Final Assessment Chapter 17 Abdomen

When examining the abdomen, what is the first examination technique used? a. Inspection b. Light palpation c. Percussion d. Auscultation

ANS: A Inspection is always used as the first technique in all stages of the physical examination, including the abdomen. In the abdomen, the auscultation is completed prior to percussion or palpation. REF: p. 381

To document absent bowel sounds correctly, one must listen continuously for: a. 30 seconds. b. 1 minute. c. 3 minutes. d. 5 minutes.

ANS: D Absent bowel sounds are confirmed after listening to each quadrant for 5 minutes. REF: p. 381

You are examining the abdomen of a 45-year-old female patient. When percussing her urine-filled bladder, you will hear _______________ tones.

ANS: dull percussion Dullness is heard over organs and solid masses. A distended bladder produces dullness in the suprapubic area. REF: p. 381

Urinary incontinence that occurs from the inability to hold urine once the stimulus to urinate is perceived is called _____ incontinence.

ANS: urge Urge incontinence is the inability to delay urination once the urge to void occurs. REF: p. 415

When palpating the aorta, a prominent lateral pulsation suggests: a. an aortic aneurysm. b. normal pulsation. c. a renal artery fistula. d. a vena cava varicosity.

ANS: A Anterior pulsations of the aorta are within normal limits; lateral pulsations suggest an aortic aneurysm. REF: p. 388

Inspection of the abdomen should begin with the patient supine and the examiner: a. seated at the patient's side. b. standing at the foot of the table. c. standing at the patient's left. d. walking around the table.

ANS: A Being seated at the patient's side is the preferred initial position because it allows tangential viewing of the abdomen for improved assessment of abdominal contour. REF: p. 377

Mr. Robins is a 45-year-old man who presents to the emergency department with a complaint of constipation. During auscultation, you note borborygmi sounds. This is associated with: a. gastroenteritis. b. peritonitis. c. satiety. d. paralytic ileus.

ANS: A Borborygmi are prolonged loud gurgles that occur with gastroenteritis, early intestinal obstruction, or hunger. Peritonitis and paralytic ileus result in hypoactive bowel sounds. Food satiety does not stimulate growling sounds as does hunger. REF: p. 381

Mrs. James is 7 months pregnant and states that she has developed a problem with constipation. She eats a well-balanced diet and is usually regular. You should explain that constipation is common during pregnancy because of changes in the colorectal areas, such as: a. decreased movement through the colon and increased water absorption from the stool. b. increased movement through the colon and increased salt taken from foods. c. looser anal sphincter and fewer nutrients taken from foods. d. tighter anal sphincter and less iron eliminated in the stool.

ANS: A Constipation and flatus are more common during pregnancy because the colon is displaced, peristalsis is decreased, and water absorption is increased. Movement through the colon is decreased during pregnancy. The colon does not absorb nutrients. A tighter sphincter tone is not related to pregnancy. REF: p. 374

Peritonitis produces bowel sounds that are: a. hypoactive. b. hyperactive. c. high-pitched. d. absent.

ANS: A Hypoactive bowel sounds occur with peritonitis and paralytic ileus. REF: p. 382

Which of the following is the most useful adjunct to the history of present illness when assessing the quantity and degree of a patient's abdominal pain? a. Appetite and recall of last meal b. Family comments about the patient c. Patient's previous medical record d. Finding abdominal scars

ANS: A Inquiring about hunger and eating patterns is an important indicator. It is unlikely that hunger will persist with an acute intraabdominal infection. REF: p. 375

The family history of a patient with diarrhea and abdominal pain should include inquiry about cystic fibrosis because it is: a. a common genetic disorder. b. one cause of malabsorption syndrome. c. a curable condition with medical intervention. d. the most frequent cause of diarrhea in general practice.

ANS: B Cystic fibrosis is an uncommon, chronic genetic disorder affecting multiple systems. In the gastrointestinal tract, it causes malabsorption syndrome because of pancreatic lipase deficiency. Steatorrhea and abdominal pain from increased gas production are frequent complaints. REF: p. 377

Baby Joe is 6 months old. He has abdominal distention and vomiting and is inconsolable. A sausage-shaped mass is palpable in his right upper quadrant. Joe's lower quadrant feels empty, and a positive Dance sign is noted in his record. Which one of the following conditions is consistent with Baby Joe's symptoms? a. Intussusception b. Kidney stones c. Meconium ileus d. Pyloric stenosis

ANS: A Intussusception refers to the prolapse of one segment of the intestine into another, causing intestinal obstruction. A sausage-shaped mass may be palpated in the right or left upper quadrant, whereas the lower quadrant feels empty (positive Dance sign); it commonly occurs between 3 and 12 months of age. REF: p. 410

Flatulence, diarrhea, dysuria, and tenderness with abdominal palpation are findings usually associated with: a. diverticulitis. b. pancreatitis. c. ruptured ovarian cyst. d. splenic rupture.

