Page 1 of 68
FINAL EXAM: NR509 / NR 509 (LATEST UPDATE 2025 /
2026) ADVANCED PHYSICAL ASSESSMENT |
QUESTIONS & ANSWERS | 100% CORRECT | GRADE
A - CHAMBERLAIN
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.
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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.
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--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
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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
FINAL EXAM: NR509 / NR 509 (LATEST UPDATE 2025 /
2026) ADVANCED PHYSICAL ASSESSMENT |
QUESTIONS & ANSWERS | 100% CORRECT | GRADE
A - CHAMBERLAIN
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.
,Page 2 of 68
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.
,Page 3 of 68
--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
, Page 4 of 68
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
