NR 509 FINAL EXAM WITH CORRECT
ANSWERS
Appendicitis c- ccorrect canswers✔✔1. cMcBurney cpoint ctenderness c
2. cRovsing csign
3. cthe cpsoas csign
4. cthe cobturator csign
--Appendicitis cis ctwice cas clikely cin cthe cpresence cof cRLQ ctenderness, cRovsing csign,
cand cthe cpsoas csign
--The cpain cof cappendicitis cclassically cbegins cnear cthe cumbilicus, cthen cmigrates cto cthe
cRLQ. cOlder cadults care cless clikely cto creport cthis cpattern.
--Localized ctenderness canywhere cin cthe cRLQ, ceven cin cthe cright cflank, csuggests
cappendicitis.
McBurney cPoint c- ccorrect canswers✔✔1. cMcBurney cpoint clies c2 cinches cfrom cthe
canterior csuperior cspinous cprocess cof cilium con ca cline cdrawn cfrom cthat cprocess cto cthe
cumbilicus
2. cAppendicitis cis cthree ctimes cmore clikely cif cthere cis cMcBurney cpoint ctenderness.
Rovsing csign c- ccorrect canswers✔✔Press cdeeply cand cevenly cin cthe cLLQ. cThen cquickly
cwithdraw cyour cfingers.
Pain cin cthe cRLQ cduring cleft-sided cpressure cis ca cpositive cRovsing csign.
Psoas cSign c- ccorrect canswers✔✔--Place cyour chand cjust cabove cthe cpatient's cright
cknee cand cask cthe cpatient cto craise cthat cthigh cagainst cyour chand. cAlternatively, cask cthe
cpatient cto cturn conto cthe cleft cside. cThen cextend cthe cpatient's cright cleg cat cthe chip.
cFlexion cof cthe cleg cat cthe chip cmakes cthe cpsoas cmuscle ccontract; cextension cstretches
cit.
--Increased cabdominal cpain con ceither cmaneuver cis ca cpositive cpsoas csign, csug-gesting
cirritation cof cthe cpsoas cmuscle cby can cinflamed cappendix.
Obturator cSign c- ccorrect canswers✔✔--Less chelpful
--Flex cthe cpatient's cright cthigh cat cthe chip, cwith cthe cknee cbent, cand crotate cthe cleg
cinternally cat cthe chip. cThis cmaneuver cstretches cthe cinternal cobturator cmuscle. c
--Right chypogastric cpain cis ca cpositive cobturator csign, cfrom cirritation cof cthe cobturator
cmuscle cby can cinflamed cappendix. cThis csign chas cvery clow csensitivity.
Acute cCholecystits c- ccorrect canswers✔✔RUQ cpain
Murphy cSign
Murphy cSign c- ccorrect canswers✔✔Hook cyour cleft cthumb cor cthe cfingers cof cyour cright
chand cunder cthe ccostal cmargin cat cthe cpoint cwhere cthe clateral cborder cof cthe crectus
,cmuscle cintersects cwith cthe ccostal cmargin. cAlternatively, cpalpate cthe cRUQ cwith cthe
cfingers cof cyour cright chand cnear cthe ccostal cmargin. cIf cthe cliver cis cenlarged, chook cyour
cthumb cor cfingers cunder cthe cliver cedge cat ca ccomparable cpoint. cAsk cthe cpatient cto ctake
ca cdeep cbreath, cwhich cforces cthe cliver cand cgallbladder cdown ctoward cthe cexamining
cfingers. cWatch cthe cpatient's cbreathing cand cnote cthe cdegree cof ctenderness.
--A csharp cincrease cin ctenderness cwith cinspiratory ceffort cis ca cpositive cMurphy csign.
cWhen cpositive, cMurphy csign ctriples cthe clikelihood cof cacute ccholecystitis.
