NR 509 Final Exam Q&A With Complete Solution(100%
VERIFIED)
Appendicitis Correct Answer- 1. McBurney point tenderness
2. Rovsing sign
3. the psoas sign
4. the obturator sign
--Appendicitis is twice as likely in the
...
NR 509 Final Exam Q&A With Complete Solution(100%
VERIFIED)
Appendicitis Correct 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 Correct 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 Correct 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 Correct 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 Correct 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 Correct Answer- RUQ pain
Murphy Sign
Murphy Sign Correct 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 Correct Answer- Intrapancreatic trypsinogen activation to trypsin and other
enzymes, result-ing in autodigestion and inflammation of the pancreas
Acute Pancreatitis Location Correct Answer- Epigastric, may radiate straight to the back or other areas of
the abdomen; 20% with severe sequelae of organ failure
Acute Pancreatitis Quality Correct Answer- Usually steady
Acute PancreatitisTiming Correct Answer- Acute onset, persistent pain
Acute Pancreatitis Aggrevating Factors Correct Answer- Lying supine; dyspnea if pleural effusions from
capillary leak syn-drome; selected medications, high triglycerides may exacerbate
Acute Pancreatitis Relieving factors Correct Answer- Leaning forward with trunk flexed
Acute Pancreatitis Associated Symptoms and Setting Correct Answer- Nausea, vomiting, abdominal distention, fever; often recurrent; 80% with history of alcohol abuse or gallstones
Peptic Ulcer Disease Process Correct Answer- 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
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