It is thought that a client may be experiencing pancreatitis. The nurse exhibits understanding of the assessment process for this pathology by:
1. Placing his or her hand on the lateral surface of the client's flexed right thigh and asking the client to push against the applied resistance.
2. Anticipating that the client's health care provider will order a barium enema.
3. Inquiring with radiology when an endoscopy can be scheduled for the client.
4. After having the client both bend the right knee and flex the right hip, he or she flexes the thigh to a right angle and externally and internally rotates the leg.
Placing his or her hand on the lateral surface of the client's flexed right thigh and asking the client to push against the applied resistance.
Rationale: This option describes the iliopsoas sign test. When this test is positive (produces pain), it indicates an inflammation of the iliopsoas muscle group. Clinically, the iliopsoas has relations to the kidneys, ureters, cecum, appendix, sigmoid colon, pancreas, lumbar lymph nodes, and nerves of the posterior abdominal wall. When there is intra-abdominal inflammation or disease of any of theses structures, movement of the iliopsoas causes pain. Barium enema would enhance intraluminal processes such as colon cancer or diverticular disease. Endoscopy allows the clinician to visualize the intraluminal space of the upper GI tract. The obturator sign (painful external and internal rotation of a flexed hip and thigh) is positive in patients with inflammation along the obturator internus muscle. Positive tests can be related to appendicitis, diverticulitis, and pelvic inflammatory disease.
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