ANS: A Only diverticulitis has all these presenting symptoms. REF: p. 403

When percussing a spleen, Traube's space is a: a. semilunar region. b. splenic percussion sign. c. left-sided pleural effusion. d. solid mass.

ANS: A Percussion of the spleen is more difficult because percussion tones elicited may be caused by other conditions. Traube's space is a semilunar region defined by the sixth ribs superiorly, the midaxillary line laterally, and the left costal margin inferiorly. REF: p. 383

What part of the small intestine forms a C-shaped curve around the head of the pancreas? a. Duodenum b. Ileum c. Jejunum d. Pylorus

ANS: A The C-shaped curve around the head of the pancreas is the duodenum, the first 12 inches of the small intestine. REF: p. 372

The esophagus travels a route from: a. behind the trachea through the mediastinal cavity. b. lateral to the trachea through the diaphragm. c. left of the trachea through the peritoneum. d. the anterior trachea through the cardiac orifice.

ANS: A The esophagus lies posteriorly to the trachea, descends through the mediastinal cavity and through the diaphragm, and enters the stomach. The esophagus connects the pharynx to the stomach. REF: p. 372

Which structure is located in the hypogastric region of the abdomen? a. Bladder b. Cecum c. Gallbladder d. Stomach

ANS: A The hypogastric (pubic) area contains the ileum, bladder, and pregnant uterus. REF: p. 379

The major occupant of the retroperitoneal space is the: a. kidneys. b. lungs. c. spleen. d. bladder.

ANS: A The kidneys occupy most of the retroperitoneal space, lying behind the abdominal cavity, beside the abdominal aorta. The lungs and bladder lie outside the peritoneum, but not in the retroperitoneal area. The spleen is within the peritoneum. REF: p. 373

The major function of the large intestine is: a. water absorption. b. food digestion. c. carbohydrate absorption. d. glucose storage.

ANS: A The major function of the large intestine is the absorption of water and excretion of solid waste materials in the form of stool. REF: p. 372

A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the: a. peritoneum. b. mediastinum. c. periosteum. d. hilum.

ANS: A The peritoneum is a serous membrane that lines the abdominal cavity and serves as a protective cover. REF: p. 370

Your patient is a 48-year-old woman with complaints of severe cramping pain in the abdomen and right flank. Her past medical history includes a history of bladder calculi. You diagnose her with renal calculi at this time. Which of the following symptoms would you expect with her diagnosis? (Select all that apply.) a. Abdominal pain on palpation b. Blumberg sign c. Cullen sign d. CVA tenderness e. Fever f. Grey Turner sign g. Hematuria h. Nausea

ANS: A, D, E, G Abdominal pain on palpation, CVA tenderness, fever, hematuria, and nausea are all signs and symptoms of renal calculi. The Cullen sign is ecchymosis around the umbilicus, the Blumberg sign is rebound tenderness for appendicitis, the Grey Turner sign is ecchymosis in the flanks, and the McBurney sign is rebound tenderness at McBurney's point. REF: p. 409

Failure to pass a meconium stool in the first 24 hours after birth, along with abdominal distention, are often the first signs of: a. Meckel diverticulum. b. cystic fibrosis. c. biliary atresia. d. hydramnios.

ANS: B Meconium ileus is often the first manifestation of cystic fibrosis or Hirschsprung disease. REF: p. 377

Most nutrient absorption takes place in the: a. stomach. b. small intestine. c. cecum. d. transverse colon.

ANS: B Most absorption takes place in the small intestine. Very little absorption takes place in the stomach. The cecum and transverse colon are part of the large intestine, and their major function is water resorption REF: p. 372

Infants born weighing less than 1500 g are at higher risk for: a. hepatitis A. b. necrotizing enterocolitis. c. urinary urgency. d. pancreatitis.

ANS: B Necrotizing enterocolitis is a gastrointestinal disease that mostly affects premature infants. It involves infection and inflammation that cause destruction of the bowel, and it becomes more apparent after feedings. REF: p. 377

Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: a. descending aorta. b. lower liver border. c. medial border of the spleen. d. upper right kidney ridge.

ANS: B Percussing along the right midclavicular line upward from the umbilicus determines the lower border of the liver. A liver border of more than 2 to 3 cm signifies hepatomegaly. REF: p. 381

When using the bimanual technique for palpating the abdomen, you should: a. push down with the bottom hand and the other hand on top. b. push down with the top hand and concentrate on sensation with the bottom hand. c. place the hands side by side and push equally. d. place one hand anteriorly and the other hand posteriorly, squeezing the hands together.

