NR 509 Final Exam Questions with Verified Answers
2025 | 2026
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.
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.
--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.
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
Acute Pancreatitis Relieving factors - ANSWER Leaning forward
with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting - ANSWER
Nausea, vomiting, abdominal dis-tention, fever; often recurrent;
80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process - ANSWER Mucosal ulcer in
stomach or duode-num >5 mm, covered with fibrin, ex-tending
2025 | 2026
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.
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.
--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.
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
Acute Pancreatitis Relieving factors - ANSWER Leaning forward
with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting - ANSWER
Nausea, vomiting, abdominal dis-tention, fever; often recurrent;
80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process - ANSWER Mucosal ulcer in
stomach or duode-num >5 mm, covered with fibrin, ex-tending
