While assessing a client's abdomen, the nurse observes sharp pains and involuntary reflex guarding on expiration. What complication does the nurse suspect based on these findings?

Malignancy

Aneurysm

Hernia

Peritonitis

Answer and Explanation

The Correct Answer is D

A. Malignancy can cause abdominal pain, but it does not typically present with acute sharp pain and involuntary guarding.
B. Aneurysms, particularly abdominal aortic aneurysms, may present with a pulsatile mass and deep, dull pain rather than sharp pain and guarding.
C. Hernias can cause pain, but they typically present with a bulging mass that increases with straining, not sharp pain with reflex guarding.
D. Peritonitis is correct because it causes severe abdominal pain, involuntary guarding, and rebound tenderness due to inflammation of the peritoneum. Reflex guarding is a protective mechanism indicating peritoneal irritation.

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Correct Answer is C

Explanation

A. The right lung is larger than the left to accommodate the heart’s position, but it is not precisely one third larger.
B. The lower lobes of both lungs are primarily located toward the posterior chest wall, not the anterior. When auscultating breath sounds in the lower lobes, the nurse should focus on the posterior thorax.
C. The right lung has three lobes (upper, middle, and lower), while the left lung has two lobes (upper and lower). This anatomical difference is important for respiratory assessment and auscultation.
D. The lungs are not structurally symmetrical; the left lung is smaller due to the cardiac notch. While there are minor functional differences, the primary distinction is anatomical.

A. Thinning of the vertebral discs leads to weight loss. B. An increase in lean body mass leads to weight gain. C. Spinal kyphosis contributes to the increase in body weight. D. Loss of muscle tissue contributes to the decrease in weight.

Correct Answer is D

Explanation

A. Thinning of the vertebral discs leads to a decrease in height, not weight.
B. Lean body mass actually decreases with aging, contributing to weight loss rather than gain.
C. Spinal kyphosis affects posture but does not significantly contribute to changes in body weight.
D. Loss of muscle tissue (sarcopenia) is correct because aging leads to a decline in muscle mass, which contributes to weight loss. Additionally, a slower metabolism and reduced physical activity further affect body composition.

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While assessing a client's abdomen, the nurse observes sharp pains and involuntary reflex guarding on expiration. What complication does the nurse suspect based on these findings?

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

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