A 15-year-old female client is evaluated for right lower quadrant pain that started 18 hours ago. The provider is considering acute appendicitis and ovarian torsion. The nurse's assessment findings are listed below. Which findings more strongly support acute appendicitis than ovarian torsion? Select all that apply.

Quick answer
Periumbilical-to-RLQ migration, anorexia before vomiting, Rovsing sign, and psoas sign (options 4, 6, 5, 8).

Why this is correct
The question asks which findings discriminate, not which findings are present in appendicitis. Early appendiceal inflammation is felt vaguely at the umbilicus and then localizes when the parietal peritoneum is irritated, and anorexia typically comes before vomiting. Rovsing and psoas signs show peritoneal or retroperitoneal irritation from the inflamed appendix. Ovarian torsion usually starts suddenly in the lower quadrant with early, prominent vomiting.

Easy analogy or mental picture
Appendicitis is like a rumor that starts vaguely in the middle of town and then settles on one address; torsion is a sudden alarm going off right at the house.

Memory hook
Middle then right, hungry-less before sick, plus Rovsing and psoas = appendix.

NCLEX decision rule
When comparing two diagnoses, choose findings that separate them; findings shared by both do not support one over the other.

Why the other choices are wrong
RLQ tenderness (option 2) and vomiting (option 3) are tempting because they are part of every appendicitis description, but torsion also causes lower quadrant tenderness and vomiting, often earlier and more prominently, so they do not discriminate. A negative hCG (option 1) is tempting because ruling out pregnancy feels like narrowing toward appendicitis, but it excludes ectopic pregnancy only and does not separate appendix from ovary. A menstrual period 13 days ago (option 7) places the client at mid-cycle, which raises ovarian considerations such as a ruptured follicle or cyst rather than supporting appendicitis.