When performing an abdominal examination on a client, which assessment technique should the nurse perform first?
- auscultation
- palpation
- percussion
- inspection correct answers inspection
A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates...
Nurs 3100 Exam 3 || A+ GRADED
When performing an abdominal examination on a client, which assessment technique should the nurse perform first? - auscultation - palpation - percussion - inspection correct answers inspection
A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates the correct way to assess the client for ascites?
-auscultate for bowel sounds in all 4 quadrants -palpate the abdomen lightly for areas of tenderness -inspect the abdominal skin for vascularity -percuss the flanks from the bed upward toward the umbilicus correct answers percuss the flanks from the bed upward toward the umbilicus
Which action by the nurse will facilitate relaxation of the abdominal muscles during examination of the abdomen?
-raise the client's arms or fold them behind the head -avoid the use of a pillow behind the head during examination
-provide privacy to the client and instruct them to relax -flex the client's legs by placing a pillow under the knees correct answers flex the client's legs
by placing a pillow under the knees
A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should the nurse measure to assess improvement?
- auscultate for bowel sounds - palpate the abdomen - measure abdominal girth - perform percussion for tympany correct answers measure abdominal girth
A nurse observes tenderness over the costovertebral angle on the right side. The nurse recognizes this as an abnormal finding for which organ?
- gallbladder - liver - spleen - kidney correct answers kidney
Which change in auscultation of bowel sounds should the nurse recognize as diagnostic of an intestinal obstruction?
- an increase in the pitch - no sound heard in 1 minute - increase in the frequency of the gurgles - a soft click every 5-15 seconds correct answers an increase in the pitch
During the abdominal exam, the nurse supports the client's right knee and ankle, flexing the client's hip and rotating the leg internally and externally. At this point, the client reports pain in the RLQ. This test is positive for which sign?
- Rovsing's - Obturator - Psoas - Murphy's correct answers Obturator
A nurse inspects a client's abdomen and notices a large bulge is present in the RLQ. How should the nurse further assess this finding using inspection?
- palpate to measure the diameter of the mass - percuss to determine if the mass is fluid filled - have the client cough forcefully a few times - ask the client to raise the head off the bed correct answers ask the client to raise the head off
the bed
A client complains of a burning sensation of in the esophagus after eating. Which associated condition should the nurse most suspect?
- acute pancreatitis - pancreatic cancer - acid reflux - gastric ulcer correct answers acid reflux
A nurse is attempting to palpate the abdomen of a 6-year-old female, but the girl is so ticklish
that the nurse cannot proceed. Which of the following should the nurse do?
- hold the nurse's hand under warm water just before the exam
- place the client's hand under the nurse's hand for a few moments
- drape the client's genital area when the client is not being examined
- adjust the bed level correct answers place the client's hand under the nurse's hand for a few moments
The abdomen is divided into six quadrants. t/f correct answers False
The peritoneum lines the abdominal cavity. t/f correct answers True
A venous hum is normally heard over the epigastric and umbilical areas. t/f correct answers False
The psoas sign is a test for cholecystitis. t/f correct answers False
The ______ is the largest solid organ in the body. correct answers liver
The ______ functions primarily to filter the blood of cellular debris, to digest microorganisms, and to return the breakdown products to the liver. correct answers spleen
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