MSN Exam for Appendicitis

1) What are diagnostic features of acute appendicitis? click all that apply

1. Low grade fever less than 100.4F/38C
2. Moderate leukocytosis (10,000-20,000)
3. Ultrasound
4. CT (with contrast depending on body habitus)
5. CT (helpful if perforation is suspected to diagnose periappendiceal abscess)

2) What best explains what happens to the appendix when it is obstructed?

1. the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
2. the inflamed tissue dies from lack of blood supply causing the appendix to burst
3. the obstruction causes pressure to build up and eventually causes the appendix to burst
4. the obstruction hardens the appendix eventually causing it to burst

3) Roxy is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be looking for tenderness on palpation at McBurney’s point, which is located in the

1. left lower quadrant
2. left upper quadrant
3. right lower quadrant
4. right upper quadrant

4) The celiac artery supplies blood to which part of the GI tract?

1. duodenum
2. jejunum
3. small intestine and proximal colon
4. mid-transverse colon to rectum
5. cecum

5) During defecation, movement of feces into the rectum initiates (click all that apply)

1. rectoanal inhibitory reflex
2. voluntary relaxation of the pelvic floor and external sphincter mechanism
3. voluntary increase in intra-abdominal pressure
4. voluntary contraction of external sphincter

6) What is the primary cause of appendicitis?

1. obstruction of the lumen between the cecum and appendix
2. inflammation due to an immune response
3. constipation
4. overuse of antibiotics

7) Jerry has diagnosed with appendicitis. He develops a fever, hypotension and tachycardia. The nurse suspects which of the following complications?

1. Intestinal obstruction
2. Peritonitis
3. Bowel ischemia
4. Deficient fluid volume

8) What are some possible causes of an obstructed appendix?

1. inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
2. infection, fecal stasis, calcium salts or undigested fiber-fecaliths, parasites, FB, and neoplasms, diarrhea
3. fecal stasis, fecaliths, FB, gastric ulcer, infection, calcium salts or undigested fiber- fecaliths, parasites,and neoplasms
4. suppositories, FB, neoplams, undigested fiber and calcium salts, calcium salts or undigested fiber-fecaliths, infection, fecal stasis, parasites

9) What is the blind sac that is in the RLQ below the ileocecal valve?

1. cecum
2. appendix
3. transverse colon
4. ascending colon

10) The middle rectal artery supplies blood to which part of the rectum?

1. The lower rectum
2. The middle rectum
3. The anal sphincters
4. upper and middle rectum

11) Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. Signs and symptoms include pain in the RLQ of the abdomen that may be localize at McBurney’s point. To relieve pain, Mr. Liu should assume which position?

1. Prone
2. Supine, stretched out
3. Sitting
4. Lying with legs drawn up

12) A patient presents with periumbilical pain that moves to the RLQ over 24 hrs. the pain is exacerbated by walking, coughing, or a car ride. The patient presents with nausea, vomiting, and a low grade fever of less than 38C or 100.4. What is the suspected diagnosis?

1. Acute appendicitis
2. Ovarian cyst
3. Volvulus
4. Acute pancreatitis
5. Acute cholecystitis

13) What type of tissue is the appendix made up of?

1. lymphatic
2. connective
3. fibrinous
4. intestinal mucosa

14) The inferior mesenteric artery supplies blood to which part of the GI tract?

1. mid-transverse colon to rectum
2. colon and anal canal
3. descending colon and rectum
4. colon and rectum
5. colon, cecum, and rectum

15) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F.  Which of the following would confirm a diagnosis of appendicitis?

1. The pain is localized at a position halfway between the umbilicus and the right iliac crest.
2. Mr. Liu describes the pain as occurring 2 hours after eating
3. The pain subsides after eating
4. The pain is in the left lower quadrant

16) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Stat appendectomy was indicated. Pre op care would include all of the following except?

1. Consent signed by the father
2. Enema STAT
3. Skin prep of the area including the pubis
4. Remove the jewelries

17) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Pre-anesthetic med of Demerol and atrophine sulfate were ordered to :

1. Allay anxiety and apprehension
2. Reduce pain
3. Prevent vomiting
4. Relax abdominal muscle

18) Which condition is most likely to have a nursing diagnosis of fluid volume deficit?

