Jensen Ch 20: Abdominal Assessment

usually difficult to localize Visceral pain occurs when hollow abdominal organs, such as the intestines, become distended or contract forcefully, or when the capsules of solid organs such as the liver and spleen are stretched. Poorly defined or localized and intermittently timed, this type of pain is often characterized as dull, aching, burning, cramping, or colicky.

Visceral pain is associated with a hollow abdominal organ such as the intestine. Visceral pain is right or left sided more severe than parietal pain also called referred pain usually difficult to localize

Acute diverticulitis Diverticulitis is caused by localized infections within the colonic diverticula. Constipation, fever, and abdominal pain are common. Mesenteric ischemia classically presents in older people with a history of vascular disease elsewhere. The typical pain is unusual in that it is not made worse by examination despite being severe. Some mistake this feature to indicate malingering with bad results.

A 76-year-old retired farmer comes to the office reporting abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating was two bags of popcorn at the movies with his grandson 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary artery disease and high blood pressure. He has been married for more than 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 100.9 degrees; other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremarkable, and his fecal occult blood test is negative. His prostate is slightly enlarged, but his testicular, penile, and inguinal examinations are all normal. Blood work is pending. What diagnosis for abdominal pain best describes his symptoms and signs? Acute diverticulitis Acute appendicitis Acute cholecystitis Mesenteric ischemia

Positive Rovsing's sign Findings indicating referred rebound tenderness is a positive Rovsing's sign. Psoas sign occurs when pain in the right lower quadrant occurs with raising of the client's right leg from the hip and pressure applied downward against the lower thigh. The obturator sign occurs when pain in the right lower quadrant results when the client's right knee and ankle are supported and the leg is rotated internally and externally. A positive hypersensitivity test occurs when the client experiences pain or exaggerated sensation when the abdomen is stroked with a sharp object.

A client comes to the emergency department complaining of pain in the right lower quadrant. Rebound tenderness is present and the nurse assesses the client for referred rebound experiences. The client experiences pain the right lower quadrant. The nurse interprets this as which of the following? Positive Rovsing's sign Psoas Sign Obturator Sign Positive hypersensitivity test

Referred pain Pancreatic inflammation, or pancreatitis, may be felt in the back. This is called "referred" pain because the pain is not felt at its source. This is not radiated pain, which extends continuously to the tissues surrounding the source, nor is it localized pain, which remains only in one small area. It is not chronic pain, as it results from acute pancreatitis.

A client complains of a sudden onset of pain in the back. On questioning the client further, the nurse learns that the cause of the pain is acute pancreatitis. The nurse recognizes that this type of pain is which of the following? Chronic pain Referred pain Radiated pain Localized pain

Crohn's disease Abdominal pain with cramping, diarrhea, nausea, vomiting, weight loss, and lack of energy is often seen in Crohn's disease. Epigastric pain accompanied by tarry stools suggests a gastric or duodenal ulcer. Pancreatitis is worsened with alcohol ingestion. Gastroesophageal reflux is worsened when supine.

A client complains of abdominal pain with cramping diarrhea, nausea, vomiting, weight loss, and loss of energy. The nurse should suspect which of the following as the underlying cause? Crohn's disease Pancreatitis Gastric ulcer Gastroesophageal reflux

Gastric ulcer Epigastric pain accompanied by tarry stools suggests a gastric or duodenal ulcer. Abdominal pain with cramping, diarrhea, nausea, vomiting, weight loss, and lack of energy is often seen in Crohn's disease. Pancreatitis is worsened with alcohol ingestion. Gastroesophageal reflux is worsened when supine.

A client complains of epigastric pain and tarry stools. The nurse should suspect which of the following as the underlying cause? Crohn's disease Gastroesophageal reflux Gastric ulcer Pancreatitis

Internal adhesions from previous surgery The key to this question is the presence of the scar. The scar in the right lower quadrant should alert the nurse to the possibility of internal adhesions which account for the pulling feeling the client reports. An intestinal obstruction would not produce a pulling feeling but the client most likely would report nausea and vomiting. With a right lower quadrant scar, the appendix may already be removed. Acute appendicitis would also present with fever, nausea and vomiting. Peritonitis would cause a rigid abdomen with generalized severe abdominal pain, and fever.

