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which developmental stage is Jean Piagets first stage of cognitive development?

sensorimotor rationale Jean Piagets first stage of cognitive development is the sensorimotor stage (birth to 2 years) the preoperational sage is the second stage (2 to 7 years of age) the concrete operational stage is the third stage (7 to 11 years of age) the formal operational stage is the fourth stage (11 years of age to adulthood)

the nurse is assessing the pain in a 3-year-old child after an appendectomy. which pain scale should the nurse use

FACES pain rating scale rationale there is a pain-rating tool identified with children as young as a neonate. because the child in this question is 3 years old, the recommended pain scale is the FACES pain scale, which can be used with children as young as 3 years of age. the numeric scale is used with children who can count to 100 by ones. the poker child tool is used beginning with children who are 4 years old

the nurse is reinforcing instructions for a client in how to perform a testicular self-examination (TSE) the nurse explains that which is the best time to perform this exam?

a) after a shower or bath rationale the nurse needs to teach the client how to perform a testicular self-examination (TSE) the nurse should instruct the client to select a day of the month and perform the exam on the same day each month. the nurse should also instruct the client that the best time to perform a TSE is after a shower or bath when the hands are warm and soapy and the scrotum is warm. this will provide ease in palpating, and the client will be better able to identify any abnormalities. the client would stand to perform the exam, but it would be difficult to perform the exam while voiding. having a bowel movement is unrelated to performing the TSE

the nurse prepares to take a blood pressure on a school-age child. where should the nurse place the blood pressure cuff to obtain an accurate measurement?

c) two thirds the distance between the antecubital fossa and the shoulder rationale the size of the BP cuff is important. cuffs that are too small will cause falsely elevated values and those that are too large will cause inaccurate low values. the cuff should cover two thirds the distance between the antecubital fossa and the shoulder

the nurse in the pediatric unit is admitting a 2-year-old child. the nurse plans care, knowing that the child is in which stage of erikson's psychosocial stage of development

d) autonomy vs shame and doubt rationale a 2-year-old child, a toddler, is in the autonomy vs shame and doubt stage. in this stage, the toddler develops a sense of control over the self and bodily functions and exerts him or herself. trust vs mistrust characteristics the stage of infancy. initiative vs guilt characterizes the preschool age. industry vs inferiority characterizes the school-age child.

according to erikson's psychosocial developmental theory, the nurse should anticipate a 5-year-old child to be in which stage

initiative vs guilt rationale a 5-year-old child would be expected to be experiencing Erikson's psychosocial stage of initiative versus guilt (late childhood, 3 to 6 years)

the parents of an 8-year-old child tell the nurse that they are concerned about the child because the child seems to be more attentive to friends than anyone else. which is the appropriate nursing response?

at this age, the child is developing his or her own personality rationale according to Erikson, at ages 7 to 12 years, the child begins to move forward receiving support from peers and friends and away from that of parents. the child also begins to develop special interests that reflect his or her own developing personality instead of those of the parents.

the nurse is reinforcing instructions to a 16-year-old male adolescent regarding dietary patterns. the nurse instructs the adolescent about the recommended amount of daily calories. how many calories a day does the nurse recommend as the approximate daily caloric allowance for a male adolescent?

c) 2200 rationale the recommended amount of daily calories for a male adolescent between the ages of 15 and 18 years is 2200.

the nurse is providing instructions to a new parent regarding the psychosocial development of the infant. using Erikson's pyschosocial development theory, which instruction should the nurse reinforce to the parents?

a) allow the infant to signal a need rationale according to Erikson, the caregiver should not try to anticipate the infant's needs at all times but rather allow the infant to signal his or her needs. if an infant is not allowed to signal a need, he or she will not learn how to control the environment. erikson believed that a delayed or prolonged response to an infant's signal would inhibit the development of trust and lead to the mistrust of others.

a 6-year-old is hospitalized with a fracture of the femur and is placed in traction. in meeting the psychosocial needs of the child, the nurse most appropriately selects which play activity for the child

a) board game rationale the school-age child becomes organized, with more direction in play activities. school-age children's interests include collections, drawing, construction, dolls, pets, guessing games, board games, riddles, hobbies, competitive games, and listening to the radio or television.

which describes lawrence kohlbergs first level of moral development?