1. Appendicitis
2. Pancreatitis
3. Cholecystitis
4. Gastric ulcer

19) Post op care for appendectomy include the following except

1. Early ambulation
2. Diet as tolerated after fully conscious
3. Nasogastric tube connect to suction
4. Deep breathing and leg exercise

20) Other condition/s that could produce pain similar to appendicitis include

1. Inflammation of gall bladder
2. Stone in ureter
3. Inflammation of right colon
4. All of the above

21) When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

1. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
2. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
3. The appendix may develop gangrene and rupture, especially in a middle-aged client.
4. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

22) The superior rectal artery supplies blood to which part of the GI tract?

1. The rectum
2. The upper and middle rectum
3. lower rectum
4. anal sphincters and rectum
5. anal sphincters only

23) Typical signs and symptoms of appendicitis include:

1. Nausea
2. Left lower quadrant pain
3. Pain when pressure is applied to the right lower quadrant of the abdomen.
4. High fever

24) What stimulates the contraction of propulsive waves that move stool distally from the cecum?

1. distention of the colonic wall
2. distention of the small intestinal wall
3. the fermenting vat located in the cecum
4. distention of the cecum wall

25) The superior mesenteric artery supplies blood to which part of the GI tract?

1. small intestine (other than duodenum) and proximal colon
2. mid-transverse colon to rectum
3. duodenum
4. cecum
5. rectum only

26) Situation: Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. After a few minutes, the pain suddenly stops without any intervention. Nurse Ray might suspect that:

1. the appendix is still distended
2. the appendix may have ruptured
3. an increased in intrathoracic pressure will occur
4. signs and symptoms of peritonitis occur

27) During the rectoanal inhibitory reflex, the internal sphincter ________ allowing the contents into the anal canal, then the external sphincter ____________ and contents are pushed back into the rectum. This occurs up to 7 times daily.

1. relaxes, relaxes
2. contracts, contracts
3. relaxes, contracts
4. contracts, relaxes

28) While examining a patient with suspected appendicitis, you would expect to find pain (with or without) gaurding, (with or without) rebound tenderness, pain (with or without) passive flexion of R hip, pain (with or without) passive flexion of L hip, and a postitive or negative obturator sign?

1. Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a positive obturator sign
2. Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a postivie obturator sign
3. Pain: without gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign
4. Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, with passive flexion of L hip, and a positive obturator sign

29) The __________ extends from the rectosigmoid junction to the anal canal and is composed of insensitive columnar epithelium.

1. Anal Canal
2. Rectum
3. Colon
4. Large bowel

30) Surgery is the definitive treatment for appendicitis.

1. True
2. False

31) If after surgery the patient’s abdomen becomes distended and no bowel sounds appreciated, what would be the most suspected complication? [1]

1. Intussusception
2. Paralytic Ileus
3. Hemorrhage
4. Ruptured colon

32) The _____________ is 3-4 cm long, starts at the dentate line, is supported by the internal and external anal sphincters, and composed of sensitive squamous epithelium.

1. Rectum
2. Anal Canal
3. Colon
4. Anal sphincter canal

33) The inferior rectal artery supplies blood to which part of the rectum?

1. the internal and external anal sphincters
2. the lower rectum
3. the upper, middle, and lower rectum
4. the external sphincter only
5. the internal sphincter only

34) What percentage of people have appendicitis in their lifetime?

1. 10%
2. 20%
3. 30%
4. 50%

35) The appendix is located on the _____ lower side of the abdomen.

1. Right
2. Left

36) Peritonitis may occur in ruptured appendix and may cause serious problems which are

1. Hypovolemia, electrolyte imbalance
2. Elevated temperature, weakness and diaphoresis
3. Nausea and vomiting, rigidity of the abdominal wall
4. Pallor and eventually shock

1. 1 and 2
2. 2 and 3
3. 1,2,3
4. All of the above

37) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. Which of the following complications is thought to be the most common cause of appendicitis?

1. A fecalith
2. Internal bowel occlusion
3. Bowel kinking
4. Abdominal wall swelling

38) What part of the colon propels retrograde waves of contraction to allow the cecum to retain liquid feces and act as a ‘fermenting vat’?

1. mid-transverse colon
2. entire transverse colon
3. ascending colon
4. descending colon
5. ileum

39) Situation: A 20 year old college student was rushed to the ER of PGH after he fainted during their ROTC drill. Complained of severe right iliac pain. Upon palpation of his abdomen, Ernie jerks even on slight pressure. Blood test was ordered. Diagnosis is acute appendicitis. Which result of the lab test will be significant to the diagnosis?

1. RBC : 4.5 TO 5 Million / cu. mm.
2. Hgb : 13 to 14 gm/dl.
3. Platelets : 250,000 to 500,000 cu.mm.
4. WBC : 12,000 to 13,000/cu.mm

40) Worms do not cause appendicitis.

