NR509 FINAL EXAM TEST BANK WITH ACTUAL
CORRECT QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS BY
EXPERTS |FREQUENTLY TESTED QUESTIONS
AND SOLUTIONS | 2024 NEWEST |ALREADY
GRADED A+|LATEST UPDATE
A 35-year-old female with a history of migraines presents to
the clinic with worsening symptoms for the past few weeks.
She reports waking up at night with headaches and nausea.
Her only medication history is oral contraceptive pills (OCPs).
Otherwise, she states she is healthy. Which of the following
actions if taken by the NP is the best next step?
Take a further history and perform a very careful neurological
exam
Appendicitis
,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
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
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
--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
--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
RUQ pain
Murphy Sign
Murphy Sign
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
Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of
the pancreas
, Acute Pancreatitis Location
Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ
failure
Acute Pancreatitis Quality
Usually steady
Acute PancreatitisTiming
Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors
Lying supine; dyspnea if pleural effusions from capillary
leak syn-drome; selected medications, high triglycerides
may exacerbate
Acute Pancreatitis Relieving factors
Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting
Nausea, vomiting, abdominal dis-tention, fever; often
recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process
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
Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality
Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
Peptic Ulcer Disease Timing
Intermittent; duodenal ulcer is more likely than gastric
ulcer or dyspepsia to cause pain that (1) wakes the patient
CORRECT QUESTIONS AND VERIFIED
DETAILED RATIONALES ANSWERS BY
EXPERTS |FREQUENTLY TESTED QUESTIONS
AND SOLUTIONS | 2024 NEWEST |ALREADY
GRADED A+|LATEST UPDATE
A 35-year-old female with a history of migraines presents to
the clinic with worsening symptoms for the past few weeks.
She reports waking up at night with headaches and nausea.
Her only medication history is oral contraceptive pills (OCPs).
Otherwise, she states she is healthy. Which of the following
actions if taken by the NP is the best next step?
Take a further history and perform a very careful neurological
exam
Appendicitis
,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
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
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
--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
--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
RUQ pain
Murphy Sign
Murphy Sign
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
Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of
the pancreas
, Acute Pancreatitis Location
Epigastric, may radiate straight to the back or other areas
of the abdomen; 20% with severe sequelae of organ
failure
Acute Pancreatitis Quality
Usually steady
Acute PancreatitisTiming
Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors
Lying supine; dyspnea if pleural effusions from capillary
leak syn-drome; selected medications, high triglycerides
may exacerbate
Acute Pancreatitis Relieving factors
Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting
Nausea, vomiting, abdominal dis-tention, fever; often
recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process
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
Epigastric, may radiate straight to the back
Peptic Ulcer Disease Quality
Variable: epigastric gnawing or burning (dyspepsia); may
also be boring, aching, or hungerlike
No symptoms in up to 20%
Peptic Ulcer Disease Timing
Intermittent; duodenal ulcer is more likely than gastric
ulcer or dyspepsia to cause pain that (1) wakes the patient
