In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change.

Epigastrium

Umbilical

Flank

Subumbilical

Answer and Explanation

The Correct Answer is B

Rationale:
A. Epigastrium refers to the upper central region of the abdomen, just below the sternum; Cullen’s sign does not appear here.
B. Umbilical region (around the navel) is where Cullen’s sign appears as a bluish discoloration due to subcutaneous fat necrosis or retroperitoneal bleeding associated with acute pancreatitis. This is the correct site.
C. Flank discoloration is known as Grey Turner’s sign, another indicator of retroperitoneal bleeding, but distinct from Cullen’s sign.
D. Subumbilical refers to the area below the umbilicus, not the typical site for Cullen’s sign.

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Correct Answer is C

Explanation

Rationale:
A. Pain assessment is important but not the immediate priority following an EGD. Discomfort is expected after the procedure, yet it does not pose the greatest risk to airway safety.

B. Nausea should be monitored, especially since sedation and irritation of the upper GI tract can cause vomiting, but this is not the most critical concern immediately after the procedure.

C. The gag reflex must be assessed first because topical anesthetics used during the EGD suppress the swallowing and protective airway reflexes. If oral fluids or food are given before the gag reflex returns, the client is at high risk for aspiration, which can lead to pneumonia or airway obstruction. Ensuring the gag reflex has returned is the priority safety measure before advancing the diet or giving oral medications.

D. Level of consciousness should also be assessed, since sedatives are commonly used during the procedure. However, the risk of aspiration from an absent gag reflex presents a more immediate threat to life and therefore takes priority.

A. Petechiae B. Peripheral ulcers C. Osteoarthritis D. Hypertension

Correct Answer is A

Explanation

Rationale:
A. Petechiae are small, red or purple spots caused by capillary bleeding and are common in advanced cirrhosis due to thrombocytopenia and coagulation defects.
B. Peripheral ulcers are not typically associated with cirrhosis.
C. Osteoarthritis is a degenerative joint condition unrelated to liver disease.
D. Hypertension is not a hallmark of advanced cirrhosis; portal hypertension may occur, but systemic hypertension is not expected.

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In reviewing the medical record for a patient admitted with acute pancreatitis, the nurse sees that the patient has a positive Cullen's sign. Indicate the area in the accompanying figure where the nurse will assess for this change.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client following an esophagogastroduodenoscopy (EGD) procedure. Which of the following assessments is the nurse's priority?

Correct Answer is C

Explanation

A nurse is assessing a client who has advanced cirrhosis. Which of the following manifestations should the nurse expect?

Correct Answer is A

Explanation

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