1. True
2. False

41) When preparing a male client, age 51, for surgery to treat appendicitis, the nurse formulates a nursing diagnosis of Risk for infection related to inflammation, perforation, and surgery. What is the rationale for choosing this nursing diagnosis?

1. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
2. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix.
3. The appendix may develop gangrene and rupture, especially in a middle-aged client.
4. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage.

42) What 3 major branches of the aorta supply blood to the intestines?

1. celiac artery, superior mesenteric artery, inferior mesenteric artery
2. celiac artery, superior mesenteric artery, and right and left gastric artery
3. superior mesenteric artery, inferior mesenteric artery, and internal and external iliac arteries
4. common iliac artery, superior mesenteric artery, inferior mesenteric arteries

43) What is the treatment for appendicitis?

1. surgical removal of inflamed appendix before it ruptures
2. pain control and antibiotics
3. pain control
4. antibiotics and observation

44) What vein carries venous blood from the intestines to the liver?

1. portal vein
2. iliac veins
3. middle colic vein
4. inferior mesenteric vein
5. superior mesenteric vein

45) McBurney Point is located ________

1. Around the umbilicus
2. In the right lower abdomen
3. In the left lower abdomen
4. In the upper abdomen

46) Perforation is not a complication of appendicitis.

1. True
2. False

47) Situation : Mr. Gerald Liu, 19 y/o, is being admitted to a hospital unit complaining of severe pain in the lower abdomen. Admission vital signs reveal an oral temperature of 101.2 0F. The doctor ordered for a complete blood count. After the test, Nurse Ray received the result from the laboratory. Which laboratory values will confirm the diagnosis of appendicitis?

1. RBC 5.5 x 106/mm3
2. Hct 44 %
3. WBC 13, 000/mm3
4. Hgb 15 g/dL

48) Diet does not influence the development of appendicitis.

