A nurse in an emergency department is assisting a provider who is assessing a client who has suspected appendicitis. Which of the following findings should the nurse expect?

Positive leukocyte esterase

Increased pain upon release of abdominal palpation

WBC 9,500 mm3

Pain from flexion of the left thigh when lying on the right side

Answer and Explanation

The Correct Answer is B

A. Positive leukocyte esterase is a laboratory finding typically identified during a urinalysis to screen for the presence of white blood cells. While this may indicate a urinary tract infection or renal calculi, it is not a diagnostic marker for an inflamed appendix. In appendicitis, the primary biochemical changes are systemic rather than localized to the urinary excretion system. The nurse would not expect this specific finding to confirm a diagnosis of appendiceal inflammation.

B. Increased pain upon the sudden release of deep abdominal palpation is known as rebound tenderness or Blumberg sign. This clinical phenomenon occurs when the parietal peritoneum is irritated due to the inflammatory process of the adjacent appendix. It is one of the most reliable physical examination findings for identifying peritoneal irritation associated with acute appendicitis. The nurse should expect this reaction during the provider's assessment of the right lower quadrant.

C. A white blood cell (WBC) count of 9,500 mm3 falls within the standard physiological reference range for a healthy adult. In a client with acute appendicitis, the nurse would instead expect to see significant leukocytosis, typically exceeding 10,000 to 18,000 mm3. This elevation in the leukocyte count reflects the body's systemic inflammatory response to the localized infection. A normal count like 9,500 mm3 would be atypical for a client with an actively inflamed appendix.

D. Pain from flexion of the left thigh while lying on the right side is not a characteristic sign of appendicitis. The psoas sign, which is associated with appendicitis, involves pain upon extension or flexion of the right thigh, as the appendix sits in the right iliac fossa. Flexing the left thigh does not cause the anatomical tension required to irritate an inflamed appendix. This finding would suggest a different pathology or involve an unaffected anatomical region.

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Correct Answer is D

Explanation

A) Decrease folic acid intake: Decreasing folic acid intake is not advisable for clients with malabsorption syndrome. In fact, clients with malabsorption often require increased folic acid due to poor absorption of nutrients, especially in conditions like celiac disease or other causes of malabsorption.

B) Increase lactose intake: Increasing lactose intake is not appropriate for clients with malabsorption syndrome, particularly if they have lactose intolerance. Lactose can exacerbate symptoms such as diarrhea and steatorrhea in these clients.

C) Provide a gluten-free diet: A gluten-free diet is crucial for clients with celiac disease, which is a type of malabsorption syndrome. However, if the malabsorption syndrome is due to another cause, a gluten-free diet might not address the issue. The focus should be on managing fat intake to reduce steatorrhea.

D) Provide a low-fat diet: A low-fat diet is the most appropriate intervention for managing severe steatorrhea, which is the presence of excess fat in the stool. Reducing fat intake helps to minimize fat malabsorption and the associated symptoms, providing relief from steatorrhea.

A. "Limit sodium intake to 3,500 milligrams per day." B. "Take ibuprofen for discomfort." C. "Increase the distance you walk by 100 feet daily, even if you feel fatigued." D. "Include no more than 2,000 milliliters of fluid intake in 24 hours."

Correct Answer is D

Explanation

A) "Limit sodium intake to 3,500 milligrams per day.":
Limiting sodium intake is crucial for managing heart failure to prevent fluid retention and exacerbation of symptoms. However, the recommended limit is typically much lower, around 1,500 to 2,000 milligrams per day, not 3,500 milligrams.

B) "Take ibuprofen for discomfort.":
Ibuprofen and other NSAIDs are not recommended for clients with heart failure as they can cause fluid retention, worsen heart failure symptoms, and increase the risk of kidney problems. Alternatives such as acetaminophen are generally safer for pain relief.

C) "Increase the distance you walk by 100 feet daily, even if you feel fatigued.":
While regular exercise is important, clients with heart failure should not push through fatigue, as overexertion can lead to worsening symptoms. Exercise recommendations should be tailored to the individual's tolerance and should be adjusted based on their energy levels.

D) "Include no more than 2,000 milliliters of fluid intake in 24 hours.":
Restricting fluid intake to 2,000 milliliters per day helps prevent fluid overload, which is critical for managing heart failure. Monitoring and limiting fluid intake can help control symptoms such as edema and shortness of breath.

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A nurse in an emergency department is assisting a provider who is assessing a client who has suspected appendicitis. Which of the following findings should the nurse expect?

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