ANS: B The bimanual technique uses one hand on top of the other. Exert pressure with the top hand while concentrating on sensation with the other hand. REF: p. 384

The most superior part of the stomach is the: a. body. b. fundus. c. pylorus. d. pyloric orifice.

ANS: B The most superior aspect of the stomach is the fundus, followed by the body and then the most distal part, the pylorus. REF: p. 372

Before performing an abdominal examination, the examiner should: a. ascertain the patient's HIV status. b. have the patient empty his or her bladder. c. don double gloves. d. completely disrobe the patient.

ANS: B The patient should empty the bladder to ensure an accurate examination of organs and provide comfort for the patient. REF: p. 377

Which of the following organs is part of the alimentary tract? a. Pancreas b. Stomach c. Gallbladder d. Liver

ANS: B The term alimentary tract refers to the continuous tract from the mouth to the esophagus, stomach, small intestine, large intestine, and anus. REF: p. 370; 372

Contraction of the gallbladder propels bile into the: a. stomach. b. duodenum. c. jejunum. d. large intestine.

ANS: B With contraction of the gallbladder, bile is excreted into the duodenum. REF: p. 373

Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition? a. Positive psoas sign b. Positive McBurney sign c. Consistent right lower quadrant (RLQ) pain d. Rebound tenderness

ANS: C A positive psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the RLQ are signs of appendicitis. The absence of pain migration makes appendicitis less likely. REF: p. 390

Your patient is complaining of acute, intense, sharp epigastric pain that radiates to the back and left scapula, with nausea and vomiting. Based on this history, your prioritized physical examination should be to: a. percuss for ascites. b. assess for rebound tenderness. c. inspect for ecchymosis of the flank. d. auscultate for abdominal bruits.

ANS: C Abdominal pain that radiates to the back could be caused by pancreatitis or a gastric ulcer, gallbladder pain usually radiates to the right or left scapula but not to the back, pancreatitis pain can radiate to the left shoulder or scapula, and nausea and vomiting usually occur with gallbladder, pancreas, or appendix conditions. Pancreatitis is a differential diagnosis for all these symptoms, so begin the examination by inspecting the flanks for the Grey Turner sign, an indication of pancreatitis. REF: p. 390

After thorough inspection of the abdomen, the next assessment step is: a. percussion. b. palpation. c. auscultation. d. rectal examination.

ANS: C Assessment of the abdomen begins with inspection followed by auscultation. This break from the usual system examination sequence occurs because palpation and percussion can alter the frequency and intensity of bowel sounds. Therefore, auscultation is done first. REF: p. 381

A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: a. use a topical, over the counter hemorrhoid treatment for 1 week. b. exercise and eat more fiber. c. come to the laboratory for a stool guaiac test. d. eat six small meals a day.

ANS: C Blood in the stool is an abnormal finding that should never be ignored, even if it can be explained by conditions other than colon cancer. She should have her stool checked for blood now as well as annually because she is older than 50 years. REF: p. 404

In older adults, overflow fecal incontinence is commonly caused by: a. malabsorption. b. parasitic diarrhea. c. fecal impaction. d. fistula formation.

ANS: C Constipation with overflow occurs when the rectum contains hard stool and soft feces above a leak around the mass of stool. REF: p. 415

An umbilical assessment in the newborn that is of concern is: a. a thick cord. b. umbilical hernia. c. one umbilical artery and two veins. d. pulsations superior to the umbilicus.

ANS: C Expect two arteries and one vein. A single umbilical artery indicates the possibility of congenital anomalies. A thick cord suggests a well-nourished fetus, an umbilical hernia will generally close spontaneously by 2 years, and pulsations to the abdomen in the epigastric area are common. REF: p. 393

To assess for liver enlargement in the obese person, you should: a. use the hook method. b. have the patient lean over at the waist. c. auscultate using the scratch technique. d. attempt palpation during deep exhalation.

ANS: C If the abdomen is obese or distended, or if the abdominal muscles are tight, you should plan on auscultating the liver using the scratch method to estimate the lower border of the liver. REF: p. 386

Costovertebral angle tenderness should be assessed whenever you suspect that the patient may have: a. cholecystitis. b. pancreatitis. c. pyelonephritis. d. ulcerative colitis.

ANS: C Pyelonephritis is characterized by flank pain and costovertebral angle tenderness. REF: p. 408

A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. Which organ is most likely injured? a. Gallbladder b. Liver c. Spleen d. Stomach

ANS: C Spleen laceration or rupture is always suspected with abdominal injury because of the spleen's anatomic location. The patient's presenting symptoms confirm this suspicion. REF: p. 407/ Table 17-2

Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: a. gallbladder. b. kidney. c. liver. d. pancreas

ANS: C The liver is responsible for converting fat-soluble waste to water-soluble materials so that the kidneys can excrete them and convert ammonia to urea. REF: p. 373

One major function of the liver is to: a. secrete pepsin. b. emulsify fats. c. store glycogen. d. absorb bile.