1. True
2. False

49) Symptoms of appendicitis include ______

1. Abdominal pain
2. Nausea
3. Constipation
4. All of the above

50) Common anesthesia for appendectomy is

1. Spinal
2. General
3. Caudal
4. Hypnosis

Answers and Rationales

1. A. Low grade fever less than 100.4F/38C , B. Moderate leukocytosis (10,000-20,000) , C. Ultrasound , D. CT (with contrast depending on body habitus) , E. CT (helpful if perforation is suspected to diagnose periappendiceal abscess)
2. A. the inflamed tissue becomes infected and dies from lack of blood supply and eventually bursts
3. C. right lower quadrant . To be exact, the appendix is anatomically located at the Mc Burney’s point at the right iliac area of the right lower quadrant.
4. A. duodenum
5. B. voluntary relaxation of the pelvic floor and external sphincter mechanism, C. voluntary increase in intra-abdominal pressure 
6. A. obstruction of the lumen between the cecum and appendix 
7. B. Peritonitis . Complications of acute appendicitis are peritonitis, perforation and abscess development.
8. A. inflammatory bowel disease, infection, fecal stasis, calcium salts or undigested fiber- fecaliths, parasites, fb, and neoplasms
9. A. cecum 
10. A. The lower rectum 
11. D. Lying with legs drawn up . Posturing by lying with legs drawn up can relax the abdominal muscle thus relieve pain.
12. A. Acute appendicitis 
13. A. lymphatic 
14. A. mid-transverse colon to rectum 
15. A. The pain is localized at a position halfway between the umbilicus and the right iliac crest. Pain over McBurney’s point, the point halfway between the umbilicus and the iliac crest, is diagnosis for appendicitis. Options b and c are common with ulcers; option d may suggest ulcerative colitis or diverticulitis.
16. B. Enema STAT 
17. A. Allay anxiety and apprehension . Pain is not reduced in appendicits. Clients are not given pain medication as to assess whether the appendix ruptured. A sudden relief of pain indicates the the appendix has ruptured and client will have an emergency appendectomy and prevent peritonitis. Demerol and Atropine are used to allay client’s anxiety pre operatively.
18. B. Pancreatitis . Hypovolemic shock from fluid shifts is a major factor in acute pancreatitis. The other conditions are less likely to exhibit fluid volume deficit.
19. B. Diet as tolerated after fully conscious. Client’s peristalsis will return in 48 to 72 hours post-op therefore, Fluid and food are witheld until the bowel sounds returns. Remember that ALL PROCUDURES requiring GENERAL and SPINAL anesthesia above the nerves that supply the intestines will cause temporary paralysis of the bowel. Specially when the bowels are traumatized during the procedure, it may take longer for the intestinal peristalsis to resume.
20. D. All of the above . Other conditions like gall stones, inflammation of gall bladder, stone in the ureter, ruptured ovarian follicle, a ruptured tubal pregnancy, perforation of stomach or duodenal ulcer, and inflammation of the right colon can produce pain similar to appendicitis.
21. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
22. B. The upper and middle rectum 
23. A. Nausea . Nausea is typically associated with appendicitis with or without vomiting. Pain is generally felt in the right lower quadrant. Rebound tenderness, or pain felt with release of pressure applied to the abdomen, may be present with appendicitis. Low-grade fever is associated with appendicitis.
24. A. distention of the colonic wall 
25. A. small intestine (other than duodenum) and proximal colon 
26. B. the appendix may have ruptured . If a confirmed diagnosis is made and the pain suddenly without any intervention, the appendix may have ruptured; the pain is lessened because the appendix is no longer distended thus surgery is still needed.
27. C. relaxes, contracts 
28. A. Pain: with gaurding, with rebound tenderness, with passive flexion of R hip, without passive flexion of L hip, and a positive obturator sign 
29. B. Rectum 
30. A. True. Surgery is the definitive treatment for appendicitis. It may be performed as an open surgery or through a laparoscope. Antibiotics are also useful in treating appendicitis, but usually require to be followed by surgery due to recurrence.
31. B. Paralytic Ileus . Paralytic Ileus is a mechanical bowel obstruction where in, the patients intestine fails to regain its motility. It is usually caused by surgery and anesthesia. Intusussusception, Appendicitis and Peritonitis also causes paralytic ileus.
32. B. Anal Canal 
33. A. the internal and external anal sphincters
34. A. 10% 
35. A. Right 
36. D. All of the above . Peritonitis will cause all of the above symptoms. The peritoneum has a natural tendency to GUARD and become RIGID as to limit the infective exudate exchange inside the abdominal cavity. Hypovolemia and F&E imbalance are caused by severe nausea and vomiting in patients with peritonitis because of acute pain. As inflammation and infection spreads, fever and chills will become more apparent causing elevation in temperature, weakness and sweating. If peritonitis is left untreated, Client will become severely hypotensive leading to shock and death.
37. A. A fecalith . A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction.
38. A. mid-transverse colon 
39. D. WBC : 12,000 to 13,000/cu.mm . WBC increases with inflammation and infection.
40. B. False . Worms can block the opening of the appendix resulting in appendicitis. In addition, fecaliths, infection or inflammation can also block the opening of the appendix leading to appendicitis.
41. B. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. A client with appendicitis is at risk for infection related to inflammation, perforation, and surgery because obstruction of the appendix causes mucus fluid to build up, increasing pressure in the appendix and compressing venous outflow drainage. The pressure continues to rise with venous obstruction; arterial blood flow then decreases, leading to ischemia from lack of perfusion. Inflammation and bacterial growth follow, and swelling continues to raise pressure within the appendix, resulting in gangrene and rupture. Geriatric, not middle-aged, clients are especially susceptible to appendix rupture.
42. A. celiac artery, superior mesenteric artery, inferior mesenteric artery 
43. A. surgical removal of inflamed appendix before it ruptures 
44. A. portal vein 
45. B. In the right lower abdomen. Pain in appendicitis normally starts around the umbilicus but later settles in the right lower abdomen near the appendix. This point is called the McBurney Point and is located midway between the umbilicus and the top of the right pelvic bone.
46. B. False. The inflamed appendix can burst resulting in inflammation of the lining of the abdomen (peritoneum), the condition being called peritonitis.
47. C. WBC 13, 000/mm3 . Increase in WBC counts is suggestive of appendicitis because of bacterial invasion and inflammation. Normal WBC count is 5, 000 – 10, 000/mm3. Other options are normal values.
48. B. False . Diet lacking in fiber is a risk factor for appendicitis.
49. D. All of the above . Symptoms of appendicitis include abdominal pain, nausea, vomiting, loss of appetite, low grade fever, constipation, diarrhea and an inability to pass gas. A swelling may subsequently appear in the abdomen overlying the appendix.
50. A. Spinal . Spinal anesthesia is the most common method used in appendectomy. Using this method, Only the area affected is anesthetized preventing systemic side effects of anesthetics like dizziness, hypotension and RR depression.