A client presents to the emergency department with reports of new onset of abdominal pain for the past three (3) days. The client states there is also a pulling feeling on the right side. Upon examination the nurse notices a 5cm transverse scar in the right lower quadrant. The nurse recognizes that this client may be experiencing what type of process? Internal adhesions from previous surgery Intestinal obstruction Acute appendicitis Peritonitis

Murphy's The gallbladder is located in the right upper quadrant of the abdomen. When it is inflamed (cholecystitis), performing the Murphy's sign will cause the client to hold the breath (inspiratory arrest). The Obturator & Psoas tests are to determine if the appendix is inflamed. Rovsing's sign test for rebound tenderness which may indicate peritoneal irritation.

A client reports the onset of discomfort and pain in the right upper quadrant of the abdomen after eating. The nurse should assess this finding using which test? Psoas Obturator Rovsing's Murphy's

Viral hepatitis Travel to or consuming food meals in an area of poor sanitation can pose a risk for contracting viral hepatitis. This information paired with the client's report of having gray colored stools increases the likelihood of obstructive jaundice related viral hepatitis. Toxic liver damage can result from side effects of certain medications, inhaling or consuming industrial solvents, or exposure to environmental toxins. Alcohol hepatitis is secondary to alcohol abuse. Intrahepatic jaundice arises from damage to the hepatocytes or intrahepatic bile ducts.

A client tells the nurse he has been having gray-colored stools after recent travel out of the country to an area with known poor sanitation. The nurse needs to investigate the possibility of which condition? alcohol hepatitis viral hepatitis intrahepatic jaundice toxic liver damage

At the symphysis pubis The urinary bladder is located behind the symphysis pubis and rises above it when distended. The nurse would begin at the symphysis pubis and move upward and outward to estimate bladder borders.

A client's bladder is found to be distended. At which location would the nurse begin palpating? In the left lower quadrant At the symphysis pubis At the umbilicus In the right lower quadrant

Liver disease Liver function tests (including alanine aminotransferase [ALT] and aspartate aminotransferase [AST] levels) indicate the health of the liver. Levels of these enzymes, which are necessary for digestion and absorption of nutrients, remain normal until liver compromise is significant.

A client's most recent laboratory results indicate increases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST). What might the nurse suspect is wrong with this client? Liver disease GI bleed Dehydration Gastroenteritis

Supply only healthy foods in the house Supply nutritional information to the child Educate the family about the poor nutritional value of fast food Teenagers assume control of their eating and may reject family values. The only control parents may have is over what food is in the house, although they should still supply nutritional information to their children. Fast food is high in fat, calories, and salt and has little fiber. Moderately active teenage girls require an average of 2,200 calories per day. Moderately active teenage boys require an average of 2,800 calories a day

A mother is worried about her teenage child's weight. The teenager weighs 80 kg (176 lbs). What can the nurse teach the mother about her child's eating habits? Select all that apply. Supply only healthy foods in the house Teach the mother that teenagers rarely have diet-related problems such as iron deficiency and anemia Educate the family about the poor nutritional value of fast food Supply nutritional information to the child Tell the mother that a teenager requires 3,500 calories per day

It is a normal-sized liver. The normal liver span is 6 to 12 cm, so this is a normal finding. Liver size begins to decrease after age 50. If the measurement was greater than 12 cm, the client's liver would be enlarged. A decreased span suggests liver atrophy.

A nurse determines that the liver span of an older adult male client measures 6 cm. How would the nurse would interpret this finding? The liver is larger than normal. It is a normal-sized liver. The liver has atrophied. The liver is smaller than normal.

Absent The nurse should find that bowel sounds are absent in a client with paralytic ileus. Paralytic ileus is a condition characterized by absence of bowel sounds, not normal bowel sounds. Hyperactive bowel sounds may be caused by diarrhea, gastroenteritis, and early bowel obstruction. Hypoactive bowel sounds may be due to surgery or late bowel obstruction. Hyperactive bowel sounds referred to as "borborygmus" may also be heard. These are the loud, prolonged gurgles characteristic of one's "stomach growling."

A nurse examines a client with a paralytic ileus. Which alteration in bowel sounds should the nurse expect to find with auscultation of the client's abdomen? Hyperactive Erratic Absent Borborygmus

Visible peristaltic waves Visible peristaltic waves typically are not visible except in very thin people. An increase in peristaltic waves with progression in a ripple like fashion suggests intestinal obstruction, necessitating further evaluation. Abdominal respiratory movements are normal findings in a male client. Symmetric appearance and absence of bulging when the client raises his head are also normal findings.

