NORCET-11 Mains: A client comes in with suspected acute cholecystitis. Which abdominal finding most strongly supports the diag…

NORCET-11 Mains

Medical & Surgical Nursing

Easy

Appeared in: NORCET-11 Mains

Explanation

This option describes a positive Murphy's sign, the most specific physical examination finding for acute cholecystitis.
The maneuver involves pressing on the right upper quadrant (RUQ) at the location of the gallbladder.
As the patient inhales deeply, the diaphragm pushes the inflamed gallbladder down onto the examiner's fingers, causing a sharp increase in pain and a sudden stop in inspiration (inspiratory arrest).
This response is due to the inflamed parietal peritoneum over the gallbladder coming into contact with the examiner's hand.
According to Harrison's Principles of Internal Medicine, this sign is a key component in diagnosing acute cholecystitis, along with RUQ tenderness, fever, and leukocytosis.

Option A: This describes rebound tenderness (Blumberg's sign), which indicates peritoneal inflammation (peritonitis). While a ruptured gallbladder can cause peritonitis, this sign is not specific to cholecystitis and can be seen in many other conditions like appendicitis or a perforated ulcer.
Option B: This describes Rovsing's sign. It is a sign of appendicitis, where pressure on the left lower quadrant stretches the peritoneum, causing pain at the site of inflammation in the right lower quadrant.
Option D: This describes Cullen's sign, which is indicative of retroperitoneal hemorrhage. It is caused by the tracking of blood from the retroperitoneum to the subcutaneous tissues around the umbilicus.

Clinical Relevance

Nursing practice connection: Use the key finding related to Physical assessment findings in acute cholecystitis to guide bedside assessment, documentation, and the next nursing action.
Nurses must be proficient in performing and interpreting these abdominal assessments to help differentiate between various acute abdominal conditions and to promptly report significant findings.
A positive Murphy's sign is a critical finding that warrants immediate notification of the physician, as it strongly suggests acute cholecystitis which may require urgent surgical intervention.
Patient Safety: Once a positive sign (like Murphy's or rebound tenderness) is elicited, the area should not be repeatedly or deeply palpated to avoid causing unnecessary pain or potentially rupturing an inflamed organ.

How to Approach the Question

First, identify the core condition mentioned in the stem: 'acute cholecystitis'.
Recall the classic physical assessment findings associated with this condition. For cholecystitis, the key sign is Murphy's sign.
Read each option carefully and identify the clinical sign it describes.
Option A describes rebound tenderness (Blumberg's sign). Option B describes Rovsing's sign. Option C describes Murphy's sign. Option D describes Cullen's sign.
Match the described signs to their associated conditions. Murphy's sign is for cholecystitis, Rovsing's for appendicitis, Blumberg's for peritonitis, and Cullen's for hemorrhage.
Select the option that describes the sign most specific to the suspected diagnosis of acute cholecystitis.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 2 pp. 636-638, 499-501

E6 Medicine Harrison 22e Part 1 p. 153-155