Mr. Kinder is a 59-year-old patient who comes to the clinic for follow-up after an emergency room visit. On examination of the abdomen, you conclude he has ascites. Which percussion findings would have supported this conclusion?
Shifting level of dullness
Which assessment finding would support documentation of borborygmi in a patient's record?
Normal hyperperistaltic bowel sounds
(Borborygmi are normal hyperperistaltic bowel sounds)
How do you palpate the aortic pulsation in an adult?
Using opposing thumb and fingers
(The aortic pulsation is palpated in the upper abdomen slightly to the left of midline using your opposing thumb and fingers. Normally it is 2.5 to 4 cm wide in the adult and pulsates in an anterior direction).
When checking the symmetry of the abdomen for bulging, which direction might you give the patient?
Sit up without using your hands."
"Breathe deeply."
Asking the patient to take a deep breath or to sit up without pushing up with his or her hands will further highlight any change in symmetric shape noticed when a light is shone either across the abdome
On previewing a patient's medical record, you note that he was seen for pyrosis 6 months ago. What was the nature of his problem?
A burning sensation in the upper abdomen
What is indicated by a finding of rebound tenderness on examination of the abdomen?
Inflammation of the peritoneum
Rebound tenderness refers to the occurrence of pain when an area of the abdomen is pushed down slowly and deeply and then suddenly released. It is a reliable sign of peritoneal inflammation.
When auscultating bowel sounds, where do you begin?
Right lower quadrant
When auscultating bowel sounds, you begin in the right lower quadrant at the ileocecal valve area because bowel sounds are normally always present here.
Where do you palpate the aortic pulsation in an adult?
Upper abdomen slightly left of the midline
When you auscultate the abdomen, you hear loud, high-pitched, rushing, tinkling sounds. How would you document this finding?
Hyperactive bowel sounds
Normal bowel sounds are high-pitched, gurgling, cascading sounds that occur at irregular intervals anywhere from 5 to 30 times per minute
When auscultating bowel sounds, how long must you listen before deciding that bowel sounds are completely absent?
5 minutes
A perfectly silent abdomen is uncommon; you must listen 5 minutes by your watch before deciding bowel sounds are absent. Bowel sounds may be absent following abdominal surgery and with inflammation of the peritoneum.
When auscultating bowel sounds, what is the normal pattern of sounds you expect?
5 to 30 sounds per minute occurring at irregular intervals
Normal bowel sounds are high-pitched, gurgling, cascading sounds
During a health history, a patient reports having black stools that "look like fresh tar." For which problem would you assess?
GI bleeding
Black stools may be tarry as a result of occult blood from GI bleeding. Ingestion of iron supplements can cause black stools but they are not tarry. Grey stools accompany hepatitis. Hematemesis, or vomited blood, is characteristic of esophagea
When examining a newborn's umbilical cord, which blood vessel finding would you interpret as normal?
Two arteries and one vein
On which patient would you obtain an Alvarado score?
Patient with a question of appendicitis
The Alvarado scoring system combines assessment findings to assist with evaluation of patients with right lower quadrant pain. A score of 7 or greater indicates an increased probability of appendicitis.
When examining a 75-year-old patient, you are able to feel the spleen bump your fingertips just under the left costal margin. What do you conclude about this finding?
The spleen is enlarged and the patient needs an immediate referral.
Normally, the spleen is not palpable. To be felt, it must be enlarged to three times its normal size. When a spleen is felt to be enlarged, palpation must be stopped because an enlarged s
A patient presents complaining of abdominal pain. On examination of the abdomen, you note distention and markedly visible peristaltic waves. Which problem is suggested by these findings?
Intestinal obstruction
You would test for Murphy's sign when you suspect which problem?
Cholecystitis
Murphy's sign the experience of pain when a deep breath is taken while the liver is being palpated. This is also referred to as inspiratory arrest and occurs with cholecystitis. It is less accurate in persons over age 60.
What is the primary reason you are careful to hold the stethoscope lightly against the skin when auscultating bowel sounds?
To avoid stimulating bowel sounds
In which situation would you use bimanual palpation to assess a patient's abdomen?
The patient is obese
For bimanual palpation, your two hands are placed on top of each other. The top hand does the pushing while the bottom hand remains relaxed and concentrates on the sense of palpation.
Mr. Sanchez is a 48-year-old patient who presents with pain in the right lower quadrant of the abdomen. In which order might you palpate his abdomen?
LUQ, LLQ, RUQ, RLQ
The painful area of the abdomen is always palpated last to avoid pain and resulting muscular rigidity, which would interfere with subsequent assessment
Which type of stool would you assess as normal in a 5-day-old breastfed infant?
Pasty, golden yellow stool
A mother brings her 2?-week-old infant to the clinic because the baby is throwing up after eating. On further questioning and examination, you determine that after feeding, peristaltic waves can be seen going from left to right on the infant's abdomen fol
Pyloric stenosis
For which reason might you ask a patient to bend the knees when assessing the abdomen?
To relax the abdominal muscles
When assessing a patient's abdomen, you would consider mild tenderness as normal when palpating which structure?
Sigmoid colon
Mild tenderness is not normal on palpation of the kidneys, uterus, or liver, and further examination would be warranted.
How would you interpret an Alvarado score of 3?
Appendicitis is unlikely
A score of 7 or greater indicates an increased probability of appendicitis. A score of 4 or less indicates a significantly decreased probability of appendicitis.
When assessing a patient's abdomen, which fact about the left kidney should be considered?
It usually cannot be felt.
Which are characteristics of umbilical hernias in infants?
Appear at 2 to 3 weeks of age
Are more prominent when the baby cries
Disappear by the time the baby is 1 year old
The abdomen normally moves with breathing until the age of ____ year(s).
7
While examining a 36-year-old mother of three children ages 10, 12, and 13 years, you note abdominal striae. How do you determine if the striae are the result of her pregnancies or of current disease?
Color
When assessing a patient, you shine a light across the abdomen toward yourself. For what are you checking?
Asymmetry