MS1 Pretest

Which action by the nurse will facilitate relaxation of the abdominal muscles during exam of the abdomen?

• Flex the client's legs by placing a pillow under the knees.

• Avoid the use of pillow under the head during exam.

• Provide privacy to the client and instruct him to relax.

• Raise the client's arms or fold them behind the head.

Nurse Obet is caring for a client with distended abdomen. Which parameter should Nurse Obet measure to assess for improvement?

• Perform percussion for tympany.

• Palpate the abdomen.

• Auscultate the bowel sounds.

• Measure abdominal girth.

Nurse Caloy observes tenderness over the costovertebral angle on the right side. He recognizes that this is an abnormal finding of which organ?

• liver

• gallbladder

• kidney

• spleen

Which change in auscultation of bowel sounds should the nurse recognize as a sign of an intestinal obstruction?

• A soft click every 5-15 seconds.

• An increase in the pitch.

• Increase in the frequency of gurgles.

• No sound heard in one minute.

Nurse Juana is performing light palpation of the abdomen and feels prominent, non-tender, pulsating mass above the umbilicus that measures approximately 6cm. What is an appropriate action by Nurse Juana?

• Assist the client to the bathroom to empty the bladder.

• Stop the palpation and notify the health care provider.

• Auscultate over the same area for the presence of a bruit.

• Use percussion to determine the solidity of the structure

A client reports severe pain in the LLQ for 3 days duration. How should the nurse conduct palpation of the abdomen due to this history?

• Encourage the client to relax to minimize pain.

• Medicate for pain before beginning the assessment.

• The LLQ is palpated last.

• This area should be avoided completely

The nurse is preparing to assess the abdomen of a hospitalized client 2 days after abdominal surgery. The nurse should first:

• Palpate the incision site.

• Auscultate for bowel sounds.

• Percuss for tympany.

• Inspect the abdominal area.

The nurse is planning to assess the abdomen of an adult male client. Before the nurse begins assessment, the nurse should:

• ask the client to empty his bladder.

• place the client in a side lying position.

• ask the client to hold his breath for a few seconds.

• tell the client to raise his arms above his head.

During a physical examination of an adult client, the nurse is preparing to auscultate the client's abdomen. The nurse should:

• palpate the abdomen before auscultation.

• listen in each quadrant for 15 seconds.

• use the diaphragm of the stethoscope.

• begin auscultation in the left upper quadrant.

The nurse is planning to assess a client's abdomen for rebound tenderness. The nurse should:

• perform this abdominal assessment first.

• ask the client to assume a side-lying position.

• palpate lightly while slowly releasing pressure.

• palpate deeply while quickly releasing pressure.