NR 509 Final Exam Questions with Correct
Answers Latest 2025 Update
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.
,Stress Incontinence Physical signs - answer-Stress incontinence may be
demonstrable, especially if the patient is examined before voiding and in a
standing position. Atrophic vaginitis may be evident. Bladder distention is
absent.
Urge incontinence problem - answer-Detrusor contractions are stronger than
normal and overcome the normal urethral resistance. The bladder is typically
small.
Urge incontinence mechanism - answer-Decreased cortical inhibition of
detrusor contractions from stroke, brain tumor, dementia, and lesions of the
spinal cord above the sacral level.
Hyperexcitability of sensory pathways, as in bladder infections, tumors, and
fecal impaction.
Deconditioning of voiding reflexes, as in frequent voluntary voiding at low
bladder volumes.
Urge incontinence symptoms - answer-Involuntary urine loss preceded by an
urge to void. The volume tends to be moderate.
Urgency, frequency, and nocturia with small to moderate volumes. If acute
inflammation is present, pain on urination.
Possibly "pseudo-stress incontinence"—voiding 10-20 sec after stresses such
as a change of position, going up-or downstairs, and possibly coughing,
laughing, or sneezing.
Urge incontinence physical signs - answer-The small bladder is not detectable
on abdominal examination.
When cortical inhibition is decreased, mental deficits or motor signs of central
nervous system disease are often present.
,When sensory pathways are hyperexcitable, signs of local pelvic problems or a
fecal impaction may be present.
Overflow incontinence problem - answer-Detrusor contractions are insufficient
to overcome urethral resistance, causing urinary retention. The bladder is
typically flaccid and large, even after an effort to void.
Overflow incontinence mechanisms - answer-Obstruction of the bladder
outlet, as in benign prostatic hyperplasia or tumor. Weakness of the detrusor
muscle associated with peripheral nerve disease at S2-4 level.
Impaired bladder sensation that interrupts the reflex arc, as in diabetic
neuropathy.
Overflow incontinence symptoms - answer-When intravesicular pressure
overcomes urethral resistance, continuous dripping or dribbling incontinence
ensues. Decreased force of the urinary stream.
Prior symptoms of partial urinary obstruction or other symptoms of peripheral
nerve disease may be present.
Overflow incontinence physical signs - answer-Examination often reveals an
enlarged, sometimes tender, bladder. Other signs include prostatic
enlargement, motor signs of peripheral nerve disease, a decrease in sensation
(including perineal sensation), and diminished to absent reflexes.
Functional incontinence problem - answer-The patient is functionally unable to
reach the toilet in
time because of impaired health or environmental conditions.
, Functional incontinence mechanisms - answer-Problems in mobility resulting
from weakness, arthritis, poor vision, or other conditions. Environmental
factors such as an unfamiliar setting, distant bathroom facilities, bed rails, or
physical restraints.
Functional incontinence symptoms - answer-Incontinence on the way to the
toilet or only in the early morning.
Functional incontinence physical signs - answer-The bladder is not detectable
on examination. Look for physical or environmental clues as the likely cause.
Incontinence secondary to medications problem - answer-Drugs may
contribute to any type of incontinence listed.
Incontinence secondary to medications mechanisms - answer-Sedatives,
tranquilizers, anticholinergics, sympathetic blockers, and potent diuretics.
Incontinence secondary to medications symptoms - answer-Variable. A careful
history and chart review are
important.
Incontinence secondary to medications physical signs - answer-Variable.
Colorectal cancer screening - answer-Adults ages 50 to 75 years—options
(grade A recommendation)
1. Hi-sens fecal occult blood testing annually
Answers Latest 2025 Update
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.
,Stress Incontinence Physical signs - answer-Stress incontinence may be
demonstrable, especially if the patient is examined before voiding and in a
standing position. Atrophic vaginitis may be evident. Bladder distention is
absent.
Urge incontinence problem - answer-Detrusor contractions are stronger than
normal and overcome the normal urethral resistance. The bladder is typically
small.
Urge incontinence mechanism - answer-Decreased cortical inhibition of
detrusor contractions from stroke, brain tumor, dementia, and lesions of the
spinal cord above the sacral level.
Hyperexcitability of sensory pathways, as in bladder infections, tumors, and
fecal impaction.
Deconditioning of voiding reflexes, as in frequent voluntary voiding at low
bladder volumes.
Urge incontinence symptoms - answer-Involuntary urine loss preceded by an
urge to void. The volume tends to be moderate.
Urgency, frequency, and nocturia with small to moderate volumes. If acute
inflammation is present, pain on urination.
Possibly "pseudo-stress incontinence"—voiding 10-20 sec after stresses such
as a change of position, going up-or downstairs, and possibly coughing,
laughing, or sneezing.
Urge incontinence physical signs - answer-The small bladder is not detectable
on abdominal examination.
When cortical inhibition is decreased, mental deficits or motor signs of central
nervous system disease are often present.
,When sensory pathways are hyperexcitable, signs of local pelvic problems or a
fecal impaction may be present.
Overflow incontinence problem - answer-Detrusor contractions are insufficient
to overcome urethral resistance, causing urinary retention. The bladder is
typically flaccid and large, even after an effort to void.
Overflow incontinence mechanisms - answer-Obstruction of the bladder
outlet, as in benign prostatic hyperplasia or tumor. Weakness of the detrusor
muscle associated with peripheral nerve disease at S2-4 level.
Impaired bladder sensation that interrupts the reflex arc, as in diabetic
neuropathy.
Overflow incontinence symptoms - answer-When intravesicular pressure
overcomes urethral resistance, continuous dripping or dribbling incontinence
ensues. Decreased force of the urinary stream.
Prior symptoms of partial urinary obstruction or other symptoms of peripheral
nerve disease may be present.
Overflow incontinence physical signs - answer-Examination often reveals an
enlarged, sometimes tender, bladder. Other signs include prostatic
enlargement, motor signs of peripheral nerve disease, a decrease in sensation
(including perineal sensation), and diminished to absent reflexes.
Functional incontinence problem - answer-The patient is functionally unable to
reach the toilet in
time because of impaired health or environmental conditions.
, Functional incontinence mechanisms - answer-Problems in mobility resulting
from weakness, arthritis, poor vision, or other conditions. Environmental
factors such as an unfamiliar setting, distant bathroom facilities, bed rails, or
physical restraints.
Functional incontinence symptoms - answer-Incontinence on the way to the
toilet or only in the early morning.
Functional incontinence physical signs - answer-The bladder is not detectable
on examination. Look for physical or environmental clues as the likely cause.
Incontinence secondary to medications problem - answer-Drugs may
contribute to any type of incontinence listed.
Incontinence secondary to medications mechanisms - answer-Sedatives,
tranquilizers, anticholinergics, sympathetic blockers, and potent diuretics.
Incontinence secondary to medications symptoms - answer-Variable. A careful
history and chart review are
important.
Incontinence secondary to medications physical signs - answer-Variable.
Colorectal cancer screening - answer-Adults ages 50 to 75 years—options
(grade A recommendation)
1. Hi-sens fecal occult blood testing annually
