A nurse collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at McBurney's point? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
The Correct Answer is "{\"xRanges\":[83.109375,104.109375],\"yRanges\":[119.5,140.5]}"
Draw an imaginary line connecting the ASIS to the umbilicus.
McBurney's point is located one-third of the distance along this line, starting from the ASIS and moving towards the umbilicus.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Wash bed linens in cold water. Washing bed linens in cold water is ineffective for killing pinworm eggs. Hot water should be used to properly sanitize linens and kill the eggs.
B. Clean the bathroom with bleach solution. While cleaning the bathroom with bleach can help reduce contamination, it is not a primary or effective measure for preventing pinworm spread and reinfection in a household setting.
C. Keep children's nails short. Keeping nails short reduces the likelihood of the child scratching the perianal area, where pinworm eggs are deposited, and then ingesting the eggs through hand-to-mouth contact. This helps prevent the spread and reinfection of pinworms.
D. Dress child in loose-fitting underwear. Loose-fitting underwear does not specifically help in preventing the spread or reinfection of pinworms. Tight-fitting underwear may actually be better to prevent the spread of eggs to other surfaces.
Correct Answer is D
Explanation
A. Maintain a saline-lock.Maintaining a saline lock is important for potential intravenous access, but it is not the most urgent priority compared to actions that directly monitor the child's condition and help manage the disease.
B. Parental education is important for long-term management and understanding of the condition, but it is not the most immediate priority in the acute phase of the illness.
C. A no-salt-added diet is important to help manage fluid retention and hypertension, which are common in acute glomerulonephritis. However, while important, it does not take immediate priority over assessing the child's fluid status.
D. Monitoring daily weight is crucial in acute glomerulonephritis, as it helps assess fluid balance and detect early signs of fluid retention or worsening kidney function, which are key concerns in this condition. This makes it a priority action.
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