A patient is complaining of a sharp pain along the costovertebral angles (CVA) during percussion.
The nurse knows that this symptom most often indicates:
Inflammation of the gallbladder.
Inflammation of the kidneys.
Enlargement of the liver.
Pancreatitis.
The Correct Answer is B
Choice A rationale
Inflammation of the gallbladder, or cholecystitis, typically causes pain in the right upper quadrant of the abdomen, often radiating to the right shoulder or back. While percussion can elicit tenderness, the primary location of pain is not the costovertebral angle, which is anatomically associated with the kidneys.
Choice B rationale
Sharp pain along the costovertebral angles (CVA) during percussion is a classic clinical sign known as CVA tenderness. This finding is highly indicative of inflammation or infection of the kidneys, such as pyelonephritis. The kidneys are retroperitoneal organs located just below the twelfth rib, making them directly accessible to percussion at this anatomical landmark.
Choice C rationale
Enlargement of the liver, or hepatomegaly, is typically assessed by palpation and percussion of the right upper quadrant, below the costal margin. While it can cause discomfort, liver enlargement does not primarily manifest as pain at the costovertebral angles upon percussion.
Choice D rationale
Pancreatitis, inflammation of the pancreas, usually causes severe epigastric pain that often radiates to the back. While it is a retroperitoneal organ, its anatomical location and the nature of the pain differ significantly from the localized tenderness elicited at the costovertebral angles during percussion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
Choice A rationale
The ventrogluteal muscle is a preferred site for Z-track injections due to its thick musculature, which minimizes the risk of hitting nerves or blood vessels. Its anatomical location provides a deep, safe space for medication deposition, allowing for effective sealing of the drug within the muscle tissue, preventing leakage and irritation to subcutaneous tissues.
Choice B rationale
The deltoid muscle is generally not preferred for Z-track injections because its smaller muscle mass and proximity to the radial nerve and brachial artery increase the risk of neurovascular injury. While used for some intramuscular injections, the Z-track technique benefits from larger muscle groups to effectively seal the medication.
Choice C rationale
The dorsogluteal muscle, though historically used, is considered less ideal than the ventrogluteal site for Z-track injections due to a higher risk of sciatic nerve injury and penetration of major blood vessels. However, its large muscle mass can still accommodate Z-track injections when alternative sites are contraindicated, if proper landmarks are meticulously observed.
Choice D rationale
The abdomen, 2 inches from the umbilicus, is primarily used for subcutaneous injections, not intramuscular Z-track injections. This area lacks the deep muscle tissue necessary to effectively deposit and seal medication using the Z-track technique, and attempting intramuscular injection here poses a high risk of hitting vital organs.
Choice E rationale
The posterior thigh, specifically the rectus femoris or vastus lateralis, can be used for intramuscular injections, but it is not a primary preferred site for the Z-track technique in adults due to varying muscle thickness and increased potential for discomfort. The ventrogluteal site generally offers a larger and safer muscle mass.
Correct Answer is ["0.45"]
Explanation
Step 1 is to determine the volume to administer. 4500 units ÷ (10,000 units/1 mL) = 0.45 mL. The nurse will administer 0.45 mL.
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