A nurse in a community clinic is caring for a client who requests assistance with smoking cessation. The nurse should expect a prescription for which of the following medications?

Rationale:

A. Rolls from back to side: This is typically the first gross motor milestone among the listed options and usually occurs around 4 months of age. It marks early trunk and upper body control development.

B. Rolls from back to abdomen: Rolling from back to abdomen requires more strength and coordination and generally occurs around 5 to 6 months of age, following the ability to roll to the side.

C. Sits steadily unsupported: Infants begin sitting without support around 7 to 8 months, once they develop adequate trunk and head control. This milestone represents a major progression in balance and posture.

D. Changes from prone to sitting: Transitioning from a prone to a sitting position typically develops around 9 to 10 months. It involves coordinated control of the arms, trunk, and legs and reflects advanced gross motor skill development.

Rationale:

• Bloody stools: Bloody stools are not a typical finding in either acute pancreatitis or peritonitis. They are more commonly associated with lower GI pathologies such as diverticulosis, hemorrhoids, or inflammatory bowel disease. Their absence here does not support either condition.
• Hyperbilirubinemia: Hyperbilirubinemia (total bilirubin 3.7 mg/dL) may occur with pancreatitis, especially if there is biliary obstruction due to inflammation or gallstones. Obstructed bile flow leads to accumulation of bilirubin, causing jaundice as seen in this client’s yellow sclera and palate.
• Elevated WBC count: Leukocytosis (WBC 18,000/mm³) is a systemic inflammatory response commonly seen in both acute pancreatitis and peritonitis. In pancreatitis, this reflects the inflammatory process of autodigestion of the pancreas. In peritonitis, it reflects infection and inflammation of the peritoneal cavity.
• Abdominal pain: Severe abdominal and epigastric pain radiating to the back is classic for acute pancreatitis. Peritonitis can also cause diffuse abdominal pain with guarding and rigidity, particularly when the peritoneum becomes inflamed. The pain in peritonitis often worsens with movement, while pancreatitis pain may worsen with eating or lying flat.