Acute cPancreatitis cProcess c- ccorrect canswers✔✔Intrapancreatic ctrypsinogen cactivation
cto ctrypsin cand cother cenzymes, cresult-ing cin cautodigestion cand cinflammation cof cthe
cpancreas
Acute cPancreatitis cLocation c- ccorrect canswers✔✔Epigastric, cmay cradiate cstraight cto
cthe cback cor cother careas cof cthe cabdomen; c20% cwith csevere csequelae cof corgan cfailure
Acute cPancreatitis cQuality c- ccorrect canswers✔✔Usually csteady
Acute cPancreatitisTiming c- ccorrect canswers✔✔Acute conset, cpersistent cpain
Acute cPancreatitis cAggrevating cFactors c- ccorrect canswers✔✔Lying csupine; cdyspnea cif
cpleural ceffusions cfrom ccapillary cleak csyn-drome; cselected cmedications, chigh
ctriglycerides cmay cexacerbate
Acute cPancreatitis cRelieving cfactors c- ccorrect canswers✔✔Leaning cforward cwith ctrunk
cflexed
Acute cPancreatitis cAssociated cSymptoms cand cSetting c- ccorrect canswers✔✔Nausea,
cvomiting, cabdominal cdis-tention, cfever; coften crecurrent; c80% cwith chistory cof calcohol
cabuse cor cgallstones
Peptic cUlcer cDisease cProcess c- ccorrect canswers✔✔Mucosal culcer cin cstomach cor
cduode-num c>5 cmm, ccovered cwith cfibrin, cex-tending cthrough cthe cmuscularis cmu-cosa;
cH. cpylori cinfection cpresent cin c90% cof cpeptic culcers
Peptic cUlcer cDisease cLocation c- ccorrect canswers✔✔Epigastric, cmay cradiate cstraight cto
cthe cback
Peptic cUlcer cDisease cQuality c- ccorrect canswers✔✔Variable: cepigastric cgnawing cor
cburning c(dyspepsia); cmay calso cbe cboring, caching, cor chungerlike
No csymptoms cin cup cto c20%
Peptic cUlcer cDisease cTiming c- ccorrect canswers✔✔Intermittent; cduodenal culcer cis cmore
clikely cthan cgastric culcer cor cdyspepsia cto ccause cpain cthat c(1) cwakes cthe cpatient cat
cnight, cand c(2) coccurs cintermittently cover ca cfew cwks, cdisappears cfor cmonths, cthen
crecurs
, Peptic cUlcer cDisease caggravating cfactors c- ccorrect canswers✔✔Variable
Peptic cUlcer cDisease crelieving cfactors c- ccorrect canswers✔✔Food cand cantacids cmay
cbring cre-lief c(less clikely cin cgastric culcers)
Peptic cUlcer cDisease cassociated csymptoms cand csetting c- ccorrect canswers✔✔Nausea,
cvomiting, cbelching, cbloating; cheartburn c(more ccommon cin cduodenal culcer); cweight closs
c(more ccommon cin cgastric culcer); cdyspepsia cis cmore ccom-mon cin cthe cyoung c(20-29
cyrs), cgastric culcer cin cthose cover c50 cyrs, cand cduodenal culcer cin cthose c30-60 cyrs
GERD cProcess c- ccorrect canswers✔✔Prolonged cexposure cof cesophagus cto cgastric
cacid cdue cto cimpaired cesopha-geal cmotility cor cexcess crelaxations cof cthe clower
cesophageal csphincter; cHelico-bacter cpylori cmay cbe cpresent
GERD cLocation c- ccorrect canswers✔✔Chest cor cepigastric
GERD cQuality c- ccorrect canswers✔✔Heartburn, cregurgitation
GERD ctiming c- ccorrect canswers✔✔After cmeals, cespecially cspicy cfoods
GERD caggravating cfactors c- ccorrect canswers✔✔Lying cdown, cbending cover; cphysical
cactivity; cdiseases csuch cas cscleroderma, cgastroparesis; cdrugs clike cnicotine cthat crelax
cthe clower cesophageal csphincter
GERD c: crelieving cfactors c- ccorrect canswers✔✔Antacids, cproton cpump cinhibi-tors;
cavoiding calcohol, csmoking, cfatty cmeals, cchocolate, cselected cdrugs csuch cas
ctheophylline, ccal-cium cchannel cblockers
GERD cassociated csymptoms cand csetting c- ccorrect canswers✔✔Wheezing, cchronic
ccough, cshort-ness cof cbreath, choarseness, cchoking csensation, cdysphagia,
cregurgitation, chalitosis, csore cthroat; cincreases crisk cof cBarrett cesophagus cand cesopha-
geal ccancer
Diverticulitis cprocess c- ccorrect canswers✔✔Acute cinflammation cof ccolonic cdiver-ticula,
coutpouchings c5-10 cmm cin cdi-ameter, cusually cin csigmoid cor cdescend-ing ccolon
Diverticulitis clocation c- ccorrect canswers✔✔Left clower cquadrant
Diverticulitis cquality c- ccorrect canswers✔✔May cbe ccramping cat cfirst, cthen csteady
Diverticulitis ctiming c- ccorrect canswers✔✔Often cgradual conset
Diverticulitis caggravating cfactors c- ccorrect canswers✔✔--
Diverticulitis crelieving cfactors c- ccorrect canswers✔✔Analgesia, cbowel crest, cantibiotics
ANSWERS
Appendicitis c- ccorrect canswers✔✔1. cMcBurney cpoint ctenderness c
2. cRovsing csign
3. cthe cpsoas csign
4. cthe cobturator csign
--Appendicitis cis ctwice cas clikely cin cthe cpresence cof cRLQ ctenderness, cRovsing csign,
cand cthe cpsoas csign
--The cpain cof cappendicitis cclassically cbegins cnear cthe cumbilicus, cthen cmigrates cto cthe
cRLQ. cOlder cadults care cless clikely cto creport cthis cpattern.
