During an examination of the abdomen in a patient with right lower quadrant pain the advanced practice registered nurse (APRN) checks for a positive psoas sign. How is this test performed?
Press on the right lower quadrant and ask the patient to say where the pain is worse.
Press on the left lower quadrant and ask the patient to say where the pain is worse.
Ask the patient to raise their thigh against resistance from the APRNSA hand.
Flex the patient's right thigh and with the knee bent rotate the leg internally at the hip.
The Correct Answer is C
A. Pressing on the right lower quadrant and asking the patient to describe where the pain is worse is incorrect because this technique evaluates rebound tenderness, which is a sign of peritoneal irritation but does not specifically assess the psoas muscle. Rebound tenderness can indicate appendicitis, peritonitis, or other intra-abdominal inflammation, but it is not the psoas sign.
B. Pressing on the left lower quadrant and asking about right-sided pain is incorrect because this describes Rovsing’s sign, which tests for appendiceal irritation indirectly by palpating the opposite quadrant. Rovsing’s sign is distinct from the psoas maneuver, which specifically evaluates irritation of the psoas muscle, often due to a retrocecal appendix.
C. Asking the patient to raise their thigh against resistance is correct. The psoas sign is performed either by having the patient actively flex the right hip against resistance while lying supine or passively extending the right hip while the patient lies on their left side. A positive psoas sign produces pain in the right lower quadrant, indicating irritation of the psoas muscle, which is most commonly due to retrocecal appendicitis. This test helps localize inflammation along the posterior abdominal wall.
D. Flexing the patient’s right thigh with the knee bent and internally rotating the hip is incorrect because this describes the obturator sign, which evaluates pelvic appendicitis by stretching the obturator internus muscle. It produces pain in the right lower quadrant if the appendix is in a pelvic location, but it is a different maneuver than the psoas test.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Rhonchi is incorrect because rhonchi are low-pitched, snoring or gurgling sounds typically heard during expiration and are caused by secretions in larger airways, such as in chronic bronchitis or pneumonia. They do not indicate upper airway obstruction.
B. Crackles is incorrect because crackles (rales) are discontinuous, popping sounds heard on inspiration, usually due to alveolar fluid, pulmonary edema, or atelectasis. Crackles are not high-pitched nor typically audible without a stethoscope.
C. Wheezing is incorrect because wheezing is a high-pitched, musical sound heard primarily during expiration caused by lower airway narrowing, as in asthma or bronchospasm. Wheezing generally reflects bronchial constriction rather than obstruction of the upper airway.
D. Stridor is correct because stridor is a high-pitched, inspiratory sound that occurs due to partial obstruction of the upper airway, such as the larynx or trachea. It is often audible without a stethoscope and is a medical emergency because it can indicate significant airway compromise, especially in post-anesthesia patients who may have laryngospasm, edema, or retained secretions.
Correct Answer is D
Explanation
A. Left-sided heart failure is incorrect because it typically presents with bilateral crackles (rales) due to pulmonary edema, not localized findings such as egophony and bronchophony. While dullness may occur, the presence of increased voice transmission findings is more specific to lung consolidation rather than fluid overload.
B. Atelectasis is incorrect because it can cause dullness to percussion and decreased breath sounds, but it usually results in decreased or absent voice sounds (not increased). Egophony and bronchophony are typically absent in atelectasis because the collapsed lung does not transmit sound effectively.
C. Pneumothorax is incorrect because it produces hyperresonance, not dullness, along with absent breath sounds and decreased fremitus. The findings described (dullness and increased voice transmission) are inconsistent with air in the pleural space.
D. Pneumonia is correct because it causes lung consolidation, which leads to dullness to percussion, decreased or bronchial breath sounds, and increased transmission of voice sounds, including egophony (“E” to “A” change) and bronchophony. The presence of rhonchi and cough further supports infection and mucus in the airways.
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