A nurse is assessing a male client's abdomen. Which of the following would lead the nurse to suspect a problem? Abdominal respiratory movements Visible peristaltic waves Symmetrical appearance Absence of bulging

Right side-lying Having the client lie on the right side may facilitate splenic palpation by moving the spleen downward and forward. Alternatively, the client may be positioned supine.

A nurse is preparing to palpate a client's spleen. Which position should the nurse use to best facilitate palpation? Semi-Fowler's Prone Sitting upright Right side-lying

"How many times have you been pregnant?" Striae are silvery white marks which are common on the abdomen from stretching of the skin during pregnancy or weight gain. They do not cause pain or any other color changes to the skin. High blood pressure may cause the dilation of the superficial arterioles or capillaries which also contain a central star (spider angioma).

A nurse observes striae on the abdomen of a middle-aged female client during the examination of the abdomen. What is an appropriate question to ask this client in regards to this finding? "Do you have high blood pressure?" "How many times have you been pregnant?" "Are you experiencing any abdominal pain?' "Have you noticed any color change to the skin?'

Full bladder Uterine enlargement Ovarian tumor Impacted colon Abdominal distention below the umbilicus can be observed with a full bladder, uterine enlargement (tumor or pregnancy), ovarian cysts or tumors, and an impacted colon. A pancreatic tumor would be apparent in the upper abdomen. A tumor on the kidney would be apparent in the flank area.

A nurse observes the abdomen of a client and notices it to be distended below the umbilicus. The nurse recognizes that this can be caused by which of these conditions? Select all that apply. Uterine enlargement Pancreatic mass Impacted colon Tumor of the kidney Ovarian tumor Full bladder

"It takes about 3 to 5 days after surgery for the bowel sounds to return completely" Bowel sound will return after surgery depending upon the location of the surgery. The small intestine functions normally in the first few hours postoperatively; stomach emptying takes 24 to 48 hours; and the colon can take 3-5 days to recover. There is no need to call the health care provider because there is no need for intervention. Listening longer is not necessary because the client is 48 hours post operative and the colon is not functioning yet. A nasogastric tube does not stop the bowel from working but is used in the event the client experiences nausea.

A student nurse is auscultating for bowels sounds on a client who returned from surgery 48 hours ago. The student tells the charge nurse that she cannot hear bowel sounds in the lower quadrants. What is the appropriate response by the charge nurse to this information? "Did you listen for five (5) minutes in all four (4) quadrants of the abdomen?" "The nasogastric tube is preventing you from hearing the bowel sounds correctly" "It takes about 3 to 5 days after surgery for the bowel sounds to return completely" "You need to call the health care provider immediately for orders"

Appendicitis This is a classic history for appendicitis. Notice that the pain has changed from visceral to parietal. It is well localized to the right lower quadrant, making appendicitis a strong consideration.

Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely? Peptic ulcer Cholecystitis Appendicitis Pancreatitis

It is a splenic rub. A rough, grating noise over this area represents a splenic rub, which can accompany splenic infarction. Rubs also occur over the liver and pleura and pericardium.

Cody is a teenager with a history of leukemia and an enlarged spleen. Today he presents with fairly significant left upper quadrant pain. On examination of this area a rough grating noise is heard. What is this sound?

Murphy's Murphy's sign is for assessment of cholecystitis and is elicited by pressing the fingers at the client's right costal margin and telling the client to inhale. The obturator sign involves pain in the right lower quadrant as a result of the nurse flexing the client's hip and rotating the leg externally and internally while supporting the client's right knee and ankle. Psoas sign involves pain in the right lower quadrant on hyperextension of the client's right leg and indicates appendicitis. Rovsing's sign involves pain caused by deep palpation in the left lower quadrant.

During the abdominal examination, a nurse presses her fingers at the client's right costal margin and tells the client to inhale. At this point, the client holds his breath as a result of experiencing a sharp pain where the nurse is pressing. This test is positive for which sign? Murphy's Rovsing's Psoas Obturator

Obturator The test indicates a positive obturator sign, which is performed to assess for appendicitis. Psoas sign involves pain in the right lower quadrant on hyperextension of the client's right leg and indicates appendicitis. Murphy's sign is for assessment of cholecystitis and is elicited by pressing the fingers at the client's right costal margin and telling the client to inhale. Rovsing's sign involves pain caused by deep palpation in the left lower quadrant.

