A patient with pancreatitis has a positive Cullen’s sign. What does the nurse expect to see upon physical examination that is associated with a positive Cullen’s sign?

Eye twitching

Pain on palpation of RUQ

Petechiae scattered on the back

Bruised blue-gray appearance around umbilicus

Answer and Explanation

The Correct Answer is D

Choice A reason: Eye twitching is unrelated to Cullen’s sign or pancreatitis. It may occur in electrolyte imbalances like hypocalcemia, but pancreatitis typically causes hypercalcemia due to fat necrosis. Cullen’s sign is a specific dermatological finding linked to intra-abdominal bleeding, not neurological or muscular symptoms like twitching.

Choice B reason: Pain on palpation of the right upper quadrant (RUQ) is associated with conditions like cholecystitis, not Cullen’s sign. Pancreatitis causes epigastric or left upper quadrant pain. Cullen’s sign indicates retroperitoneal hemorrhage, manifesting as periumbilical bruising, not RUQ tenderness, which is unrelated to this physical finding.

Choice C reason: Petechiae scattered on the back are not indicative of Cullen’s sign. Petechiae suggest thrombocytopenia or coagulopathy, not specific to pancreatitis. Cullen’s sign is localized bruising around the umbilicus due to intraperitoneal or retroperitoneal bleeding, distinguishing it from diffuse petechiae, which have a different etiology and distribution.

Choice D reason: Cullen’s sign is a bruised, blue-gray appearance around the umbilicus, indicating retroperitoneal or intraperitoneal hemorrhage in severe pancreatitis. Blood tracks along fascial planes to the periumbilical area, causing discoloration. This sign reflects significant pancreatic inflammation or necrosis, making it a critical finding in assessing pancreatitis severity.

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Correct Answer is D

Explanation

Choice A reason: CPTT (likely a typo for aPTT, activated partial thromboplastin time) measures clotting time in the intrinsic pathway, used to monitor heparin therapy. It does not detect protein fragments from fibrinolysis. In DVT, aPTT is normal unless anticoagulation is involved, making it unhelpful for detecting fibrin degradation products.

Choice B reason: INR (international normalized ratio) assesses the extrinsic clotting pathway, primarily for warfarin monitoring. It does not measure fibrin degradation products like D-dimer. In DVT, INR is typically normal unless the patient is on anticoagulants, so it is not useful for confirming fibrinolysis or diagnosing DVT.

Choice C reason: Impedance plethysmography is a non-invasive test measuring blood flow changes in veins, used to detect DVT by identifying obstructions. It does not measure protein fragments or fibrinolysis products. It assesses physical blood flow, not biochemical markers, making it irrelevant for detecting fibrin degradation in DVT.

Choice D reason: D-dimer is a specific test for fibrin degradation products, elevated in DVT due to fibrinolysis of clots. A high D-dimer indicates active clot breakdown, supporting DVT diagnosis. It is sensitive but not specific, requiring imaging confirmation, but it directly addresses the question of detecting protein fragments from fibrinolysis.

A. Serum chloride level of 98 mEq/L (98 mmol/L) B. Serum sodium level of 137 mEq/L C. Serum calcium level of 8.8 mg/dL D. Serum potassium level of 2.5 mEq/L (2.5 mmol/L)

Correct Answer is D

Explanation

Choice A reason: A serum chloride level of 98 mEq/L is within the normal range (97–107 mEq/L). It does not indicate an immediate issue in a patient receiving IV insulin. Chloride levels may shift in DKA or other conditions, but this value is normal and does not require urgent intervention, as it poses no immediate risk to cardiac or metabolic function.

Choice B reason: A serum sodium level of 137 mEq/L is within the normal range (135–145 mEq/L). Sodium levels may fluctuate in hyperglycemia due to osmotic shifts, but this value is stable. It does not warrant immediate intervention in a patient on IV insulin, as it does not indicate a critical imbalance affecting neurological or cardiovascular function.

Choice C reason: A serum calcium level of 8.8 mg/dL is within the normal range (8.5–10.2 mg/dL). Calcium levels are not directly affected by IV insulin therapy, and this value does not indicate a critical issue. No immediate intervention is needed, as it does not pose a risk to neuromuscular or cardiac function in this context.

Choice D reason: A serum potassium level of 2.5 mEq/L is critically low (normal: 3.5–5.0 mEq/L). IV insulin drives potassium into cells, worsening hypokalemia, which can cause life-threatening arrhythmias, muscle weakness, or respiratory failure. Immediate intervention, such as potassium supplementation, is required to prevent cardiac complications and ensure patient safety during insulin therapy.

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A patient with pancreatitis has a positive Cullen’s sign. What does the nurse expect to see upon physical examination that is associated with a positive Cullen’s sign?

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