--Localized ctenderness canywhere cin cthe cRLQ, ceven cin cthe cright cflank, csuggests
cappendicitis.
McBurney cPoint c- ccorrect canswers✔✔1. cMcBurney cpoint clies c2 cinches cfrom cthe
canterior csuperior cspinous cprocess cof cilium con ca cline cdrawn cfrom cthat cprocess cto cthe
cumbilicus
2. cAppendicitis cis cthree ctimes cmore clikely cif cthere cis cMcBurney cpoint ctenderness.
Rovsing csign c- ccorrect canswers✔✔Press cdeeply cand cevenly cin cthe cLLQ. cThen cquickly
cwithdraw cyour cfingers.
Pain cin cthe cRLQ cduring cleft-sided cpressure cis ca cpositive cRovsing csign.
Psoas cSign c- ccorrect canswers✔✔--Place cyour chand cjust cabove cthe cpatient's cright
cknee cand cask cthe cpatient cto craise cthat cthigh cagainst cyour chand. cAlternatively, cask cthe
cpatient cto cturn conto cthe cleft cside. cThen cextend cthe cpatient's cright cleg cat cthe chip.
cFlexion cof cthe cleg cat cthe chip cmakes cthe cpsoas cmuscle ccontract; cextension cstretches
cit.
--Increased cabdominal cpain con ceither cmaneuver cis ca cpositive cpsoas csign, csug-gesting
cirritation cof cthe cpsoas cmuscle cby can cinflamed cappendix.
Obturator cSign c- ccorrect canswers✔✔--Less chelpful
--Flex cthe cpatient's cright cthigh cat cthe chip, cwith cthe cknee cbent, cand crotate cthe cleg
cinternally cat cthe chip. cThis cmaneuver cstretches cthe cinternal cobturator cmuscle. c
--Right chypogastric cpain cis ca cpositive cobturator csign, cfrom cirritation cof cthe cobturator
cmuscle cby can cinflamed cappendix. cThis csign chas cvery clow csensitivity.
Acute cCholecystits c- ccorrect canswers✔✔RUQ cpain
Murphy cSign
Murphy cSign c- ccorrect canswers✔✔Hook cyour cleft cthumb cor cthe cfingers cof cyour cright
chand cunder cthe ccostal cmargin cat cthe cpoint cwhere cthe clateral cborder cof cthe crectus
,cmuscle cintersects cwith cthe ccostal cmargin. cAlternatively, cpalpate cthe cRUQ cwith cthe
cfingers cof cyour cright chand cnear cthe ccostal cmargin. cIf cthe cliver cis cenlarged, chook cyour
cthumb cor cfingers cunder cthe cliver cedge cat ca ccomparable cpoint. cAsk cthe cpatient cto ctake
ca cdeep cbreath, cwhich cforces cthe cliver cand cgallbladder cdown ctoward cthe cexamining
cfingers. cWatch cthe cpatient's cbreathing cand cnote cthe cdegree cof ctenderness.
--A csharp cincrease cin ctenderness cwith cinspiratory ceffort cis ca cpositive cMurphy csign.
cWhen cpositive, cMurphy csign ctriples cthe clikelihood cof cacute ccholecystitis.