During the abdominal examination, a nurse supports the client's right knee and ankle. The nurse flexes the client's hip and rotates the leg externally and internally. At this point, the client reports pain in the right lower quadrant. This test is positive for which sign? Psoas Murphy's Rovsing's Obturator

Irritable bowel syndrome Although colon cancer should be a consideration, these symptoms are intermittent and no note is made of progression. Cholecystitis usually presents with right upper quadrant pain. Inflammatory bowel disease is often associated with fever and hematochezia. Because there is relief with defecation and there are no mentioned structural or biochemical abnormalities, irritable bowel syndrome seems most likely, especially given that she is a young woman. This very common condition can be triggered by certain foods and stress.

Monique is a 33-year-old administrative assistant who has had intermittent lower abdominal pain approximately one week a month for the past year. It is not related to her menses. She notes relief with defecation, and a change in form and frequency of her bowel movements with these episodes. Which of the following is most likely? Inflammatory bowel disease Colon cancer Irritable bowel syndrome Cholecystitis

Tympany that changes location with client position A diagnosis of ascites is supported by findings that are consistent with movement of fluid and gas with changes in position. Gas-filled loops of bowel tend to float, so dullness when supine would argue against this. Likewise, because fluid gathers in dependent areas, the flanks should ordinarily be dull with ascites. Tympany that changes location with client position ("shifting dullness") would support the presence of ascites. A fluid wave and edema would support this diagnosis as well.

Mr. Maxwell has noticed that he is gaining weight and has increasing girth. Which of the following would argue for the presence of ascites? Tympany that changes location with client position Dullness that remains despite change in position Dullness centrally when the client is supine Bilateral flank tympany

Jejunum Absorption of nutrients takes place almost exclusively in the small intestine. In the first portion of the small intestine—the duodenum—pancreatic juices and bile are secreted into the chyme. This makes the nutrients in the chyme available for absorption by the many villi that line the walls of the remaining two portions of the small intestine: the jejunum and the ileum.

Nursing students are giving a class presentation on the digestive process. The students would identify villi as being present in what part of the GI tract? Duodenum Jejunum Ilium Large intestine

Fluid accumulation Pale and taut skin indicates significant abdominal swelling caused by accumulation of fluid in the abdominal cavity, or ascites. Bleeding within the abdominal wall would manifest as purple discoloration at the flanks. Inflammation of the peritoneum and obstruction of the intestine does not contribute to pale and taut abdominal skin.

On inspection of the abdomen, a nurse notes that the client's skin appears pale and taut. The nurse recognizes that this finding is most likely due to what process occurring within the abdominal cavity? Fluid accumulation Inflammation Bleeding Obstruction

Monitor pulse and blood pressure every 15 minutes until stable The nurse should monitor this client's pulse and blood pressure every 15 minutes until stable. The nurse would assess for signs of hypovolemia including postural hypotension, poor skin turgor, thirst, sunken eyeballs, and weakness. Monitoring of intake and output and weights would happen daily. The client would not need physical therapy.

The nurse assigns a nursing diagnosis of fluid volume deficit to an older adult client diagnosed with severe dehydration. Her vital signs are P 120, BP 84/52, respirations 24, and temperature 37.4°C (99.3°F;). Which of the following interventions is appropriate for this client? Monitor intake and output and weights once a week Assess for signs of hypervolemia Monitor pulse and blood pressure every 15 minutes until stable Get a physical therapy consult

Standing The ideal position for measuring abdominal girth is the standing position; otherwise, the client should be in the supine position.

The nurse is assessing a client who is in liver failure and who has developed ascites. When measuring the client's abdominal girth, the nurse should place the client in which position? Standing Supine Sitting Prone

Suprapubic Bladder disorders may cause suprapubic pain.

The nurse is assessing a client with a bladder disorder. Where would the nurse expect the pain to be? Perineal Upper abdomen Back Suprapubic

Limited access to a grocery store Risks for nutritional deficits include limited access to a grocery store, reduced income, compromised cooking facilities, and physical disability. A daughter shopping once a week might provide sufficient resources for the client to be adequately nourished. 2,000 calories a day is sufficient intake for nourishment. A UTI would need medical attention but would not correlate with malnutrition.

The nurse is assessing an older adult client for severe malnutrition. Which of the following factors increases this client's risk for malnutrition? Daughter shopping once a week. Limited access to a grocery store New onset of UTI Only eats 2,000 calories a day

The client is more vulnerable to impaired nutrition due to decreased appetite. Older adults experience a decline in appetite, although enzyme production does not significantly decrease. The liver decreases in size with age. Bowel motility declines as well, making the older adult vulnerable to constipation.

