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) Place a sign on the client's door indicating visual impairment:
While indicating the client’s visual impairment to staff can be helpful, privacy and dignity should also be considered. Alternative methods to inform the staff without compromising the client's privacy should be used.

B) Provide the client with a brightly colored plate and utensils:
Brightly colored plates and utensils can help clients with partial vision impairment but may not be significantly beneficial for those who are fully visually impaired.

C) When ambulating with the client, grasp the client's arm above the elbow:
Grasping the client's arm above the elbow is an effective way to guide a visually impaired person. This allows the client to follow the nurse's movements more naturally and ensures better support and guidance.

D) Speak in an elevated tone of voice when providing care:
Elevating the tone of voice is unnecessary and may be misinterpreted as condescending. Clear, normal, and respectful communication is essential for all clients, regardless of visual impairment.

A. It manifests as a sense of relief upon the loved one's death. B. It causes a prolonged grief response to occur. C. It occurs when the loss of a loved one cannot be shared openly. D. It remains difficult to process due to a lack of finality.

Correct Answer is B

Explanation

A) It manifests as a sense of relief upon the loved one's death: This describes a possible outcome of anticipatory grief but does not define anticipatory grief itself. While relief can be a reaction, it is not the core characteristic of anticipatory grief.

B) It causes a prolonged grief response to occur: Anticipatory grief involves experiencing grief before the actual loss occurs. This process can sometimes lead to a prolonged grief response, as individuals might go through stages of grief before and after the loss.

C) It occurs when the loss of a loved one cannot be shared openly: This describes disenfranchised grief, which happens when the loss is not socially acknowledged or supported. Anticipatory grief occurs prior to the loss, not due to a lack of social support.

D) It remains difficult to process due to a lack of finality: While anticipatory grief can be challenging due to ongoing uncertainties and emotional strain, it is not primarily defined by a lack of finality. The grief occurs as individuals anticipate the impending loss.

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