An NP is assessing an adult patient with a fever and right flank pain, which physical exam finding would the NP expect?

Fever combined with right flank pain is the classic presentation of pyelonephritis or another process affecting the right kidney, such as renal abscess. The expected physical examination finding is costovertebral angle tenderness, elicited by percussing or applying firm pressure over the area at the junction of the twelfth rib and the vertebral column. Inflammation of the kidney produces pain and tenderness in this region, and CVA tenderness is considered a hallmark sign of upper urinary tract infection or renal pathology. Rigidity on abdominal palpation is associated with peritonitis, indicating involuntary muscle guarding in response to peritoneal irritation, which is not the primary finding in renal disease. A splenic friction rub on auscultation suggests splenic infarction or perisplenitis, which is unrelated to the right flank and renal presentation. Abdominal wall ecchymosis, such as Grey Turner's sign or Cullen's sign, is associated with retroperitoneal or intra-abdominal hemorrhage, classically seen in severe hemorrhagic pancreatitis, not in the scenario described. CVA tenderness therefore best correlates with the clinical picture presented.