a) children determine the goodness or badness of an action in terms of the consequences rationale kohlberg's first level of moral development is the preconventional stage in which children determine the goodness or badness of an action in terms of the consequences.

which toy is age-appropriate for a 1-month old child?

b) nursery mobile rationale the nursery mobile is recommended for a 1-month-old child because it provides visual stimulation. if it is a musical mobile, it also serves the purpose of providing auditory stimulation.

which are components of Kohlberg's theory of moral development? select all that apply

moral development progresses in relation to cognitive development // a person's ability to make moral judgments develops over a period of time // the theory provides a framework for understanding how individuals determine a moral code to guide their behavior // in stage 2 (instrumental relativist orientation), the child conforms to rules to obtain rewards or to have favors returned rationale kohlbergs theory states that individuals move through the six stages of development in a sequential fashion but not everyone reaches stages 5 and 6 during his or her development of personal morality. the theory provides a framework for understanding how individuals determine a moral code to guide their behavior. it also states that moral development progresses in relation to cognitive development and a person's ability to make moral judgments develops over a period of time. in stage (ages 2 and 3 years; punishment-obedience orientation) children cannot reason as mature members of society because they are too young to do so. in stage 2 (ages 4 to 7 years; instrumental relativist orientation) the child conforms to rules to obtain rewards or have favors returned

which developmental stage is Jean Piaget's first stage of stage of cognitive development

sensorimotor rationale Jean Piaget's first stage of cognitive development is the sensorimotor stage (birth to 2 years) the preoperational stage is the second stage (2 to 7 years of age) the concrete operational stage is the third stage (7 to 1 years of age) the formal operational stage is the fourth stage (11 years of age to adulthood)

the nurse is checking a dark-skinned client for the presence of petechiae. which body area is best for the nurse to check in this client?

b) oral mucosa rationale in a dark-skinned client, petechiae are best observed in the conjunctivae and oral mucosa. cyanosis is best noted on the palms of the hands and soles of the feet. jaundice would be best noted in the sclera of the eye

the nurse is assessing a 36-month-old child during a wellness visit to the pediatrician. the child weights 43 pounds and is 41 inches tall. after plotting the measurements on the standardized growth charts for a 36-month-old, which should the nurse do next?

a) assess the parents body shape and stature rationale the most prominent feature of childhood and adolescents is physical growth. birth weight for infants doubles in 4 to 7 months and triples by the end of the first year of life. weight quadruples by the end of the second year, and then slows to a steady annual rate of 4.4 to 6 pounds (2.09 to 2.73 kg) of weight gain per year until the adolescent growth spurt. the average weight for a 3-year-old is 32 pounds (14.6 kg) growth in height remains steady at a yearly increase of 2 1/2 to 3 inches (6.75 to 7.5 cm). the average height for a 3-year-old is 37 1/4 inches (95 cm) this child is above the 100th percentile for height and weight when plotted on the growth charts for both male and female. a strong correlation exists between parent and child with regard to traits such as height, weight and rate of growth. most physical characteristics, including shape and form of features, body build, and physical peculiarities are inherited and influence the way in which children grow and interact with their environment. therefore, the nurse should assess the parents characteristics for tall, well-proportioned adults. adequate nutrition is closely related to growth and good health. however, this child is proportional for height and weight. there is no evidence that this child is obese. the child is above the 100th percentile on growth charts so further assessment is warranted. counseling on appropriate physical acitivites and exercise is an appropriate part of wellness education but does not relate to this child's weight and height

a 4-year-old child diagnosed with leukemia is hospitalized for chemotherapy. the child is fearful of the hospitalization. which nursing intervention should the nurse suggest to alleviate the child's fears?

a) encourage the child's parents to stay with the child rationale although the preschooler may already be spending some time away from parents at a day care center or preschool, illness adds a stressor that makes separation more difficult. the child may repeatedly ask when parents will be coming for a visit or may constantly want to call the parents.

the parent of a 4-year-old child expresses concern because her hospitalized child has started sucking his thumb. the mother states that this behavior began 2 days after hospital admission. which is the appropriate nursing response?

a) it is best to ignore the behavior rationale in the hospitalized preschooler, it is best to accept regression if it occurs, because it is most often caused by the stress of the hospitalization. parents may be overly concerned about regression and should be told that their child may continue the behavior at home. there is no need to call the HCP.

