The nurse is percussing the right intercostal space at the midclavicular line over the liver.
Which sound should the nurse expect to hear?
A) Dullness
Which structure is located in the lower left quadrant of the abdomen?
D) Sigmoid colon
A patient is having difficulty in swallowing food and medications. The nurse should document this as:
C) Dysphagia
The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?
D) Percuss and palpate the mid-line area above the supra-pubic bone.
The nurse is aware that one change that may occur in the GI system of an aging adult is?
D) Decreased gastric acid secretion
A 22-year-old man comes to the clinic for an examination after falling off of his motorcycle and landing on his left side on the handlebars. The nurse suspects that he may have injured his spleen. Which of these statements is true regarding assessment of
D) An enlarged spleen should not be palpated because it can rupture easily.
A patient's abdomen is bulging and stretched in appearance. The nurse should describe this finding as?
D) Protuberant
The nurse is describing a scaphoid abdomen. To the horizontal plane, a scaphoid contour of the abdomen depicts a __________ profile.
D) Concave
While examining the patient, the nurse observes abdominal pulsations between the xiphoid and the umbilicus. The nurse would suspect that these are?
C) Normal abdominal aortic pulsations
A patient has hypo-active bowel sounds. The nurse knows that a potential cause of hypo-active bowel sounds is?
B) Peritonitis
The nurse is watching a new graduate nurse perform auscultation of a patient's abdomen. Which statement by the new graduate nurse shows a correct understanding of the reason auscultation precedes percussion and palpation of the abdomen?
B) "It prevents distortion of the bowel sounds that might occur after percussion and palpation.
The nurse is listening to bowel sounds. Which of these statements is true about bowel sounds?
B) They are usually high-pitched, gurgling, irregular sounds.
The physician comments that a patient has abdominal borborygami. The nurse knows that this term refers to?
D) Hyperactive bowel sounds
During an abdominal assessment, he nurse would consider which of these findings as normal?
B) A tympanic percussion note in the umbilical region
The nurse is assessing the abdomen of a pregnant woman who is complaining of having "acid indigestion" all the time. The nurse knows that esophageal reflux during pregnancy can cause?
B) Pyrosis
The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include?
C) Tympani, hyperressonance, and dullness
An older patient has been diagnosed with pernicious anemia. The nurse knows that this condition could be related to?
B) Decreased gastric acid secretion
A patient is complaining of a sharp pain along the costovertebral angles. The nurse knows that this symptom is most often indicative of?
C) Kidney inflammation
A nurse notices that a patient has ascites, which indicates the presence of?
A) Fluid
The nurse knows that during an abdominal assessment, deep palpation is used to determine?
B) Enlarged organs
The nurse notices that a patient has had a black, tarry stool and recalls that a possible cause would be?
C) GI bleeding
During an abdominal assessment, the nurse elicits tenderness on light palpation in the right lower quadrant. The nurse interprets that this finding could indicate a disorder of which of these structures?
C) Appendix
The nurse is assessing the abdomen of an aging adult. Which of these statements regarding the aging adult and abdominal assessment is true?
B) The abdominal musculature is thinner
During an assessment of a newborn infant, the nurse recalls that pyloric stenosis would be manifested by?
A) Projectile vomiting
To detect diastasis recti, the nurse should have the patient perform which of these maneuvers?
D) Raise the head while remaining supine
The nurse is reviewing the assessment of an aortic aneurysm. Which of these statements is true regarding an aortic aneurysm?
C) A pulsating mass is usually present
During an abdominal assessment, the nurse is unable to hear bowel sounds in a patient's abdomen. Before reporting this finding as "silent bowel sounds" the nurse should listen for at least ______ minutes.
B) Five minutes
A patient is suspected of having inflammation of the gallbladder, or cholecystitis. The nurse should conduct which of these techniques to assess for this condition?
B) Test for Murphy's sign
Just before going home, a new mother asks the nurse about the infant's umbilical cord. Which of these statements is correct?
A) "It should fall off by 10 to 14 days.
Which of these percussion findings would the nurse expect to find in a patient with a large amount of ascites?
A) Dullness across the abdomen
A 40-year-old man states that his physician told him that he has a hernia. He asks the nurse to explain what a hernia is. Which response by the nurse is appropriate?
B) "A hernia is a loop of bowel protruding through a weak spot in the abdominal muscles.
A 45-year-old man is in the clinic for a physical examination. During the abdominal assessment, the nurse percusses the abdomen and notices an area of dullness above the right costal margin of about 10 cm. The nurse should?
D) Consider this a normal finding and proceed with the examination.
When palpating the abdomen of a 20-year-old patient, the nurse notices the presence of tenderness in the upper left quadrant with deep palpation. Which of these structures is most likely to be involved?
A) Spleen
The nurse is reviewing statistics for lactose intolerance. In the USA, the incidence of lactose intolerance is higher in adults of which ethnic group?
A) African-Americans
The nurse is assessing a patient for possible peptic ulcer disease and knows that which condition often causes this problem?
D) Frequent use of non-steroidal anti-inflammatory drugs
During report, the student nurse hears that a patient has "hepatomegaly" and recognizes that this term refers to?
A) An enlarged liver
During an assessment the nurse notices that a patient's umbilicus is enlarged and everted. It is midline, and there is no change in skin color. The nurse recognizes that the patient may have which condition?
C) Umbilical hernia
During an abdominal assessment, the nurse tests for a fluid wave. A positive fluid wave test occurs with?
D) Ascites
The nurse is preparing to examine a patient who has been complaining of right lower quadrant pain. Which technique is correct during the assessment?
B) Examine the tender area last
During a health history, the patient tells the nurse, "I have pain all the time in my stomach. It's worse two hours after I eat, but it gets better if I eat again!" The nurse suspects that the patient has which condition, based on these symptoms?
C) Duodenal ulcer
The nurse suspects that a patient has appendicitis. Which of these procedures are appropriate for use when assessing for appendicitis or a perforated appendix?
Select all that apply:
B) Test for Blumberg's sign.
D) Perform iliopsoas muscle test.