NR 509 FINAL EXAM 88 PRACTICE AND STUDY
GUIDE 2026 CLINICAL APPLICATION AND
HEALTH ASSESSMENT FRAMEWORK
◉ 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.
◉ 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
◉ Peptic Ulcer Disease Process.
Answer: 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.
Answer: Epigastric, may radiate straight to the back
◉ Peptic Ulcer Disease Quality.
Answer: Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
GUIDE 2026 CLINICAL APPLICATION AND
HEALTH ASSESSMENT FRAMEWORK
◉ 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.
◉ 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
◉ Peptic Ulcer Disease Process.
Answer: 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.
Answer: Epigastric, may radiate straight to the back
◉ Peptic Ulcer Disease Quality.
Answer: Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
