A nurse is caring for a child who is admitted with right lower quadrant abdominal pain, nausea, and vomiting.
Which condition does the nurse suspect?
Gastroesophageal reflux disease.
Appendicitis.
Cirrhosis.
Cholecystitis.
The Correct Answer is B
Choice A rationale
Gastroesophageal reflux disease is characterized by the retrograde flow of gastric contents into the esophagus due to lower esophageal sphincter dysfunction. Typical symptoms include pyrosis, which is heartburn, and regurgitation, often occurring after meals. This condition does not typically present with localized right lower quadrant pain. Instead, discomfort is usually substernal or epigastric. In pediatric patients, it might cause poor weight gain or respiratory issues rather than the acute surgical abdomen described here.
Choice B rationale
Appendicitis is the most common cause of acute abdominal pain requiring surgery in children. It typically begins with periumbilical pain that migrates to McBurney point in the right lower quadrant. The inflammation of the appendix triggers the visceral and somatic pain pathways, often accompanied by nausea, vomiting, and anorexia. Normal white blood cell counts are 5,000 to 10,000 cells/mm, but appendicitis often elevates this above 15,000. Physical exam findings usually include rebound tenderness and guarding.
Choice C rationale
Cirrhosis involves chronic liver damage leading to scarring and liver failure. In children, it may result from biliary atresia or metabolic disorders. Clinical manifestations usually include jaundice, ascites, splenomegaly, and hepatomegaly rather than acute right lower quadrant pain. Laboratory findings would show elevated bilirubin and low albumin levels. Normal total bilirubin is 0.3 to 1.0 mg/dL. Cirrhosis is a progressive, chronic condition that does not align with the sudden onset of localized lower abdominal pain and vomiting.
Choice D rationale
Cholecystitis is the inflammation of the gallbladder, usually caused by gallstones obstructing the cystic duct. Pain associated with cholecystitis is typically localized in the right upper quadrant and may radiate to the right scapula. While it involves nausea and vomiting, the anatomical location of the pain distinguishes it from appendicitis. It is less common in children than in adults unless there are underlying conditions like hemolytic anemia. Diagnostic ultrasound would show gallbladder wall thickening or pericholecystic fluid.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Hepatitis D is a unique virus that requires the presence of the Hepatitis B virus to replicate. It is transmitted through percutaneous or mucosal contact with infected blood or body fluids, similar to Hepatitis B. It is not transmitted through the ingestion of contaminated food or water. Therefore, outbreaks are usually seen in populations with high rates of Hepatitis B infection, particularly among those who use intravenous drugs or receive multiple blood transfusions.
Choice B rationale
Hepatitis A is an acute viral infection that is primarily transmitted via the fecal-oral route. This occurs when an individual consumes food or water that has been contaminated with the feces of an infected person. It is often associated with poor sanitation, lack of clean water, and improper hand hygiene in food preparation. Unlike other forms of hepatitis, it does not typically lead to chronic liver disease, but it can cause significant acute illness.
Choice C rationale
Hepatitis C is a bloodborne virus that is most commonly transmitted through the sharing of needles among injection drug users or through needle-stick injuries in healthcare settings. Before widespread screening was implemented, it was also commonly spread through blood transfusions. It is characterized by a high rate of chronic infection and is not spread through food, water, or casual contact. It requires direct blood-to-blood contact for transmission to occur effectively.
Choice D rationale
Hepatitis B is transmitted through exposure to infectious blood, semen, and other body fluids. Common routes include perinatal transmission from mother to child, sexual contact, and the use of contaminated needles. It can result in both acute and chronic infections. Like Hepatitis C, it is not an enterically transmitted virus, meaning it does not enter the body through the digestive tract via contaminated food or water sources under normal circumstances.
Correct Answer is C
Explanation
Choice A rationale
The occipital lobe serves as the primary hub for visual information. It allows an individual to recognize shapes, colors, and motion. While it helps one see written words, the actual comprehension of those words as language happens elsewhere. Receptive aphasia involves a failure to understand the meaning of spoken or written language, which is a higher-level cognitive linguistic function not performed by the primary visual processing neurons located in the most posterior brain region.
Choice B rationale
The frontal lobe is the seat of executive function, personality, and motor control. It includes Broca's area, which is responsible for the motor production of speech. While the frontal lobe is essential for planning what to say, it is not the primary site for decoding the meaning of incoming verbal communication. Receptive aphasia is a sensory-linguistic deficit rather than an executive or motor deficit, making the frontal lobe an unlikely primary site for this specific pathology.
Choice C rationale
The temporal lobe, specifically Wernicke's area in the superior temporal gyrus, is the primary region for language comprehension. When this area is damaged, the individual experiences receptive aphasia. They can hear words but cannot process their meaning, often perceiving speech as a foreign language. Consequently, their own speech remains fluent in rhythm but is filled with nonsensical words or paraphasias because they cannot monitor the meaningfulness of their own output during conversation.
Choice D rationale
The parietal lobe manages somatosensory perception and integrates sensory input to assist with spatial awareness. While it plays a role in some aspects of reading and writing through its connection to other regions, it is not the primary center for understanding spoken language. An injury here might result in difficulty with sensory localization or navigation but would not typically manifest as the profound loss of linguistic comprehension that defines receptive aphasia in a clinical setting.
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