NR 509 Final Exam Question And
Answers 2024
Appendicitis - correct 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 - correct 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 - correct 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.
,NR 509 Final Exam Question And
Answers 2024
Psoas Sign - correct 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 - correct 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 - correct answers✅RUQ pain
Murphy Sign
Murphy Sign - correct 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
,NR 509 Final Exam Question And
Answers 2024
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 - correct
answers✅Intrapancreatic trypsinogen activation to
trypsin and other enzymes, result-ing in autodigestion
and inflammation of the pancreas
Acute Pancreatitis Location - correct
answers✅Epigastric, may radiate straight to the back or
other areas of the abdomen; 20% with severe sequelae of
organ failure
Acute Pancreatitis Quality - correct answers✅Usually
steady
Acute PancreatitisTiming - correct answers✅Acute
onset, persistent pain
, NR 509 Final Exam Question And
Answers 2024
Acute Pancreatitis Aggrevating Factors - correct
answers✅Lying supine; dyspnea if pleural effusions from
capillary leak syn-drome; selected medications, high
triglycerides may exacerbate
Acute Pancreatitis Relieving factors - correct
answers✅Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting -
correct answers✅Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Peptic Ulcer Disease Process - correct
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 - correct
answers✅Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality - correct
answers✅Variable: epigastric gnawing or burning
(dyspepsia); may also be boring, aching, or hungerlike
Answers 2024
Appendicitis - correct 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 - correct 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 - correct 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.
,NR 509 Final Exam Question And
Answers 2024
Psoas Sign - correct 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 - correct 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 - correct answers✅RUQ pain
Murphy Sign
Murphy Sign - correct 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
,NR 509 Final Exam Question And
Answers 2024
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 - correct
answers✅Intrapancreatic trypsinogen activation to
trypsin and other enzymes, result-ing in autodigestion
and inflammation of the pancreas
Acute Pancreatitis Location - correct
answers✅Epigastric, may radiate straight to the back or
other areas of the abdomen; 20% with severe sequelae of
organ failure
Acute Pancreatitis Quality - correct answers✅Usually
steady
Acute PancreatitisTiming - correct answers✅Acute
onset, persistent pain
, NR 509 Final Exam Question And
Answers 2024
Acute Pancreatitis Aggrevating Factors - correct
answers✅Lying supine; dyspnea if pleural effusions from
capillary leak syn-drome; selected medications, high
triglycerides may exacerbate
Acute Pancreatitis Relieving factors - correct
answers✅Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting -
correct answers✅Nausea, vomiting, abdominal dis-
tention, fever; often recurrent; 80% with history of alcohol
abuse or gallstones
Peptic Ulcer Disease Process - correct
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 - correct
answers✅Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality - correct
answers✅Variable: epigastric gnawing or burning
(dyspepsia); may also be boring, aching, or hungerlike
