A nurse is monitoring a client admitted to the hospital with a diagnosis of appendicitis. The client is scheduled for surgery in 2 hours. The client begins to complain of increased abdominal pain and begins to vomit. On assessment the nurse notes that the abdomen is distended and the bowel sounds are diminished. Which of the following is the most appropriate nursing intervention?

Correct Answer: B

Rationale: In this scenario, the most appropriate nursing intervention is to select option B, which is to notify the physician. This is the correct choice because the client is exhibiting signs of a potential complication related to appendicitis, such as increased abdominal pain, vomiting, distended abdomen, and diminished bowel sounds. These symptoms could indicate a worsening condition, such as appendiceal perforation or peritonitis, which require immediate medical attention and possibly a change in the surgical plan. Option A, administering dilaudid, is not the correct choice in this situation because managing pain should not be the priority when the client is showing signs of a potential surgical emergency. Delaying necessary medical intervention by trying to manage pain pharmacologically can lead to serious complications. Option C, calling the operating room team to perform the surgery as soon as possible, is not the most appropriate action because the client's current condition needs to be assessed by the physician before proceeding with surgery. Rushing into surgery without a proper evaluation could be dangerous and lead to unnecessary risks. Option D, repositioning the client and applying a heating pad, is also not the best choice as heat application can potentially worsen the condition if there is an underlying surgical emergency. It is crucial to prioritize medical assessment and intervention over comfort measures in this situation. Educationally, this scenario highlights the importance of recognizing early signs of complications in patients with appendicitis and the significance of prompt communication with the healthcare team. It emphasizes the critical role of nursing assessment in identifying changes in a patient's condition and advocating for appropriate medical intervention to ensure patient safety and optimal outcomes.

Correct Answer: A

Rationale: In this scenario, the correct answer is option A) Lying supine with the legs straight. The rationale behind this is that maintaining a supine position with the legs straight can exacerbate abdominal pain in clients with Crohn's disease due to increased intra-abdominal pressure and potential strain on the abdomen. Option B) Massaging the abdomen can actually help alleviate some abdominal discomfort by promoting relaxation and aiding in easing muscle tension. Option C) Using antispasmodic medication may be appropriate for managing abdominal pain in Crohn's disease by reducing spasms in the intestines. Option D) Using relaxation techniques such as deep breathing or guided imagery can be beneficial in managing pain and stress associated with Crohn's disease. In an educational context, it is crucial for nursing students to understand the specific needs of clients with Crohn's disease and how certain interventions can either alleviate or worsen their symptoms. Teaching clients to avoid positions or activities that can exacerbate their pain is essential in their overall management and quality of life.

Correct Answer: D

Rationale: The correct answer is D: Steady. The pain associated with appendicitis is typically constant and steady, especially in the lower right quadrant of the abdomen. It is not described as aching (choice A) because it is more persistent and severe than a dull ache. It is not fleeting (choice B) as appendicitis pain tends to worsen over time. It is also not intermittent (choice C) as the pain is continuous and does not come and go.

Correct Answer: D

Rationale: The correct answer is D: Assessing for symptoms of peritonitis. This intervention is crucial in managing a client with appendicitis because it indicates a possible rupture of the inflamed appendix. Symptoms of peritonitis include severe abdominal pain, fever, nausea, vomiting, and abdominal rigidity. Prompt recognition of these symptoms is essential for timely intervention and surgical management. Choices A, B, and C are incorrect because while assessing for pain is important, assessing for symptoms of peritonitis takes precedence due to the critical nature of appendicitis. Encouraging oral intake of clear fluids and providing discharge teaching are not immediate priorities in the management of a client with acute appendicitis.

Correct Answer: C

Rationale: The correct answer is C: 'Inflammation of the gastric mucosa.' Gastritis is characterized by inflammation of the stomach lining, specifically the gastric mucosa. This inflammation can be caused by various factors such as infections, medications, alcohol, or autoimmune diseases. Choice A, 'Erosion of the gastric mucosa,' is incorrect because erosion refers to the wearing away of tissue rather than inflammation. Choice B, 'Inflammation of a diverticulum,' is incorrect because gastritis specifically involves inflammation of the stomach lining, not a diverticulum. Choice D, 'Reflux of stomach acid into the esophagus,' describes gastroesophageal reflux disease (GERD), which is different from gastritis.