A patient presents with intense RLQ pain. What exam can the NP use to support a diagnosis of appendicitis?

The choice involving McBurney's point, the Psoas sign, and Rovsing's sign is particularly relevant for supporting a diagnosis of appendicitis.

McBurney's point is located two-thirds of the way from the umbilicus to the anterior superior iliac spine, and tenderness at this spot is a classic indicator of appendicitis. When the examiner palpates this area, sharp pain is often indicative of inflammation of the appendix.

The Psoas sign is elicited by extending the patient's hip while they lie on their side. If this maneuver causes increased pain in the right lower quadrant, it suggests an inflamed appendix may be irritating the psoas muscle.

Rovsing's sign is assessed by palpating the left lower quadrant, which can provoke pain in the right lower quadrant if the appendix is inflamed. This transfer of pain is often due to the shared nerve pathways involved in the innervation of the abdominal viscera.

Together, these three assessments create a more comprehensive picture when evaluating a patient with symptoms suggestive of appendicitis, making this combination particularly useful for diagnostic purposes.