The advanced practice nurse (APRN) is assessing a patient who presents with right upper quadrant pain. On exam the APRN deeply palpates the right upper quadrant and asks the patient to take a deep breath. The patient abruptly stops Inspiration and reports increased pain. The APRN notes that this positive sign likely indicates what disease process?
Appendicitis
Pancreatitis
Cholecystitis
Gastroenteritis
The Correct Answer is C
A. Appendicitis is incorrect because appendicitis usually causes pain localized to the right lower quadrant rather than the right upper quadrant. Classic signs include tenderness at McBurney’s point, rebound tenderness, Rovsing’s sign (pain in the right lower quadrant when the left lower quadrant is palpated), and psoas sign (pain on hip extension). Murphy’s sign is specific to gallbladder irritation, so it would not be positive in appendicitis.
B. Pancreatitis is incorrect because pancreatitis typically presents with epigastric or periumbilical pain that may radiate to the back. Additional symptoms include nausea, vomiting, anorexia, and sometimes fever. While patients may have some tenderness in the right upper quadrant if the pancreas head is involved, deep palpation with inspiration does not produce Murphy’s sign, making this maneuver not diagnostic for pancreatitis.
C. Cholecystitis is correct because acute cholecystitis is inflammation of the gallbladder, usually due to gallstones obstructing the cystic duct. During the Murphy’s sign test, the examiner palpates the right upper quadrant beneath the costal margin at the mid-clavicular line and asks the patient to inhale deeply. The descending diaphragm pushes the inflamed gallbladder against the examiner’s fingers, causing abrupt pain and halting inspiration. This is a classic and highly suggestive finding for acute cholecystitis.
D. Gastroenteritis is incorrect because gastroenteritis causes diffuse abdominal cramping, diarrhea, nausea, and sometimes fever, without localized right upper quadrant inflammation. Deep palpation of the right upper quadrant with inspiration does not produce abrupt pain, so Murphy’s sign would be negative in gastroenteritis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. "We will talk more about this in the interview." is incorrect because this response delays assessment and does not gather immediate, relevant information about the patient’s current symptom. Prompt assessment is crucial for acute complaints like abdominal pain.
B. "Have you ever had any children?" is incorrect because this question is not immediately relevant to the onset of new abdominal pain. While obstetric history may be important later, it is not the first question to assess acute symptoms.
C. "What have you eaten in the last four hours?" is incorrect because while dietary history can provide useful information for gastrointestinal issues, it is secondary to establishing the onset, location, and characteristics of the pain, which helps guide urgent assessment and intervention.
D. "When did this abdominal pain start?" is correct because determining the onset of the symptom is a priority in evaluating acute conditions. Knowing when the pain began helps the clinician assess urgency, potential causes, and whether immediate intervention is required. It is a focused, open-ended question that allows for rapid clinical decision-making.
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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