A nurse in an emergency department is assisting a provider who is assessing a client who has suspected appendicitis. Which of the following findings should the nurse expect?

Positive leukocyte esterase

Increased pain upon release of abdominal palpation

WBC 9,500 mm3

Pain from flexion of the left thigh when lying on the right side

Answer and Explanation

The Correct Answer is B

A. Positive leukocyte esterase is a laboratory finding typically identified during a urinalysis to screen for the presence of white blood cells. While this may indicate a urinary tract infection or renal calculi, it is not a diagnostic marker for an inflamed appendix. In appendicitis, the primary biochemical changes are systemic rather than localized to the urinary excretion system. The nurse would not expect this specific finding to confirm a diagnosis of appendiceal inflammation.

B. Increased pain upon the sudden release of deep abdominal palpation is known as rebound tenderness or Blumberg sign. This clinical phenomenon occurs when the parietal peritoneum is irritated due to the inflammatory process of the adjacent appendix. It is one of the most reliable physical examination findings for identifying peritoneal irritation associated with acute appendicitis. The nurse should expect this reaction during the provider's assessment of the right lower quadrant.

C. A white blood cell (WBC) count of 9,500 mm3 falls within the standard physiological reference range for a healthy adult. In a client with acute appendicitis, the nurse would instead expect to see significant leukocytosis, typically exceeding 10,000 to 18,000 mm3. This elevation in the leukocyte count reflects the body's systemic inflammatory response to the localized infection. A normal count like 9,500 mm3 would be atypical for a client with an actively inflamed appendix.

D. Pain from flexion of the left thigh while lying on the right side is not a characteristic sign of appendicitis. The psoas sign, which is associated with appendicitis, involves pain upon extension or flexion of the right thigh, as the appendix sits in the right iliac fossa. Flexing the left thigh does not cause the anatomical tension required to irritate an inflamed appendix. This finding would suggest a different pathology or involve an unaffected anatomical region.

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Correct Answer is C

Explanation

A) Asking the client how she feels about her understanding of diabetes can provide some insight into her confidence and perceived knowledge. However, it does not objectively measure her actual understanding or ability to apply diabetes management information.

B) Asking the client how often she reads food labels assesses a specific behavior related to diabetes management but does not fully evaluate the client's overall health literacy. The frequency of reading food labels may indicate some level of engagement, but it does not necessarily reflect comprehensive understanding or effective diabetes self-management.

C) Requesting the client to explain what she read from a brief handout about diabetes management provides a direct assessment of her comprehension and retention of diabetes management information. This approach effectively measures her ability to understand and apply critical health information, which is a core component of health literacy.

D) Inquiring about the timing of her last HbA1c test assesses adherence to diabetes monitoring but does not gauge the client's understanding of diabetes management. While important, this question does not provide a clear picture of her health literacy or ability to manage her condition effectively.

A. Hyperreflexia B. Diarrhea C. Muscle twitching D. Lethargy

Correct Answer is D

Explanation

A) Hyperreflexia:
Hyperreflexia is typically associated with low calcium levels (hypocalcemia), not elevated levels. An elevated calcium level often results in reduced neuromuscular excitability, leading to diminished reflexes rather than heightened ones.

B) Diarrhea:
Elevated calcium levels are more likely to cause constipation rather than diarrhea. Hypercalcemia often slows gastrointestinal motility, which can lead to decreased bowel movements and constipation.

C) Muscle twitching:
Muscle twitching is generally a symptom of hypocalcemia rather than hypercalcemia. Elevated calcium levels tend to depress neuromuscular activity, making muscle twitching less likely.

D) Lethargy:
Lethargy is a common symptom of hypercalcemia. High calcium levels can depress the central nervous system, leading to symptoms such as fatigue, weakness, confusion, and lethargy. This makes lethargy a likely finding in a client with an elevated total calcium level.

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