the parent of a 4-year-old child expresses concern because her hospitalized child has started sucking his thumb. the mother states that this behavior began 2 days after hospital admission. which is the appropriate nursing response.

a) it is best to ignore the behavior rationale in the hospitalized preschooler, it is best to accept regression if it occurs, because it is most often caused by the stress of the hospitalization. parents may be overly concerned about regression and should be told that their child may continue the behavior at home. there is no need to call the HCP.

upon palpation of the fontanel of a 3-month-old newborn, the nurse notes that the anterior fontanel has not closed and is soft and flat. which action should the nurse take?

b) document the findings rationale the anterior fontanel is diamond shaped and located on the top of the head. it should be soft and flat in a normal infant, and it normally closes by 12 to 18 months of age. the posterior fontanel closes by 2 to 3 months of age. therefore, because the findings are normal, the nurse should document the findings.

according to Erikson's pyschosocial development theory, the nurse anticipate an adolescent to be in which stage?

identity vs role confusion rationale an adolescent (12 to 20 years) would be expected to be experiencing Erikson;s psychosocial stage of identity vs role confusion. erikson's psychosocial stage of initiative vs guilt occurs in late childhood (3 to 6 years) industry vs inferiority occurs during school-age years (6 to 12 years) autonomy vs shame and doubt occurs during toddlerhood (early childhood, 18 months to 3 years)

the nurse is caring for a 14-year-old boy who is hospitalized and placed in Crutchfield traction. the child is having difficulty adjusting to the length of the hospital confinement. which nursing action would be appropriate to meet the child's needs?

a) let the child war his own clothing when friends visit rationale adolescents need to identify with their peers and have a strong need to belong to a group. they like to dress like the group and wear similar hairstyles . because crutchfield traction uses skeletal pins, hair dye is not appropriate. the boy should be allowed to wear his own clothes to feel a sense of belonging to the group. loud music may disturb others in the hospital. the boy's request for a darkened room is indicative of a possible problem with depression that may need further evaluation and intervention

the nurse employed in a well baby clinic is collecting data on the language and communication developmental milestones of a 4-month-old infant. based on the age of the infant, the nurse expects to note which highest level of development milestones

c) babbling sounds rationale babbling sounds are common between the ages of 3 and 4 months. additionally during this age, crying becomes more differentiated. between the ages of 1 and 3 months, the infant will produce cooing sounds. an increased interest in sounds occurs between 6 and 8 months, and the use of gestures occurs between 9 and 12 months.

the nurse is collecting medication information from a client and the client states that she is taking garlic as an herbal supplement. the nurse understands that the client is most likely treating which condition

d) hyperlipidemia rationale garlic is an herbal supplement that is used to treat hyperlipidemia and hypertension. an herbal supplement that may be used to treat eczema is evening primrose. insomnia has been treated with both valerian root and chamomile. migraines have been treated with feverfew.

the nursing instructor asks a nursing student to describe the formal operations stage of Piaget's cognitive developmental theory. the appropriate response by the nursing student is which?

a) the child has the ability to think abstractly rationale in the formal operations stage, the child has the ability to think abstractly and solve problems.

the nurse is asked to test the visual acuity of a client using a Snellen chart. the nurse prepares to perform the test, knowing that which identifies the accurate procedure for this visual acuity test?

a) the right eye is tested, followed by the left eye, and then both eyes are tested rationale visual acuity is tested in one eye at a time, and then in both eyes together, with the client comfortably seated. begin with the right eye while the left eye is covered, and then test the left eye with the right eye covered followed by testing both eyes together. visual acuity is measured with or without corrective lenses, with the client standing at a distance of 20 feet from the chart

the clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold, cough, and lung congestion, which should the nurse include for this type of data collection?

auscultating lung sounds // obtaining clients temperature // obtaining information about the clients respirations rationale a focused data collection process focuses on a limited or short-term problem, such as the client's complaint. because the client is complaining of symptoms of a cold, a cough and lung congestion, the nurse would focus on the respiratory system and the presence of an infection. a complete data collection includes a complete health history and physical examination and forms a baseline database. checking the strength of peripheral pulses relates to a vascular assessment, which is not related to this client's complaints. a musculoskeletal and neurological examination also is not related to this client's complaints. however, strength of peripheral pulses and a musculoskeletal and neurological examination would be included in a complete data collection likewise, asking the client about a family history of any illness or disease would be included in a complete assessment

an LPN is assisting a high school nurse in conducting a session with female adolescents regarding the menstrual cycle. the LPN tells the adolescents that the normal duration of the menstrual cycle is about how many days?