The nurse is assessing the gastrointestinal system of an 81-year-old client. What age-related change should the nurse consider when collecting and analyzing assessment data? The client derives less nutritional value from food because of decreased enzyme production. The client is more vulnerable to impaired nutrition due to decreased appetite.

Bruit Bruits are swishing sound that indicate turbulent blood flow. Borborygmi is increased bowel sounds. A venous hum is a soft-pitched humming sound associated with partial obstruction of an artery and reduced blood flow to the organ. Friction rubs are a grating sounds with inspiration.

The nurse is auscultating the abdomen and notes a swishing sound in the abdominal area. The nurse would document this sounds as a what? Bruit Borborygmi Friction rub Venous hum

Right lower quadrant The appendix is located in the right lower quadrant. If the client has appendicitis, pressing deeply in this location with a sudden release of pressure will elicit a sharp, stabbing pain, which is called "rebound tenderness."

The nurse is evaluating a new graduate's ability to perform a rebound tenderness test. The nurse identifies correct technique when the new graduate is observed pressing deeply at which abdominal location? Left upper quadrant Right lower quadrant Left lower quadrant Right upper quadrant

Right lower quadrant The appendix is located in the right lower quadrant. If the client has appendicitis, pressing deeply in this location with a sudden release of pressure will elicit a sharp, stabbing pain, which is called "rebound tenderness."

The nurse is evaluating a new nursing graduate's ability to perform a rebound tenderness test for suspected appendicitis. The nurse determines correct technique when the new graduate is observed pressing deeply at which anatomic location? Left lower quadrant Right upper quadrant Left upper quadrant Right lower quadrant

Tympany Generalized tympany predominates over the abdomen because of air in the stomach and intestines. Dullness is heard over the liver and spleen. Accentuated tympany or hyperresonance is heard over a gaseous, distended abdomen.

The nurse is percussing a client's abdomen. What predominant sound should the nurse expect to hear over the majority of the abdomen? Accentuated tympany Dullness Tympany Hyperresonance

Dullness Normal percussion findings include dullness over the liver in the RUQ and hollow tympanic notes in the LUQ over the gastric bubble. Hums and rubs are auscultatory sounds.

The nurse is performing percussion on a client's abdomen. What would the nurse expect to hear over the liver of the right upper quadrant? Hollow tympanic notes Rub Hum Dullness

Deep epigastrium to the left of midline To palpate the aorta, the nurse would palpate deeply in the epigastrium, slightly to the left of midline. The pregnant uterus may be palpated above the level of the symphysis pubis in the midline. A filled bladder may be palpated in the abdomen above the symphysis pubis.

The nurse is preparing to assess the size of the client's aorta. The nurse should palpate at which location? Deep epigastrium to the left of midline Midline at the umbilicus Between the umbilicus and the symphysis pubis Slightly above the suprapubic area

Produces clotting factors The liver produces clotting factors. The pancreas secretes insulin, amylase and lipase.

The nurse understands that the liver does what? Secretes lipase Secretes amylase Secretes insulin Produces clotting factors

Applying and releasing pressure to the abdomen Pain that occurs after applying and releasing pressure to the abdomen would be a positive Blumberg sign. Murphy sign occurs when the client holds his breath and there is pain. Blunt pressure at the CVA assesses for kidney pain. Liver span test occurs at the MCL.

The nurse would assess for positive Blumberg sign how? Having the client breathe deeply Applying blunt pressure at the costovertebral angle (CVA) Applying blunt pressure that the midclavicular line (MCL) Applying and releasing pressure to the abdomen

right lower quadrant. The appendix is located in the right lower quadrant.

To palpate an adult client's appendix, the nurse should begin the abdominal assessment at the client's Left lower quadrant Left upper quadrant right lower quadrant right upper quadrant

left upper quadrant. The spleen is located in the left upper quadrant.

To palpate the spleen of an adult client, the nurse should begin the abdominal assessment of the client at the left lower quadrant. left upper quadrant. right upper quadrant. right lower quadrant.

right upper quadrant. The liver is located in the right upper quadrant. Percuss the span or height of the liver by determining its lower and upper borders. The lower border of liver dullness is located at the costal margin to 1 to 2 cm below. To assess the lower border, begin in the RLQ at the mid-clavicular line (MCL) and percuss upward.

To percuss the liver of an adult client, the nurse should begin the abdominal assessment at the client's right lower quadrant. left upper quadrant. left lower quadrant. right upper quadrant.

