Which of the following is consistent with a positive obturator sign?
Pain distant from the site used to check rebound tenderness
Right hypogastric pain with the right hip flexed and the hip internally rotated
Pain with extension of the right thigh while the patient is on their left side
Pain that stops inhalation in the right upper quadrant
The Correct Answer is B
A. Pain distant from the site used to check rebound tenderness is incorrect because this describes referred pain or peritoneal irritation, but not the obturator sign specifically. The obturator sign is localized to the hypogastric or pelvic region.
B. Right hypogastric pain with the right hip flexed and the hip internally rotated is correct because the obturator sign is elicited by flexing the patient’s hip and knee at 90° and then internally rotating the hip. Pain in the right hypogastric or pelvic area indicates irritation of the obturator internus muscle, often due to an inflamed appendix in a pelvic position or other pelvic pathology. This is a classic sign in appendicitis when the appendix is located in the pelvis.
C. Pain with extension of the right thigh while the patient is on their left side is incorrect because this describes the psoas sign, which tests for irritation of the iliopsoas muscle and is also used to detect appendicitis, but specifically for a retrocecal appendix.
D. Pain that stops inhalation in the right upper quadrant is incorrect because this describes Murphy’s sign, which is indicative of cholecystitis, not appendiceal or pelvic irritation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Chief Complaint/Concern is incorrect because this section is reserved for the primary reason the patient is seeking care, typically expressed in their own words. For example, a patient may report, “I have chest discomfort” or “I am having difficulty breathing.” The statement provided lists denied symptoms, not the patient’s presenting complaint, so it does not belong under chief complaint.
B. Past Medical History is incorrect because this section documents the patient’s previous medical diagnoses, chronic illnesses, hospitalizations, surgeries, and ongoing treatments. The provided information does not describe past illnesses or interventions but rather current symptom assessment, making it unrelated to past medical history.
C. Social History is incorrect because it includes details about lifestyle factors, habits, occupational exposures, living situation, and social support systems. Examples include tobacco or alcohol use, exercise routines, employment, and household composition. Symptom denial or presence is not part of social history.
D. Review of Systems (ROS) is correct because it is a systematic inventory of patient-reported symptoms organized by body system. The APRN or clinician asks about symptoms such as chest pain, palpitations, shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea, and the patient’s denials are documented to indicate the absence of these symptoms. ROS allows the healthcare provider to identify both present and absent symptoms, providing a comprehensive overview of the patient’s health status and highlighting areas that may need further evaluation or monitoring.
Correct Answer is C
Explanation
A. Suprapubic area is incorrect because this region is located just above the bladder. Tenderness here usually indicates bladder pathology, such as cystitis, bladder distention, or other lower urinary tract issues, rather than kidney problems. While suprapubic pain may coexist with kidney disease if infection spreads, it does not reliably indicate renal tenderness.
B. Periumbilical area is incorrect because this area surrounds the navel and is typically evaluated for abdominal and gastrointestinal conditions such as early appendicitis, bowel obstruction, or gastroenteritis. Kidney pain originates higher in the back, near the costovertebral angle, and periumbilical assessment does not provide information about renal involvement.
C. Costovertebral angle is correct because the costovertebral angle (CVA) is located at the junction of the 12th rib and the vertebral column on each side of the back. It is the standard anatomical landmark for assessing kidney tenderness. The APRN typically uses percussion (CVA punch) or gentle palpation to evaluate for pain. Tenderness in this area is associated with upper urinary tract conditions such as pyelonephritis, renal calculi, or hydronephrosis. CVA tenderness helps distinguish kidney pathology from lower urinary tract or abdominal causes.
D. Epigastric area is incorrect because this area is located just above the stomach and below the sternum, and it is assessed for gastric, pancreatic, cardiac, or hepatobiliary issues, not kidney disease. Tenderness in the epigastric region does not provide information about renal function or pathology.
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