NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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.
,NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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.
,NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
--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.
, NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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.
,NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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.
,NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
--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.
, NR 509 | WEEK 8 FINAL | ACTUAL PROCTORED
EXAM | DUE JUNE 2026-2027(ACTUAL EXAM
PROCTORED THROUGH EXAMLIFY) | 100
QUESTIONS AND ANSWERS (100% GRADED A+
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
