A nurse is reinforcing teaching with the guardians of a child who has a new diagnosis of Duchenne muscular dystrophy about passive range of motion exercises to prevent contractures. Identify the joint the nurse should use to demonstrate joint hyperextension. (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)

Rationale for correct choices

• Right upper quadrant abdominal pain rated 7/10: Severe pain in the right upper quadrant may indicate acute cholecystitis, cholangitis, or hepatitis, which can rapidly progress if untreated. The intensity and location of pain require immediate evaluation and possible imaging or intervention.

• Abdominal distention and feeling of fullness: These symptoms can signal biliary obstruction or gastrointestinal compromise. When present with severe pain, nausea, and elevated WBC, they support the need for urgent assessment and diagnostic testing.

• Manifestations worsened after a large meal: Pain or discomfort exacerbated by food intake is a key indicator of hepatobiliary or gastrointestinal pathology, such as gallstones or gastritis, requiring prompt evaluation.

• Nausea: Persistent nausea, especially with abdominal pain and distention, may indicate acute inflammation, obstruction, or infection, warranting timely intervention to prevent further complications.

• Appears restless: Restlessness may be an early sign of pain, hypoxemia, infection, or worsening metabolic state, indicating the client’s condition is unstable and needs rapid assessment.

Rationale for incorrect choices

• Skin turgor less than 2 seconds: Mild dehydration is present but not an immediate threat; it can be corrected with IV fluids and ongoing monitoring.

A. Plan a time at the end of the shift to document nursing interventions: Waiting until the end of the shift to document can lead to incomplete or inaccurate records. Timely documentation throughout the shift ensures accuracy and supports continuity of care.

B. Keep track of how long it takes to complete certain tasks: Monitoring task duration helps the nurse identify which activities take longer than expected, allowing for better planning and adjustment of the workflow to maximize efficiency.

C. Complete activities with one client before moving to another client: Focusing solely on one client at a time can reduce efficiency, especially if tasks can be batched or delegated. Prioritizing multiple clients based on acuity is a more effective time-management strategy.

D. Make a priority to-do list at the beginning of the shift: Creating a prioritized list helps the nurse identify urgent and important tasks, organize the workflow, and ensure that critical interventions are completed on time.

E. Delegate collection of vital signs to the assistive personnel on the team: Delegating routine tasks, such as vital signs, allows the nurse to focus on higher-level assessments and interventions, optimizing time and ensuring safe, efficient care delivery.