Acute cPancreatitis cProcess c- ccorrect canswers✔✔Intrapancreatic ctrypsinogen cactivation
cto ctrypsin cand cother cenzymes, cresult-ing cin cautodigestion cand cinflammation cof cthe
cpancreas
Acute cPancreatitis cLocation c- ccorrect canswers✔✔Epigastric, cmay cradiate cstraight cto
cthe cback cor cother careas cof cthe cabdomen; c20% cwith csevere csequelae cof corgan cfailure
Acute cPancreatitis cQuality c- ccorrect canswers✔✔Usually csteady
Acute cPancreatitisTiming c- ccorrect canswers✔✔Acute conset, cpersistent cpain
Acute cPancreatitis cAggrevating cFactors c- ccorrect canswers✔✔Lying csupine; cdyspnea cif
cpleural ceffusions cfrom ccapillary cleak csyn-drome; cselected cmedications, chigh
ctriglycerides cmay cexacerbate
Acute cPancreatitis cRelieving cfactors c- ccorrect canswers✔✔Leaning cforward cwith ctrunk
cflexed
Acute cPancreatitis cAssociated cSymptoms cand cSetting c- ccorrect canswers✔✔Nausea,
cvomiting, cabdominal cdis-tention, cfever; coften crecurrent; c80% cwith chistory cof calcohol
cabuse cor cgallstones
Peptic cUlcer cDisease cProcess c- ccorrect canswers✔✔Mucosal culcer cin cstomach cor
cduode-num c>5 cmm, ccovered cwith cfibrin, cex-tending cthrough cthe cmuscularis cmu-cosa;
cH. cpylori cinfection cpresent cin c90% cof cpeptic culcers
Peptic cUlcer cDisease cLocation c- ccorrect canswers✔✔Epigastric, cmay cradiate cstraight cto
cthe cback
Peptic cUlcer cDisease cQuality c- ccorrect canswers✔✔Variable: cepigastric cgnawing cor
cburning c(dyspepsia); cmay calso cbe cboring, caching, cor chungerlike
No csymptoms cin cup cto c20%
Peptic cUlcer cDisease cTiming c- ccorrect canswers✔✔Intermittent; cduodenal culcer cis cmore
clikely cthan cgastric culcer cor cdyspepsia cto ccause cpain cthat c(1) cwakes cthe cpatient cat
cnight, cand c(2) coccurs cintermittently cover ca cfew cwks, cdisappears cfor cmonths, cthen
crecurs
, Peptic cUlcer cDisease caggravating cfactors c- ccorrect canswers✔✔Variable
Peptic cUlcer cDisease crelieving cfactors c- ccorrect canswers✔✔Food cand cantacids cmay
cbring cre-lief c(less clikely cin cgastric culcers)
Peptic cUlcer cDisease cassociated csymptoms cand csetting c- ccorrect canswers✔✔Nausea,
cvomiting, cbelching, cbloating; cheartburn c(more ccommon cin cduodenal culcer); cweight closs
c(more ccommon cin cgastric culcer); cdyspepsia cis cmore ccom-mon cin cthe cyoung c(20-29
cyrs), cgastric culcer cin cthose cover c50 cyrs, cand cduodenal culcer cin cthose c30-60 cyrs
GERD cProcess c- ccorrect canswers✔✔Prolonged cexposure cof cesophagus cto cgastric
cacid cdue cto cimpaired cesopha-geal cmotility cor cexcess crelaxations cof cthe clower
cesophageal csphincter; cHelico-bacter cpylori cmay cbe cpresent
GERD cLocation c- ccorrect canswers✔✔Chest cor cepigastric
GERD cQuality c- ccorrect canswers✔✔Heartburn, cregurgitation
GERD ctiming c- ccorrect canswers✔✔After cmeals, cespecially cspicy cfoods
GERD caggravating cfactors c- ccorrect canswers✔✔Lying cdown, cbending cover; cphysical
cactivity; cdiseases csuch cas cscleroderma, cgastroparesis; cdrugs clike cnicotine cthat crelax
cthe clower cesophageal csphincter
GERD c: crelieving cfactors c- ccorrect canswers✔✔Antacids, cproton cpump cinhibi-tors;
cavoiding calcohol, csmoking, cfatty cmeals, cchocolate, cselected cdrugs csuch cas
ctheophylline, ccal-cium cchannel cblockers
GERD cassociated csymptoms cand csetting c- ccorrect canswers✔✔Wheezing, cchronic
ccough, cshort-ness cof cbreath, choarseness, cchoking csensation, cdysphagia,
cregurgitation, chalitosis, csore cthroat; cincreases crisk cof cBarrett cesophagus cand cesopha-
geal ccancer
Diverticulitis cprocess c- ccorrect canswers✔✔Acute cinflammation cof ccolonic cdiver-ticula,
coutpouchings c5-10 cmm cin cdi-ameter, cusually cin csigmoid cor cdescend-ing ccolon
Diverticulitis clocation c- ccorrect canswers✔✔Left clower cquadrant
Diverticulitis cquality c- ccorrect canswers✔✔May cbe ccramping cat cfirst, cthen csteady
Diverticulitis ctiming c- ccorrect canswers✔✔Often cgradual conset
Diverticulitis caggravating cfactors c- ccorrect canswers✔✔--
Diverticulitis crelieving cfactors c- ccorrect canswers✔✔Analgesia, cbowel crest, cantibiotics