b) 28 days rationale the normal duration of the menstrual cycle is about 28 days, although it may range from 20 to 45 days. significant deviations from the 28-day cycle are associated with reduced fertility. the first day of the menstrual period is counted as day 1 of the woman's cycle

the nurse is preparing to assist the HCP to test the extraocular movements in a client for muscle weakness in the eyes. the nurse anticipates that which physical assessment technique will be done to assess for muscle weakness in the eye?

c) testing the six cardinal positions of gaze rationale testing the six cardinal positions of gaze is done to check for muscle weakness in the eyes. the client is asked to hold the head steady, then to follow movement of an object through the positions of gaze. the client should follow the object in a parallel manner with two eyes. a Snellen eye chart checks visual acuity and cranial nerve II (optic) testing sensory function by having the client close his or her eyes and then lightly touching areas of the face and testing the corneal reflexes check cranial nerve V (trigeminal)

the nurse provides information to the mother of a toddler regarding toilet-training. the nurse should tell the mother what information?

the child should not be forced to sit on the potty for long periods // the ability of the child to remove clothing is a sign of physical readiness // waiting until the child is 24 to 30 months old makes the task considerably easier // at the age of 24 to 30 months old, the toddler is usually less negative and more willing to control their sphincters to please their parents rationale waiting until the child is 24 to 30 months old makes the task considerably easier because toddlers of this age are less negative and usually more willing to control their sphincters to please their parents. bowel control typically occurs before bladder control. the child should not be forced to sit for long periods. the ability to remove clothing is one of the physical signs of readiness.

which observation indicates that the nurse is performing a whispered voice hearing assessment test procedure correctly?

b) asks the client to block one ear at a time rationale in a voice test, the nurse, while facing the client, stands 1 to 2 feet away and asks the client to block one external ear canal. the nurse quietly whispers a statement and asks the client to repeat it. each ear is tested separately. although closing the eyes would prevent lip reading, it is not a condition of the screening

the nurse employed in the emergency department is collecting data on a 7-year-old child with a fractured arm. the child is hesitant to answer questions that the nurse is asking and consistently looks at the parents in a fearful manner. the nurse suspects physical abuse and continues with the data collection procedures. which finding would most likely assist in verifying the suspicion?

b) bald spots on the scalp rationale bald spots on the scalp are most likely to be associated with physical abuse. the most likely findings in sexual abuse include difficulty walking or sitting; torn, stained, or bloody underclothing; pain; swelling or itching of the genitals; and bruises, bleeding or lacerations in the genital or anal area. poor hygiene may be indicative of physical neglect

which statement by a nursing student about kohlberg's theory of moral development indicates the need for further teaching about the theory?

individuals move through all six stages in a sequential fashion rationale kohlberg's theory states that individuals move through the six stages of development in a sequential fashion but that not everyone reaches stages 5 or 6 as part of their development of personal morality.

the nursing student is preparing a conference on Freud's psychosexual stages of development, specifically the anal stage. which appropriately relates to this stage?

b) beginning of toilet training rationale toilet training generally occurs during this period. according to freud, the child gains pleasure from both elimination and retention of feces.

the nurse has reinforced information to the mother of a toddler regarding toilet training. which statement by the mother would indicate a need for further teaching?

b) i should have my child sit on the potty until my child urinates rationale the mother should wait until the child is 24 to 30 months old because this makes the task of toilet training considerably easier. toddlers of this age are less negative and usually are more willing to control their sphincters to please their parents. bowel control is usually achieved before bladder control. the child should not be forced to sit on the potty for long periods. the ability to sit, squat, and walk well are physical signs of readiness.

according to kohlberg's theory of moral development at the preconventional level, moral development is thought to be motivated by which factor?

d) punishment and reward rationale in the preconventional level, morals are thought to be motivated by punishment and reward. if the child is obedient and not punished, then he or she is being moral. the child sees actions as either good or bad. if the child's actions are good, then the child is praised. if the child's actions are bad, then the child is punished.

