A nurse is assessing a client with suspected acute cholecystitis. Which of the following physical examination findings is a hallmark sign of this condition?

A. Mild, intermittent right upper quadrant (RUQ) pain is more characteristic of chronic cholecystitis rather than acute cholecystitis, which typically presents with severe pain.
B. Left lower quadrant (LLQ) pain with rebound tenderness is more indicative of conditions like diverticulitis, not acute cholecystitis.
C. Severe, colicky abdominal pain radiating to the right shoulder is the most common presentation of acute cholecystitis, often caused by gallbladder inflammation and obstruction of the cystic duct. The pain is due to irritation of the phrenic nerve, which supplies both the gallbladder and right shoulder.
D. Epigastric pain worsened by fatty meals is often seen in gallbladder disease but is more characteristic of biliary colic rather than acute cholecystitis.

Choice A reason:

Encouraging the client to eat a high-fat meal the night before the surgery is not recommended. Instead, clients scheduled for surgery, especially abdominal surgery, are typically instructed to have a clear liquid diet or nothing by mouth (NPO) after midnight to prevent aspiration during anesthesia.

Choice B reason:

Administering antibiotics prophylactically before surgery is often done to prevent infection during the procedure. However, it is at the discretion of the healthcare provider based on the client's specific condition and surgical plan.

Choice C reason:

Avoiding deep breathing exercises is not recommended preoperatively. Deep breathing exercises help prevent respiratory complications after surgery and promote lung function.

Choice D reason:

This statement is correct. Instructing the client to remain NPO after midnight before the surgery is essential to prevent aspiration during anesthesia. Clients should not eat or drink anything after the specified time to ensure their stomach is empty during the surgery.