Appendicitis (10 Questions)

1. Mme. Ginette Roy, 19 years old, is admitted with suspected appendicitis. She has been crying in pain (8/10) and curling up in a fetal position. Suddenly, she rings the call bell and tells the nurse, "I feel so much better! The pain is almost gone."

Medical Orders:
*Appendectomy scheduled for 14:00.
*NPO.
*IV fluids.

Question:
What is the nurse’s priority interpretation and action? *

The appendix has healed spontaneously; cancel the surgery.

The patient was exaggerating her pain; administer Tylenol.

Document the relief and allow the patient to sleep.

The appendix has ruptured; notify the surgeon immediately.

2. M. Pierre Gagnon, 30 years old, is waiting for the surgeon to evaluate his RLQ abdominal pain. He is shivering and asks the nurse, "Can I have a heating pad to put on my stomach? It really hurts."

Medical Orders:
*Monitor vital signs.
*NPO.

Question:
What is the correct nursing response? *

"Yes, heat will help relax the muscles and reduce the cramping."

"I will apply a warm blanket instead of a heating pad."

"I can give you a hot water bottle, but not an electric pad."

"I cannot apply heat to your stomach because it increases blood flow and could cause the appendix to burst."

3. Mme. Claire Bouchard, 45 years old, arrives at triage complaining of abdominal pain and bloating. She states, "I haven't had a bowel movement in 3 days. I think I'm just constipated. Can you give me a laxative or an enema?" The nurse notes tenderness in the RLQ and a low-grade fever.

Medical Orders:
*Abdominal assessment.

Question:
Why is the administration of a laxative or enema contraindicated in this patient? *

It will mask the symptoms of constipation.

It will cause dehydration.

It stimulates bowel motility.

It will interfere with the results of the abdominal CT scan.

4. Mme. Sophie Lemieux, 16 years old, is scheduled for an emergency appendectomy in 2 hours. She tells the nurse, "I am dying of thirst. Can I just have a small glass of orange juice?"

Medical Orders:
*Strict NPO.
*IV Lactated Ringer's.
*Antibiotics on call to OR.

Question:
What is the nurse’s best response? *

"You can have a few sips of clear water only."

"I can give you the juice because the surgery is 2 hours away."

"You must stay NPO; I can moisten your lips with a wet sponge."

"Let me check if the juice is pulp-free; if so, it is okay."

5. M. Sylvain Cote, 50 years old, was admitted for observation of abdominal pain. Two hours later, the nurse reassesses him. M. Cote is lying completely still with his legs flexed. His abdomen feels rigid and board-like, and he has a fever of 39.5°C.

Medical Orders:
*Notify MD of changes.
*Monitor vitals q4h.

Question:
What condition has developed? *

Paralytic Ileus.

Peritonitis.

Gastritis.

Kidney Stone.

6. M. Michel Desjardins, 33 years old, complains of abdominal pain. The nurse pushes fingers deeply and slowly into the RLQ, then quickly releases the pressure. M. Desjardins cries out in pain upon the release of the pressure.

Medical Orders:
*Abdominal assessment.

Question:
What does this finding indicate? *

Cholecystitis.

Peritoneal irritation.

Urinary retention.

Abdominal Aortic Aneurysm.

7. Mme. Valérie Turcotte, 82 years old, is brought to the clinic by her daughter. The daughter states, "She is just not herself. She is confused and isn't eating." The nurse notes a temperature of 37.5°C (low grade) and only mild tenderness in the right lower abdomen.

Medical Orders:
*Urinalysis.
*CBC.
*Abdominal CT.

Question:
Why is the nurse concerned about appendicitis despite the mild symptoms? *

Elderly patients always have high fevers with infection.

Elderly patients often present with vague symptoms.

Appendicitis is more common in the elderly than in children.

Confusion is the primary sign of bowel obstruction.

8. M. André Lemieux, 28 years old, had a laparoscopic appendectomy this morning. He calls the nurse complaining of sharp pain in his right shoulder. His abdominal incisions are well-approximated and dry.

Medical Orders:
*Diet as tolerated.
*Early ambulation.

Question:
What is the nurse’s explanation and intervention? *

"You may have injured your shoulder during the transfer; stay in bed."

"This is referred pain from your heart; I will get an ECG."

"This is caused by the carbon dioxide gas used during surgery; getting up and walking will help your body absorb it."

"This is a sign of infection; I will check your temperature."

9. M. Jacques Tremblay, 22 years old, presents to the Emergency Department. He reports that the pain started around his belly button a few hours ago and has now moved to his lower right side. He is nauseous and has vomited once. Upon palpation, the nurse notes localized tenderness at a specific point halfway between the umbilicus and the anterior superior iliac spine.

Medical Orders:
*NPO.
*IV fluids Normal Saline at 100 mL/hr.
*CBC and Electrolytes.

Question:
The nurse documents tenderness at which anatomical landmark? *

Murphy’s Point.

McBurney’s Point.

The Epigastrium.

The Costovertebral Angle.

10. M. Robert Fortin, 25 years old, is being examined by the nurse. The nurse palpates the Left Lower Quadrant (LLQ) of his abdomen. M. Fortin grimaces and complains of pain in his Right Lower Quadrant (RLQ).

Medical Orders:
*Physical exam.

Question:
How should the nurse document this finding? *

Positive Psoas Sign.

Positive Obturator Sign.

Positive Blumberg’s Sign.

Positive Rovsing’s Sign.