Place a pillow under both of the client's knees. Placing a pillow under the client's knees provides slight flexion, which helps to relax the abdominal muscles. Having the client breathe through the mouth and take slow deep breaths promotes overall relaxation. A warm blanket prevents chilling. The nurse would inform the client that painful areas will be assessed last and would assure the client that he or she will be forewarned about examining these areas.

To promote relaxation of the abdominal muscles, which of the following would be most appropriate for the nurse to do? Apply a warm blanket. Place a pillow under both of the client's knees.

Splenomegaly Normally, tympany or resonance is heard at the last left interspace. Dullness suggests splenomegaly. The liver would be percussed anteriorly. An increased liver span would suggest hepatomegaly. Percussion and palpation in any area of the abdomen might reveal an abdominal mass. Intestinal air would be noted by tympany.

What would a nurse suspect if dullness is percussed at the last left interspace at the anterior axillary line on deep inspiration? Splenomegaly Appendicitis Trapped air in intestines

Bowel sounds normal Normal bowel sounds consist of clicks and gurgles that occur at an estimated frequency of 5 to 30 per minute. The nurse should document that the bowel sounds are normal. Twenty bowel sounds in a minute is not hyperactive, hypoactive, or inconsistent.

When conducting the physical examination of a client's abdomen, the nurse auscultates 20 clicks and gurgles over 1 minute. Which of the following statements would accurately describe this finding? Bowel sounds normal Bowel sounds hypoactive Bowel sounds inconsistent Bowel sounds hyperactive

True

When the spleen enlarges, the nurse would not be surprised to percuss dullness over the stomach. True False

Large intestine Any food particles not absorbed by the small intestine pass into the large intestine, where a few electrolytes and water are further absorbed.

Where in the digestive tract is most of the water absorbed? Duodenum Ilium Large intestine

An enlarged liver felt during palpation The liver normally decreases in size after age 50 years. An enlarged liver needs further assessment. Appetite decreases with age due to altered metabolism, decreased taste sensation, decreased mobility, and possibly depression. Tympany is a normal finding over the stomach. The fluid wave test should be negative unless fluid (ascites) is present in the abdomen.

Which finding obtained during the abdominal assessment in an older adult client should prompt the nurse to perform an additional assessment to determine the cause? Decreased appetite Tympany heard over stomach Negative fluid wave test An enlarged liver felt during palpation

Food-service workers Hepatitis A and B immunizations are recommended for all infants; people whose work may expose them to blood, body fluids, or unsanitary conditions (i.e., health care, food services, sex workers); and those traveling to parts of the world where these illnesses are prevalent.

Which of the following people need to be vaccinated for hepatitis A and B? Food-service workers Truck drivers Housekeeper Postage delivery person

The gallbladder is deep to the liver and cannot normally be distinguished from the liver clinically. Because the gallbladder is deep to the liver, it is normally not amenable to direct examination by auscultation, palpation, or percussion. This does not mean, however, that cholecystitis and cholelithiasis cannot be assessed for a thorough history. The gallbladder and the spleen are not proximate.

Which of the following statements provides the most accurate guide to the assessment of the gallbladder? The margins of the gallbladder are obscured by the spleen. The gallbladder should be percussed and palpated prior to the liver to avoid confusing it with the larger organ. The gallbladder is deep to the liver and cannot normally be distinguished from the liver clinically. Cholecystitis and cholelithiasis are not amenable to diagnosis in the clinical setting.

intestinal obstruction. High-pitched tinkling and rushes of high-pitched sounds with abdominal cramping usually indicate obstruction.

While assessing the abdominal sounds of an adult client, the nurse hears high-pitched tingling sounds throughout the distended abdomen. The nurse should refer the client to a physician for possible gastroenteritis. intestinal obstruction. inflamed appendix. cirrhosis of the liver.

Dark urine may be from dehydration Cloudy urine may indicate UTI. Sediment may indicate kidney disease. Blood can be caused from renal injury, renal disease, or trauma to a catheter. Dark urine may be from dehydration.

Why is the appearance of urine important to evaluate during an abdominal examination? Blood could indicate cholecystitis Dark urine may be from dehydration Cloudy urine rules out urinary tract infection Sediment in the urine could indicate malnutrition

Murphy sign A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes a positive Murphy sign of acute cholecystitis. Hepatic tenderness may also increase with this maneuver but is usually less well localized.

You are assessing a client for acute cholecystitis. What sign would you assess for? Obstipation sign Psoas sign Murphy sign Cutaneous hyperesthesia