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A nurse is assessing a client who complains of left shoulder pain after a recent fall.
Which additional symptoms would support the nurse's suspicion of a splenic injury? Select all that apply.

Abdominal pain.

Headache.

Hypotension.

Tachycardia.

Polyuria.

Wide pulse pressure.

Nausea.

Answer and Explanation

Correct Answer : A,C,D,G

Splenic rupture involves internal hemorrhage and peritoneal irritation. Assessing this requires understanding Kehr sign and signs of hypovolemic shock. Knowledge of hemodynamic parameters and abdominal symptoms is essential to identify occult bleeding and impending cardiovascular collapse following trauma.

Choice A rationale

Splenic injury causes blood to accumulate in the peritoneal cavity, leading to abdominal pain and distension. This irritation of the peritoneum is a hallmark sign of internal organ damage following blunt force trauma to the left side.

Choice B rationale

Headaches are not typically associated with splenic injury unless there is concurrent head trauma. While shock can cause lightheadedness, a primary headache is not a specific or supportive clinical indicator for an isolated splenic laceration or rupture.

Choice C rationale

Hypotension occurs as a result of significant internal bleeding and decreased circulating blood volume. Blood pressure falls below the normal systolic range of 90 to 120 mmHg as the body fails to compensate for acute blood loss.

Choice D rationale

Tachycardia is a compensatory mechanism where the heart rate increases above 100 beats per minute to maintain cardiac output during hemorrhage. It is often one of the earliest signs of volume depletion and internal splenic bleeding.

Choice E rationale

Polyuria, or excessive urination, is not a sign of splenic injury or hypovolemia. In fact, blood loss usually leads to oliguria, where urine output drops below 30 mL per hour as the kidneys conserve fluid and sodium.

Choice F rationale

Wide pulse pressure is often seen in conditions like aortic regurgitation or increased intracranial pressure. Splenic rupture causes hypovolemia, which typically results in a narrow pulse pressure as the systolic pressure falls and diastolic pressure stays.

Choice G rationale

Nausea is a common symptom of peritoneal irritation and the systemic response to acute internal bleeding. The presence of blood in the abdominal cavity can stimulate the vagus nerve and gastrointestinal distress, leading to vomiting or nausea.

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Correct Answer is D

Explanation

This question requires knowledge of acid-base balance and pathophysiology of chronic kidney disease. Understanding how impaired renal function leads to metabolic acidosis through decreased hydrogen ion excretion and reduced bicarbonate regeneration is essential to identify the correct values.

Choice A rationale

A pH of 7.55 and HCO3 of 30 indicate metabolic alkalosis. Normal pH is 7.35 to 7.45 and HCO3 is 22 to 28 mEq/L. Renal failure typically results in acid accumulation, not excess base.

Choice B rationale

A pH of 7.30 and PaCO2 of 50 indicate respiratory acidosis. In renal failure, the lungs typically compensate for metabolic acid by hyperventilating to lower PaCO2, which is the opposite of the hypoventilation shown here.

Choice C rationale

A pH of 7.50 and PaCO2 of 32 indicate respiratory alkalosis. This state occurs when the patient hyperventilates excessively, leading to an alkaline pH, which does not align with the metabolic acidosis expected in renal disease.

Choice D rationale

Chronic kidney disease causes metabolic acidosis. A pH of 7.25 and HCO3 of 19 mEq/L demonstrate low pH and low bicarbonate. The PaCO2 of 30 mm Hg reflects respiratory compensation for the primary metabolic acid-base imbalance.

A. Peaked T-waves. B. Shortened QT interval. C. Widened QRS complex. D. Prolonged QT interval.

Correct Answer is D

Explanation

Assessing electrolyte imbalances in pancreatitis requires understanding how calcium sequestration affects cardiac conduction. Knowledge of cardiac electrophysiology is applied to identify how low serum calcium, typically below 8.5 mg/dL, alters the duration of ventricular depolarization and repolarization.

Choice A rationale

Peaked T-waves are classically associated with hyperkalemia, not hypocalcemia. Hyperkalemia involves potassium levels > 5.0 mEq/L. This ECG change reflects rapid repolarization and is not an anticipated finding for a client experiencing a deficit in calcium.

Choice B rationale

A shortened QT interval is a characteristic finding in hypercalcemia, where serum calcium levels exceed 10.5 mg/dL. Excess calcium accelerates the plateau phase of the action potential, leading to faster ventricular repolarization and a shortened interval.

Choice C rationale

A widened QRS complex is usually seen in hyperkalemia or bundle branch blocks. While severe electrolyte shifts can affect the QRS, it is not the primary or most common ECG manifestation of isolated low calcium.

Choice D rationale

Hypocalcemia slows the entry of calcium into cardiac cells during the plateau phase. This delay lengthens the ST segment and the QT interval. A prolonged QT interval increases the risk for lethal ventricular arrhythmias like Torsades.

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A nurse is assessing a client who complains of left shoulder pain after a recent fall. Which additional symptoms would support the nurse's suspicion of a splenic injury? Select all that apply.

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A nurse is assessing a client who complains of left shoulder pain after a recent fall.
Which additional symptoms would support the nurse's suspicion of a splenic injury? Select all that apply.