A nurse is caring for a client who is in labor.

Exhibits

Which of the following actions should the nurse take? Select (3) options.

Rationale:

A. Decreased blood pressure in the arms with increased blood pressure in the legs is incorrect because coarctation of the aorta narrows the aortic arch near the ductus arteriosus, usually after the vessels that supply the head and arms. This results in higher pressure in the upper extremities compared with the lower extremities, not the reverse.

B. Increased blood pressure in the arms with decreased blood pressure in the legs is correct because the obstruction in the aorta causes restricted blood flow to the lower extremities, leading to weak or delayed femoral pulses and lower blood pressure in the legs. Conversely, the upper extremities receive normal or elevated blood flow, resulting in higher blood pressure. This is a hallmark finding in coarctation of the aorta.

C. Decreased blood pressure in both the arms and the legs is incorrect because blood flow to the upper extremities is typically preserved or even increased, not decreased. Low pressure in both the arms and legs would suggest generalized shock or severe heart failure, not isolated coarctation.

D. Increased blood pressure in both the arms and the legs is incorrect because the obstruction limits perfusion to the lower body. While upper extremity pressure may be elevated due to increased resistance, lower extremity pressure is reduced, not increased.

Rationale:

A. Pain in both quadrants of the upper abdomen is incorrect because upper abdominal discomfort is usually related to disorders of the stomach, liver, gallbladder, or pancreas. Conditions such as gastritis, peptic ulcer disease, or cholecystitis can cause upper abdominal pain, but appendicitis typically does not present with pain in the upper quadrants, especially not bilaterally, as the appendix is located in the lower abdomen.

B. Pain in the left lower quadrant of the abdomen is incorrect because left lower quadrant pain is more characteristic of conditions such as constipation, gastroenteritis, urinary tract infection, or diverticulitis. Appendicitis rarely causes pain in the left lower quadrant unless the appendix is in an atypical location, which is uncommon.

C. Pain in the right upper quadrant of the abdomen is incorrect because this is associated with hepatobiliary disorders such as cholecystitis, hepatitis, or pneumonia affecting the lower right lung. While referred pain can occasionally be misleading, classic appendicitis pain does not typically localize to the right upper quadrant.

D. Pain in the right lower quadrant of the abdomen is correct because the classic presentation of appendicitis in children includes initial periumbilical pain that is vague and poorly localized, which gradually migrates to the right lower quadrant at McBurney’s point, approximately one-third of the distance from the anterior superior iliac spine to the umbilicus. Pain becomes sharp, constant, and more localized as the parietal peritoneum becomes inflamed. Associated symptoms often include nausea, vomiting, anorexia, low-grade fever, and sometimes rebound tenderness or guarding on palpation. Recognizing right lower quadrant pain as a hallmark sign allows the nurse to anticipate the need for prompt diagnostic evaluation, such as ultrasound, CT scan, or laboratory studies showing elevated WBC count, and to notify the provider for possible surgical intervention. Early recognition is critical to prevent perforation and peritonitis, which can significantly increase morbidity in children.