A nurse is assessing a client who has suspected appendicitis. which of the following manifestations

Internet Citation: Research Protocol: Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis. Content last reviewed December 2019. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.
https://effectivehealthcare.ahrq.gov/products/appendicitis/research-protocol

This is a quiz that contains NCLEX review questions for appendicitis. As a nurse providing care to a patient with appendicitis, it is important to know the classic signs and symptoms of appendicitis, the complications (peritonitis, perforation etc.), pre-opt and post-opt nursing care.

In the previous NCLEX review series, I explained about other GI disorders you may be asked about on the NCLEX exam, so be sure to check out those reviews and quizzes as well.

(NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.)

Appendicitis NCLEX Questions

1. True or False: The appendix is found on the left lower side of the abdomen and is connected to the cecum of the large intestine.

2. Select all the following options that are NOT causes of appendicitis:

A. Fecalith

B. Routine usage of NSAIDs

C. Infection due to Helicobacter pylori

D. Lymph node enlargement due to viral or bacterial infection

E. Diet low in fiber

3. A 23 year old patient is admitted with suspected appendicitis. The patient states he is having pain around the umbilicus that extends into the lower part of his abdomen. In addition, he says that the pain is worst on the right lower quadrant. The patient points to his abdomen at a location which is about a one-third distance between the anterior superior iliac spine and umbilicus. This area is known as what?

A. Rovsing’s Point

B. Hamman’s Point

C. McBurney’s Point

D. Murphy’s Point

4. Thinking back to the scenario in question 3, what other signs and symptoms are associated with appendicitis. SELECT-ALL-THAT-APPLY:

A. Increased red blood Cells

B. Patient has the desire to be positioned in the prone position to relieve pain

C. Umbilical pain that extends in the right lower quadrant

D. Abdominal rebound tenderness

E. Abdominal Flaccidity

5. An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention?

A. “The pain hurts so much it is making me nauseous.”

B. “I have no appetite.”

C. “The pain seems to be gone now.”

D. “If I position myself on my right side, it makes the pain less intense.”

6. You’re providing education to a group of nursing students about the care of a patient with appendicitis. Which statement by a nursing student requires re-education about your teaching?

A. “After an appendectomy the patient may have a nasogastric tube to remove stomach fluids and swallowed air.”

B. “Non-pharmacological techniques for a patient with appendicitis include application of heat to the abdomen and the side-lying position.”

C. “The nurse should monitor the patient for signs and symptoms of peritonitis which includes increased heart rate, respirations, temperature, abdominal distention, and intense abdominal pain.”

D. “It is normal for some patients to have shoulder pain after a laparoscopic appendectomy.”

7. Your patient is 4 days post-opt from an appendectomy. Which assessment finding requires further evaluation?

A. The patient reports their last bowel movement was the day before surgery.

B. The patient reports incisional pain.

C. The patient coughs and deep breathes while splinting the abdominal incision.

D. Options A and C

8. A patient is recovering after having an appendectomy. The patient is 48 hours post-opt from surgery and is tolerating full liquids. The physician orders for the patient to try solid foods. What types of foods should the patient incorporate in their diet?

A. Foods high in fiber

B. Foods low in fiber

C. Foods high in carbohydrates

D. Foods low in protein

9. A patient is scheduled for appendectomy at noon. While performing your morning assessment, you note that the patient has a fever of 103.8 ‘F and rates abdominal pain 9 on 1-10. In addition, the abdomen is distended and the patient states, “I was feeling better last night but it seems the pain has become worst.” The patient is having tachycardia and tachypnea. Based on the scenario, what do you suspect the patient is experiencing?

A. Pulmonary embolism

B. Colon Fistulae

C. Peritonitis

D. Hemorrhage

Answer Key:

1. False 2. B, C, E 3. C 4. C, D 5. C 6. B 7. A 8. A

9. C

1. Larner AJ. The aetiology of appendicitis. Br J Hosp Med 1988;39: 540-2. [PubMed] [Google Scholar]

2. Hospital Episode Statistics. Primary diagnosis: summary. www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=202 (accessed 28 Aug 2006).

3. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132: 910-25. [PubMed] [Google Scholar]

4. Murphy J. Two thousand operations for appendicitis, with deductions from his personal experience. Am J Med Sci 1904;128: 187-211. [Google Scholar]

5. Andersson R. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg 2004;91: 28-37. [PubMed] [Google Scholar]

6. McBurney C. Experiences with early operative interference in cases of diseases of the vermiform appendix. N Y Med J 1889;50: 676-84. [Google Scholar]

7. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004;141: 537-46. [PubMed] [Google Scholar]

8. Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J. MRI for clinically suspected appendicitis during pregnancy. Am J Roentgenol 2004;183: 671-5. [PubMed] [Google Scholar]

9. Weston A, Jackson T, Blamey S. Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care 2005;21: 368-79. [PubMed] [Google Scholar]

10. Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surgeons 2005;201: 933. [PubMed] [Google Scholar]

11. Fitz R. Perforating inflammation of the vermiform appendix, with special reference to its early diagnosis and treatment. Trans Assoc Am Physicians 1886;1: 107-44. [Google Scholar]

12. Thomas SH, Silen W. Effect on diagnostic efficiency of analgesia for undifferentiated abdominal pain. Br J Surg 2003;90: 5-9. [PubMed] [Google Scholar]

13. Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy. Cochrane Database Syst Rev 2005;(3):CD001439. [PMC free article] [PubMed]

14. Abou-Nukta F, Bakhos C, Arroyo K, Koo Y, Martin J, Reinhold R, et al. Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg 2006;141: 504-7. [PubMed] [Google Scholar]

15. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults: a prospective study. Ann Surg 1995;221: 278-81. [PMC free article] [PubMed] [Google Scholar]

16. Bickell NA, Aufses JAH, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J Am Coll Surg 2006;202: 401-6. [PubMed] [Google Scholar]

17. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2004;(4):CD001546. [PubMed]

18. Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R. Laparoscopic versus open appendectomy: a prospective randomized double-blind study. Ann Surg 2005;242: 439-48, discussion 448-50. [PMC free article] [PubMed] [Google Scholar]

19. Styrud J, Eriksson S, Nilsson I, Ahlberg G, Haapaniemi S, Neovius G, et al. Appendectomy versus antibiotic treatment in acute appendicitis: a prospective multicenter randomized controlled trial. World J Surg 2006;30: 1033. [PubMed] [Google Scholar]

20. Blomqvist PG, Andersson RE, Granath F, Lambe MP, Ekbom AR. Mortality after appendectomy in Sweden, 1987-1996. Ann Surg 2001;233: 455-60. [PMC free article] [PubMed] [Google Scholar]

21. Andersson R, Lambe M, Bergstrom R. Fertility patterns after appendicectomy: historical cohort study. BMJ 1999;318: 963-7. [PMC free article] [PubMed] [Google Scholar]

22. Guttman R, Goldman RD, Koren G. Appendicitis during pregnancy. Can Fam Physician 2004;50: 355-7. [PMC free article] [PubMed] [Google Scholar]

23. Andersson REB, Lambe M. Incidence of appendicitis during pregnancy. Int J Epidemiol 2001;30: 1281-5. [PubMed] [Google Scholar]

24. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med 2001;344: 808-14. [PubMed] [Google Scholar]

25. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy is followed by increased risk of Crohn's disease. Gastroenterology 2003;124: 40. [PubMed] [Google Scholar]

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Imaging and diagnosis of acute appendicitis