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The nurse is percussing the seventh right intercostal space at the mid-clavicular line over the liver. Which sound should the nurse expect to hear?
Dullness
Liver is located in the R upper quadrant
Which structure is located in the lower left quadrant of the abdomen?
Sigmoid colon
A patient is having difficulty swallowing medications and food. The nurse would document that this patient has:
Dysphasia
The nurse suspects that a patient has a distended bladder. How should the nurse assess for this condition?
Percuss and palpate the midline area above the suprapubic bone
The nurse is aware that one change that may occur in the gastrointestinal system of an aging adult is:
decreased gastric acid secretion
A 22 year old man comes to the clinic for an examination after falling off his motorcycle and landing on his left side on the handle bars. The nurse suspects that he may have injured his spleen. Which of these statements is TRUE regarding assessment of the spleen in this situation?
An enlarged spleen should not be palpated because it can easily rupture
A patients abdomen is bulging and stretched in appearance. The nurse should describe this finding as:
Protuberant
The nurse is describing a scaphoid abdomen. To the horizontal plane, a scaphoid contour of the abdomen depicts a ________ profile.
Concave
While examining a patient, the nurse observes abdominal pulsations between the xiphoid process and umbilicus. The nurse would suspect that these are:
normal abdominal aortic pulsations
A patient has hypoactive bowel sounds. The nurse knows that a potential cause of hypoactive bowel sounds is:
peritonitis
The nurse is watching a new graduate nurse perform ausculation of a patients abdomen. Which statement by the new graduate shows a correct understanding of the reason ausculations precedes percussion and palpation of the abdomen?
Auscultation prevents distortion of bowel sounds that might occur after percussion and palpation
The nurse is listening to bowel sounds. Which of these statements is true of bowel sounds? Bowel sounds are:
usually high pitched, gurgling, and irregular
The physician comments that a patient has abdominal borborygmi. The nurse knows that this term refers to:
hyperactive bowel sounds
During an abdominal assessment, the nurse would consider which of these findings as normal?
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:
pyrosis
pyrosis
a burning sensation in the chest or throat, often associated with acid reflux.
The nurse is performing percussion during an abdominal assessment. Percussion notes heard during the abdominal assessment may include:
tympany, dullness, and hyper-resonance.
An older patient has been diagnosed with pernicious anemia. The nurse knows that this condition could be related to:
decreased gastric acid secretion
A patient is complaining of a sharp pain along the costovertebral angles. The nurse is aware that this symptom is most often indicative of:
kidney inflammation
A nurse notices that a patient has ascites, which indicated the presence of:
fluid
Ascites
is the accumulation of fluid in the abdominal cavity, often due to liver disease or heart failure.
The nurse knows that during an abdominal assessment, deep palpation is used to determine:
enlarged organs
The nurse notices that a patient has had a black, tarry stool and recalls that a possible cause would be:
gastrointestinal 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?
Appendix
The nurse is assessing the abdomen of an older adult. Which statement regarding the older adult and abdominal assessment is true?
Abdominal musculature is thinner
During an assessment of a newborn infant, the nurse recalls that pyloric stenosis would be exhibited by:
Projectile vomiting and dehydration.
The nurse is reviewing the assessment of an aortic aneurysm. Which of these statements is true regarding an aortic aneurysm?
A pulsating mass is usually present
During an abdominal assessment, the nurse is unable to hear bowel sounds in a patients abdomen. Before reporting this finding as SILENT BOWEL SOUNDS, the nurse should listen for at least:
5 minutes
A patient is suspected of having inflammation of the gallbladder, or choleccystitis. The nurse should conduct which of these techniques to assess for this condition?
Test for Murphy sign
Murphy Sign
A physical examination technique used to assess for gallbladder inflammation, where the patient experiences pain upon inhalation while the examiner palpates the right upper quadrant.
Just before going home, a new mother asks the nurse about the infants unbilical cord. Which of these statements is correct?
It should fall off in 10 to 14 days
Which of these percussion findings would the nurse expect to find in a patient with a large amount of ascites?
Dullness across the abdomen
A 44 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?
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 approximately 11 cm. The nurse should:
consider this finding as normal, and proceed with the exam
When palpating the abdomen of a 20 year old patient, the nurse notices the presence of tenderness in the left upper quadrant with deep palpation. Which of these structures is most likely to be involved?
Spleen
The nurse is reviewing statistics for lactose intolerance. In the United States, the incidence of lactose intolerance is higher in adults of which ethnic group?
Blacks
The nurse is assessing a patient for possible peptic ulcer disease. Which condition or history often causes this problem?
Frequent use of non-steroidal anti-inflammatory drugs (NSAIDs)
During reporting, the student nurse hears that a patient has hepatomegaly and recognizes that this term refers to:
enlarged liver
During an assessment, the nurse notices that a patients umbilicus is enlarged and everted. It is positioned midline with no change in skin color. The nurse recognizes that the patient may have which condition?
Umbilical hernia
During an abdominal assessment, the nurse tests for a fluid wave. A positive fluid wave test occurs with:
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?
Examine the tender area last
During a health history, the patient tells the nurse, “I have pain all the time in my stomach. Its worse 2 hours after I eat, but it gets better if I eat again.” Based on these symptoms, the nurse suspects that the patient has which condition?
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? (SATA)
Test for the blumberg sign
Perform the iliopsoas muscle test
The organ in the right upper quadrant of the abdomen is the:
liver
The abdomen normally moves with breathing until the age of _______ years
7
Moles on the abdomen:
are common
Older adults have:
decreased salivation leading to dry mouth
The four layers of large, flat abdominal muscles form the:
ventral abdominal wall
Ascites is defined as:
an abnormal accumulation of serous fluid within the peritoneal cavity
Pyrosis is:
a burning sensation in the upper abdomen
The symptoms occuring with lactose intolerance include:
bloating and flatulence
Methods to enhance abdominal wall relaxation during examination include:
positioning the patient with knees bent
Pyloric stenosis is a(n):
congenital narrowing of the pyloric sphincter