American Association of Critical-Care Nurses (AACN) Certification Practice Test

Kehr's sign is associated with what underlying condition?

1. Hepatitis

2. Pancreatitis

3. Splenic rupture

4. Gallbladder attack

The correct answer is: Splenic rupture

Kehr's sign is a clinical symptom that indicates referred pain, specifically in the left shoulder, due to irritation of the diaphragm. This phenomenon is most commonly associated with splenic rupture. When the spleen ruptures, blood and other irritants can spill into the peritoneal cavity, leading to diaphragmatic irritation that then causes pain that radiates to the left shoulder. This is a key diagnostic indicator in the assessment of a patient who may have sustained splenic trauma or injury. The other conditions listed may present with abdominal pain but do not typically result in this specific referred shoulder pain related to diaphragmatic irritation. Hepatitis and pancreatitis often present with abdominal pain that is more localized to the abdomen rather than referred pain to the shoulder. In the case of a gallbladder attack, while there may be referred pain to the shoulder (specifically the right shoulder in gallbladder cases), it is not classically associated with Kehr's sign. Hence, identifying Kehr's sign in a clinical scenario typically leads to a suspicion of splenic rupture.