Costovertebral angle tenderness should be assessed whenever the nurse suspects:

Choice A reason: Opisthotonos is a severe arching of the back with hyperextension of the neck and limbs due to intense muscle spasms, often linked to tetanus or severe meningitis. It does not involve the specific arm adduction and foot plantar flexion with internal rotation described. This posture is unrelated to the neurological damage indicated, as it reflects a different pathological mechanism.

Choice B reason: Flaccid quadriplegia involves complete loss of muscle tone and voluntary movement in all four limbs, typically from spinal cord injury or neuromuscular disorders. The patient’s rigid arm adduction and plantar flexion indicate active muscle contraction, not flaccidity, making this an incorrect descriptor for the observed posture.

Choice C reason: Decorticate rigidity features arm flexion, clenched fists, and extended legs, typically due to cerebral cortex or internal capsule damage above the brainstem. The patient’s arm adduction and foot plantar flexion with internal rotation do not match this pattern, as decorticate posture lacks the internal rotation component.

Choice D reason: Decerebrate rigidity is marked by arm adduction, extension, and internal rotation, with legs extended and feet plantar flexed, as observed. This results from severe brainstem injury below the midbrain, disrupting corticospinal and vestibulospinal tracts, leading to unopposed extensor activity, accurately describing the patient’s posture.

Choice A reason: Deep-vein thrombophlebitis involves deep vein inflammation and clotting, causing pain, swelling, and warmth, but not typically visible dilated veins. The described tortuous veins are superficial, not deep, making this an incorrect diagnosis for the findings.

Choice B reason: Varicose veins are dilated, tortuous superficial veins, often in the lower legs, causing heaviness or aching. These result from venous insufficiency, leading to blood pooling, which matches the patient’s visible veins and symptoms, making this correct.

Choice C reason: Peripheral artery disease causes reduced arterial blood flow, leading to pain, pallor, or claudication, not dilated veins. The visible tortuous veins suggest a venous issue, not arterial, making this an incorrect condition for the findings.

Choice D reason: Chronic lymphedema causes swelling due to lymphatic fluid accumulation, typically without dilated veins. The patient’s tortuous veins and heaviness point to venous pathology, not lymphatic, making this an incorrect diagnosis for the described symptoms.