# Situation: A 24-year-old woman comes to the emergency department with 14 hours of abdominal pain that began around the umbilicus and has moved to the right lower quadrant (RLQ). Anorexia and nausea started after the pain. Her temperature is 37.9 °C. She is sexually active, uses condoms, and says her last menstrual period, 3 weeks ago, was normal. Imaging to confirm the diagnosis is being planned. Which test should the nurse make sure is done FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630380  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 24-year-old woman comes to the emergency department with 14 hours of abdominal pain that began around the umbilicus and has moved to the right lower quadrant (RLQ). Anorexia and nausea started after the pain. Her temperature is 37.9 °C. She is sexually active, uses condoms, and says her last menstrual period, 3 weeks ago, was normal.

Imaging to confirm the diagnosis is being planned. Which test should the nurse make sure is done FIRST?

## 보기

1. Complete blood count with differential
2. Upright and supine abdominal X-ray
3. Urine or serum pregnancy test **✔ 정답**
4. Urinalysis for white cells and blood

**정답: 3**

## 해설

Every client who could be pregnant needs a pregnancy test before imaging. An ectopic pregnancy can mimic appendicitis and is an emergency, and a positive result changes imaging to ultrasound or MRI instead of CT. Condom use and a recent normal period do not exclude pregnancy, so the test is still done first.

## 심화 해설

The first test to ensure
Before imaging, every client who could be pregnant needs a urine or serum pregnancy test. An ectopic pregnancy can mimic appendicitis and is an emergency, and a positive result changes the imaging choice to ultrasound or MRI instead of CT.

Why pregnancy testing comes first
The client is a 24-year-old sexually active woman with RLQ pain. A ruptured or rupturing ectopic pregnancy can cause lower abdominal pain, nausea, and signs of peritoneal irritation that closely resemble appendicitis, and it can lead to life-threatening hemorrhage. Knowing pregnancy status also protects a possible fetus: computed tomography (CT) involves ionizing radiation, so in a pregnant client ultrasound is used first and MRI may follow if needed. The test is quick and inexpensive, and its result directly changes the diagnostic pathway and the urgency of care.

| Test | Usefulness | Does it decide safe imaging? |
| --- | --- | --- |
| Complete blood count with differential | Shows leukocytosis; not specific | No |
| Upright and supine abdominal X-ray | Not the diagnostic imaging for appendicitis; involves radiation | No |
| Urine or serum pregnancy test | Rules out pregnancy, including ectopic pregnancy | Yes |
| Urinalysis for white cells and blood | Helps exclude urinary causes | No |

Why reported history is not enough
Watch out! The client says she uses condoms and that her last menstrual period, 3 weeks ago, was normal. These details make pregnancy less likely, but they do not exclude it. Condoms can fail, and bleeding from an early or ectopic pregnancy may be mistaken for a normal period. For this reason, standard practice is to test all clients of reproductive age who could be pregnant, regardless of the history, before imaging or procedures that involve radiation or anesthesia.

Why the other tests are not first
A complete blood count often shows leukocytosis in appendicitis, but it is not specific and does not change the choice of imaging. Plain abdominal X-rays are not the diagnostic study for appendicitis and still expose a possible pregnancy to radiation. A urinalysis helps rule out urinary tract infection or stones, which can also cause lower abdominal pain, but it does not decide which imaging is safe. These tests remain part of the workup, but the pregnancy test comes first.

Exam takeaway
Key point! In any client who could be pregnant with abdominal pain, ensure a pregnancy test before imaging. It rules out ectopic pregnancy and determines whether CT or ultrasound and MRI should be used.

## 임상 시나리오

Pregnancy Test Before ImagingRLQ pain in a woman of reproductive age
Anyone who could be pregnant needs a urine or serum pregnancy test before imaging for suspected appendicitis.

An ectopic pregnancy can mimic appendicitis and is an emergency. A positive result changes imaging to ultrasound or MRI instead of CT.

CBC and urinalysis are useful but do not decide safe imaging. Plain X-rays are not diagnostic for appendicitis and add radiation.

CautionCondom use and a recent normal period do not exclude pregnancy. Test before any imaging or procedure involving radiation or anesthesia.

## 핵심 개념

- **Ectopic pregnancy** — A pregnancy implanted outside the uterus, usually in a fallopian tube, which can rupture and bleed.
- **Pregnancy test** — A urine or serum test for human chorionic gonadotropin to detect pregnancy.
- **Computed tomography** — An imaging test using ionizing radiation, avoided when possible in pregnancy.
- **Appendicitis** — Inflammation of the appendix, typically with periumbilical pain that moves to the RLQ.
- **Leukocytosis** — An elevated white blood cell count, common but not specific in appendicitis.

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