according to Freud's theory of personality development, which statement best describes the phallic stage?

c) children recognize differences between males and females rationale Freud's phallic stage of development includes the recognition of differences between the sexes.

when reinforcing appropriate developmental skills interventions for a 1-year-old child who was born 2 months premature, the nurse should plan to encourage the parents to support the child to achieve which developmentally appropriate goal?

a) sit independently rationale for premature infants, calculate the developmental age by deducting the time of prematurity from the age of the child until reaching the age of 2 years. in this case, subtract 2 months from 1 year to equal 10-month-old child can sit independently. by 15 moths of age, a child should walk independently

the nurse is reinforcing instructions to the mother of a 2-year-old child regarding dental care. which statement by the mother indicates the need for further teaching?

b) proper dental care is not necessary for toddlers until their permanent teeth erupt rationale the nurse should instruct the mother that proper dental care to a toddler is important. it is important to instruct the mother to substitute sweets with healthy food itmes to prevent dental caries. the first dental visit should be made after the first primary tooth erupts and no later than 30 months of age. it will not hurt the child if some of the toothpaste is swallowed

during a well-child visit a mother states she is frustrated with her 2-year-old child. whenever she asks him if he wants something to eat, he says, "no,' but then he starts to cry when she does not give him the food. which statement by the nurse would indicate an understanding of psychosocial concepts related to growth and development of the toddler?

b) your toddler is asserting his independence as he is progressing through the stage of autonomy versus shame and doubt rationale according to Erikson, toddlers are acquiring a sense of autonomy while overcoming a sense of shame and doubt. they are attempting to relinquish their dependence and assert independence, which will be present as negativism in their quest for independence. the word no is a very strong part of their vocabulary.

during a routine well-child checkup for a 2 1/2-year-old, the nurse plans to teach the mother proper nutrition and weight gain expectations for her child. the nurse reviews the chart and finds that the toddlers birth weight was 7 pounds 15 ounces. the nurse expects that the child should weigh approximately how much at this time?

c) 31 pounds 12 ounces rationale by the age of 2 1/2 years, the toddler should have quadrupled his or her birth weight. the child doubles the birth weight by ages 5 and 6 months and triples the birth weight by 1 year of age

the nurse notes documentation that a client has conductive hearing loss. the nurse understands that which is a cause of this type of hearing loss

c) a physical obstruction to the transmission of sound waves rationale a conductive hearing loss occurs as a result of a physical obstruction to the transmission of sound waves. a sensorineural hearing loss occurs as a result of a pathological process in the inner ear, a defect in the 8th cranial nerve, or a defect of the sensory fibers that lead to the cerebral cortex.

the nurse is auscultating bowel sounds. which are appropriate data collection methods?

divide the abdomen into four quadrants at the umbilicus // do not feed the client if no sounds are audible in 5 minutes // listen in each quadrant for gurgling sounds indicating movement rationale dividing the abdomen into four quadrants allows listening to each section of the colon. not hearing audible peristalsis within 5 minutes may indicate a paralytic ileus. listening in each quadrant for gurgling sounds indicates peristalsis, which may be missed if not listened for separately. the nurse should listen for 5 minutes in each quadrant before determining that bowel sounds are absent. 20 sounds within 1 minute would be within normal range.

the nurse notes documentation that a client has conductive hearing loss. the nurse understands that which is a cause of this type of hearing loss?

c) a physical obstruction to the transmission of sound waves rationale a conductive hearing loss occurs as a result of a physical obstruction to the transmission of sound waves. a snsorineural hearing loss occurs as a result of a pathological process in the inner ear, a defect in the 8th cranial nerve, or a defect of the sensory fibers that lad to the cerebral cortex.

the nurse caring for an adolescent client recently diagnosed with bone cancer is monitoring the client for depression. to best recognize these symptoms in the adolescent, which characteristic should the nurse recall about adolescents?

c) adolescents like to stay up late but rarely have insomnia rationale the signs of depression include crying spells, insomnia, eating disorders, social isolation and withdrawal, serious acting-out behavior, feelings of hopelessness, unexplained physical symptoms, loss of interest in appearance and giving away things or possessions.

the nurse is caring for a 6-month old infant. which developmental ability should the nurse expect to note in this infant?

