The nurse should use which location for eliciting deep tendon reflexes?

Choice A rationale

Administering medication on an empty stomach generally promotes faster absorption due to several physiological factors. Without food, gastric emptying time is significantly reduced, meaning the drug spends less time in the stomach and moves more quickly into the small intestine, which is the primary site for nutrient and drug absorption. Furthermore, the absence of food also minimizes potential drug-food interactions that could chelate or bind the drug, thereby decreasing its bioavailability and absorption rate.

Choice B rationale

Enzymes in the colon primarily function in the digestion of undigested food components, particularly complex carbohydrates, through microbial fermentation. While some drug metabolism can occur via colonic microbiota, the colon is not a primary site for drug absorption, and enzymatic activity in the colon is not the main factor influencing the absorption rate of orally administered medications, especially in the initial stages after ingestion.

Choice C rationale

Taking a drug on an empty stomach typically accelerates absorption, not slows it. Food in the stomach can delay gastric emptying, dilute the drug concentration, and create a physical barrier that impedes contact with the absorptive surfaces of the gastrointestinal tract. Therefore, the presence of food is more likely to slow absorption.

Choice D rationale

Pancreatic enzymes, such as amylase, lipase, and proteases, are secreted into the duodenum to aid in the digestion of carbohydrates, fats, and proteins, respectively. While these enzymes can interact with certain drugs, particularly protein-based medications, they are primarily involved in digestion rather than direct neutralization of most orally administered drugs in a manner that would significantly alter absorption on an empty stomach.

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.