A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point. (Selectable areas, or "Hot Spots," are outlined in the artwork below. Select only the outlined area that corresponds to your answer.)

Left upper quadrant

Right upper quadrant

Right lower quadrant

Left upper quadrant

Answer and Explanation

The Correct Answer is C

Choice A reason:

McBurney's point is a point on the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus

Choice B reason:

McBurney's point is a point on the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus

Choice C reason:

McBurney's point is a point on the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus

Choice D reason:

McBurney's point is a point on the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus

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Correct Answer is A

Explanation

Choice A Reason:

After a Billroth I procedure, where the stomach is anastomosed directly to the duodenum, some patients may experience diarrhea and feelings of fullness due to the direct passage of food into the small intestine without the buffering effect of the pyloric valve.

Choice B reason:

Gastric reflux and belching are not typically associated with a Billroth I procedure.

Choice C reason:

Persistent feelings of hunger and thirst are not common adverse effects associated specifically with a Billroth I procedure.

Choice D reason:

Constipation or bowel incontinence are not typically associated with a Billroth I procedure, as this surgery involves the upper gastrointestinal tract.

A. Asterixis B. Fetor hepaticus C. Palmar erythema D. Constructional apraxia

Correct Answer is A

Explanation

Choice A reason:

Asterixis is a characteristic sign of hepatic encephalopathy, characterized by a flapping tremor of the hands. It is associated with liver dysfunction and is indicative of impaired ammonia metabolism in the brain.

Choice B reason:

Fetor hepaticus refers to a musty, sweet odor of the breath that is associated with severe liver disease. It is not related to the flapping tremor observed in this case.

Choice C reason:

Palmar erythema is a reddening of the palms and is associated with various conditions, including liver disease. However, it is not the sign described in the scenario.

Choice D reason:

Constructional apraxia is a neurological deficit characterized by difficulty in copying or constructing simple drawings or designs. It is not related to the flapping tremor seen in hepatic encephalopathy.

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A nurse is admitting a client with suspected appendicitis. Identify where the nurse will palpate to assess for pain at McBurney's point. (Selectable areas, or "Hot Spots," are outlined in the artwork below. Select only the outlined area that corresponds to your answer.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient is receiving education about his upcoming Billroth I procedure (gastroduodenostomy). This patient should be informed that he may experience which of the following adverse effects associated with this procedure?

Correct Answer is A

Explanation

A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?

Correct Answer is A

Explanation

A nurse is caring for a patient with hepatic encephalopathy. The nurse's assessment reveals that the patient exhibits episodes of confusion, is difficult to arouse from sleep and has rigid extremities. Based on these clinical findings, the nurse should document what stage of hepatic encephalopathy?

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