c) babbles using single consonants rationale using single-consonant babbling occurs between 6 and 8 months. between 8 and 9 months the infant begins to understand and obey simple commands such as "wave bye-bye" using simple words such as "mama" and the use of gestures to communicate begin between 9 and 12 months.

the nurse provides instructions to a parent of a toddler experiencing physiological anorexia. the nurse determines the need for further teaching if the parent makes which statement?

c) i should feed my child if she will not eat rationale toddlers have the skills required to feed themselves. children who can feed themselves should not be fed or force fed. to increase nutritious intake, juice intake is limited to 6 ounces per day, and milk intake to 16 to 24 ounces per day. in addition, the nurse instructs the mother to limit nutritious snacks to two per day and to give them only at the toddler's request

during a well-child checkup for a 4-month-old, the nurse reinforces instructing the mother how to introduce solid foods into her childs diet. which statement indicates the mother needs further teaching?

c) i will start giving home-prepared orange juice when my child is 3 months old rationale solids should be introduced over a period of time between the ages of 4 to 6 months. failure to introduce solids by 6 months of age might prevent the child from accepting solids later. the pattern in which solids are introduced is not important as long as meats are introduced after cereals, fruits and vegetables. a single food should be consumed several times over a course of several days to determine if the child has an allergy. home-prepared orange juice should not be given to the infant before 4 to 6 months of age because of the high nitrite level and high risk for allergic reaction

the nurse notes that the physical assessment findings for a client with meningeal irritation indicate a positive brudzinski sign. the nurse understands that which observation was made?

c) the client passively flexes the hip and knee in response to neck flexion and reports pain in the vertebral column rationale brudzinkski's sign is tested with the client in the supine position. the examiner flexes the clients head, and there should be no reports of pain or resistance to the neck flexion. a positive brudzinski's sign is observed if the client passively flexes the hip and knee in response to neck flexion and reports pain the vertebral column. kernig's sign also tests for meningeal irritation and is positive when the client flexes the legs at the hip and knee and complains of pain along the vertebral column when the leg is extended. decerebrate posturing is abnormal extension and occurs when the arms are fully extended, forearms pronated, wrists and fingers flexed, jaws clenched, neck extended, and feet plantar-flexed. decorticate posturing is abnormal flexion and is noted when the client's upper arms are flexed and held tightly to the sides of the body and the legs are extended and internally rotated.

a young adult college student begins to throw objects, shout insults, and stamp his feet after an instructor returned his work, noting it was substandard. using erikson's theory of personality development, which developmental stage has this individual unsuccessfully mastered?

d) autonomy vs shame and doubt rationale a widely accepted theory of personality development is that by erikson. each of eriksons eight stages has two components: the favorable and unfavorable aspects of the core conflict. no core conflict is ever totally mastered, and when individuals face new situations in life, they may revert to a previously mastered core conflict. negative feelings of doubt and shame arise when individuals are made to feel self-conscious and shame. the positive outcomes of mastering this developmental stage are self-control and willpower. the lasting outcomes of initiative vs guilt are direction and purpose. not mastering this stage leads to guilt and lack of purpose. the ego quality developed from a sense of industry is competence. feelings of inadequacy and inferiority may result from not mastering this task. the outcome of successful mastery of identity vs role confusion is a sense of personal identity. inability to solve this conflict results in role confusion

a client's vision is tested with a Snellen chart. the results of the test are documented as 20/60. how should the nurse interpret this result

d) the client can read at a distance of 20 feet what a client with normal vision can read at 60 feet rationale vision that is 20/20 is normal; that is, the client can read from 20 feet what a person with normal vision can read from 20 feet. a client with a visual acuity of 20/60 can only raed at a distance of 20 feet what a person with normal vision can read at 60 feet

a nursing student enrolled in a physical assessment course is asked to describe the probably signs of pregnancy. which are probable signs indicating possible pregnancy?

hegar's // chadwicks// mcdonald's rationale hegar's sign is softening of the lower uterine segement. this allows the body of the uterus to flex against the cervix which is termed mcdonald's sign chadwick's sign is a purple or blue discoloration of the cervix, vagina, and vulva caused by increased vascular congestion. moro's sign is also called the startle reflex seen in normal newborns. mcburney's sign is pain in the lower right abdominal quadrant and is frequently seen in appendicitis


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