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
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
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason:
Chronic blood loss is a common complication of ulcerative colitis. Inflammation and ulcers in the colon can lead to ongoing bleeding, resulting in iron deficiency anemia.
Choice B reason:
While intestinal malabsorption can occur in some gastrointestinal disorders, it is not a primary mechanism in ulcerative colitis. In ulcerative colitis, the main factor leading to anemia is chronic blood loss.
Choice C reason:
Dietary iron restrictions may exacerbate anemia in individuals with ulcerative colitis, but the primary cause of anemia in this condition is chronic blood loss.
Choice D reason:
Intestinal parasites are not a common factor in ulcerative colitis and are not a primary cause of anemia in this condition. Chronic blood loss is the main contributing factor.
Correct Answer is B
Explanation
Choice A reason:
While thirst can be a sign of dehydration, it is not specific to recurrence of a GI bleed.
Choice B reason:
This is the correct answer. Tachycardia (rapid heart rate), hypotension (low blood pressure), and tachypnea (rapid breathing) are signs of potential recurrence of a GI bleed and should be closely monitored.
Choice C reason:
Diaphoresis (excessive sweating) and sudden onset of abdominal pain could be indicative of various conditions, but they are not specific to recurrence of a GI bleed.
Choice D reason:
Tarry, foul-smelling stools are indicative of melena, which is a sign of a GI bleed. However, in this scenario, the bleeding has been controlled, so this is not an expected sign of recurrence.
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