An occupational health nurse provides monthly lunch and learn sessions to employees of a rail transportation manufacturer. This month, they are providing education on the risk factors for peptic ulcer disease. Which risk factors should the nurse include in the educational session?

Choice A reason: Rebound tenderness at McBurney’s point, located in the right lower quadrant, is a classic sign of appendicitis. It occurs due to peritoneal irritation from an inflamed appendix, causing pain when pressure is released. This reflects localized inflammation and is a key diagnostic finding, often accompanied by guarding and fever.

Choice B reason: Hyperactive bowel sounds are not typical in appendicitis. Early in the condition, bowel sounds may be normal, but as inflammation progresses, paralytic ileus develops, leading to hypoactive or absent bowel sounds. Hyperactive sounds suggest other conditions, like gastroenteritis or obstruction, not the peritoneal irritation characteristic of appendicitis.

Choice C reason: Increased urinary output is not associated with appendicitis. Inflammation may cause systemic effects, but the kidneys typically reduce urine output (oliguria) in response to stress or hypovolemia from fluid shifts. Appendicitis does not directly affect renal function to increase urine production, making this an unlikely finding.

Choice D reason: A soft, non-tender abdomen is not expected in appendicitis. The condition causes localized tenderness, guarding, and rigidity in the right lower quadrant due to inflammation. A soft abdomen suggests no significant peritoneal irritation, which contradicts the pathophysiology of appendicitis, where pain and muscle guarding are prominent features.

Choice A reason: Methylprednisolone, a corticosteroid, reduces inflammation in anaphylaxis by inhibiting immune responses. However, its onset is slow, taking hours to act, making it unsuitable as the first-line treatment for acute anaphylactic shock. It is used as an adjunct to stabilize symptoms after epinephrine addresses immediate life-threatening bronchoconstriction and hypotension.

Choice B reason: Epinephrine is the first-line treatment for anaphylactic shock. It acts rapidly via alpha- and beta-adrenergic receptors to reverse bronchoconstriction, vasodilation, and hypotension. It constricts blood vessels, increases cardiac output, and relaxes airway smooth muscles, alleviating life-threatening symptoms like airway obstruction and shock, making it critical for immediate administration.

Choice C reason: Dobutamine, a beta-agonist, enhances cardiac contractility and is used in cardiogenic shock. It does not address the histamine-mediated vasodilation, bronchoconstriction, or angioedema in anaphylaxis. Its use could worsen hypotension by increasing cardiac demand without correcting the underlying immune-mediated mechanisms, making it inappropriate for this emergency.

Choice D reason: Furosemide, a diuretic, treats fluid overload in conditions like heart failure. In anaphylactic shock, it would exacerbate hypotension by reducing intravascular volume, worsening tissue perfusion. Anaphylaxis involves histamine-induced vascular leak, not fluid overload, so furosemide is contraindicated and would not address the acute airway or cardiovascular symptoms.