphy Sign - 🧠 ANSWER ✔✔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.
COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
3
, Acute Pancreatitis Process - 🧠 ANSWER ✔✔Intrapancreatic trypsinogen
activation to trypsin and other enzymes, result-ing in autodigestion and
inflammation of the pancreas
Acute Pancreatitis Location - 🧠 ANSWER ✔✔Epigastric, may radiate
straight to the back or other areas of the abdomen; 20% with severe
sequelae of organ failure
Acute Pancreatitis Quality - 🧠 ANSWER ✔✔Usually steady
Acute PancreatitisTiming - 🧠 ANSWER ✔✔Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors - 🧠 ANSWER ✔✔Lying supine;
dyspnea if pleural effusions from capillary leak syn-drome; selected
medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors - 🧠 ANSWER ✔✔Leaning forward with
trunk flexed
Acute Pancreatitis Associated Symptoms and Setting - 🧠 ANSWER
✔✔Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80%
with history of alcohol abuse or gallstones
Questions and Verified Answers |
Already Graded A+
Appendicitis - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔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 - 🧠 ANSWER ✔✔--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 - 🧠 ANSWER ✔✔--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 - 🧠 ANSWER ✔✔RUQ pain
Murphy Sign
Murphy Sign - 🧠 ANSWER ✔✔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.
COPYRIGHT©NINJANERD 2025/2026. YEAR PUBLISHED 2025. COMPANY REGISTRATION NUMBER: 619652435. TERMS OF USE. PRIVACY
STATEMENT. ALL RIGHTS RESERVED
3
, Acute Pancreatitis Process - 🧠 ANSWER ✔✔Intrapancreatic trypsinogen
activation to trypsin and other enzymes, result-ing in autodigestion and
inflammation of the pancreas
Acute Pancreatitis Location - 🧠 ANSWER ✔✔Epigastric, may radiate
straight to the back or other areas of the abdomen; 20% with severe
sequelae of organ failure
Acute Pancreatitis Quality - 🧠 ANSWER ✔✔Usually steady
Acute PancreatitisTiming - 🧠 ANSWER ✔✔Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors - 🧠 ANSWER ✔✔Lying supine;
dyspnea if pleural effusions from capillary leak syn-drome; selected
medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors - 🧠 ANSWER ✔✔Leaning forward with
trunk flexed
Acute Pancreatitis Associated Symptoms and Setting - 🧠 ANSWER
✔✔Nausea, vomiting, abdominal dis-tention, fever; often recurrent; 80%
with history of alcohol abuse or gallstones