ANS: C The liver plays a metabolic role; it converts glucose to glycogen, stores it, and then converts glycogen back to glucose as needed by the body REF: p. 373

Peristalsis of intestinal contents is under the control of: a. cognitive processes. b. gravity. c. the autonomic nervous system. d. the fluid content of the stomach.

ANS: C The movement of food and digestive products is regulated by the autonomic nervous system. REF: p. 372

Which organs have both an excretion function and function as endocrine glands? a. Kidney and liver b. Liver and gallbladder c. Pancreas and kidney d. Gallbladder and pancreas

ANS: C The pancreas excretes pancreatic juices and produces insulin and glucagons; the kidneys excrete urine and produce rennin and erythropoietin. Although the kidneys excrete urine and function as an endocrine gland, the gallbladder is an excretory organ that is not considered an endocrine gland. The liver and gallbladder are excretory organs and are not considered endocrine glands. Although the pancreas excretes pancreatic juices and produces insulin and glucagons, the gallbladder is an excretory organ that is not considered an endocrine gland. REF: p. 373

Which of the following is true regarding the stomach? a. It lies in the lower right quadrant of the abdomen. b. It secretes gastric lipase, which digests protein. c. Very little absorption takes place in the stomach. d. The stomach produces most of the body's bile.

ANS: C The stomach has a very small role in the absorption of nutrients. The stomach lies across the upper abdomen, not in the lower right quadrant. The stomach secretes gastric lipase, but gastric lipase does not digest protein. The stomach does not produce most of the body's bile. REF: p. 372

You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient: a. hold his or her breath. b. sit upright. c. flex his or her knees. d. raise his or her head off the pillow.

ANS: C To help relax the abdominal musculature, it is helpful to place a small pillow under the patient's head and under slightly flexed knees. The other techniques are not helpful because they increase muscle flexion. REF: p. 377

A mother brings her 2-year-old child for you to assess. The mother feels a lump whenever she fastens the child's diaper. Nephroblastoma is a likely diagnosis for this child when your physical examination of the abdomen reveals a(n): a. fixed mass palpated in the hypogastric area. b. tender, midline abdominal mass. c. olive-sized mass of the right upper quadrant. d. nontender, slightly movable, flank mass.

ANS: D A Wilms tumor (nephroblastoma) is the most common intraabdominal tumor of childhood. It presents with hypertension, fever, malaise, and a firm nontender mass deep within the flank that is only slightly movable and is usually unilateral. REF: p. 414

Mrs. Little is a 44-year-old patient who presents to the office with abdominal pain and fever. During your examination, you ask the patient to raise her head and shoulders while she lies in a supine position. A midline abdominal ridge rises. You chart this observation as a(n): a. small inguinal hernia. b. large epigastric hernia. c. abdominal lipoma. d. diastasis recti.

ANS: D A diastasis recti occurs when the abdominal contents bulge between two abdominal muscles to form a midline ridge as the head is lifted. It has little clinical significance and usually occurs in women who have had repeated pregnancies and in obese patients. REF: p. 374

When assessing abdominal pain in a college-age woman, one must include: a. history of interstate travel. b. food likes and dislikes. c. age at completion of toilet training. d. the first day of the last menstrual period.

ANS: D Exploring abdominal pain complaints in a young woman can reveal multiple causes related to the menstrual cycle, including menstrual pain, ovulation discomfort, and abnormal menses. Asking the patient to tell you the first day of her last menstrual period can help discriminate among these factors. History of international travel and traveler's diarrhea can be related to abdominal pain, but interstate travel usually does not. Food preferences and age at completion of toilet training are not relevant. REF: p. 377

The most common congenital anomaly of the gastrointestinal tract is: a. biliary atresia. b. pyloric stenosis. c. intussusception. d. Meckel diverticulum.

ANS: D Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract. REF: p. 412

The most pronounced functional change of the gastrointestinal (GI) tract in older adults is: a. decreased hydrochloric acid production. b. increased saliva secretion. c. decreased bile absorption. d. decreased motility.

ANS: D Motility of the intestine is the most pronounced GI change in older adults. REF: p. 375

Percussion of the abdomen begins with establishing: a. liver dullness. b. spleen dullness. c. gastric bubble tympany. d. overall dullness and tympany in all quadrants.

ANS: D Percussion begins with a general establishment over all quadrants for areas of dullness and tympany and then proceeds to specific target organs. REF: p. 381

A 23-year-old man comes to the urgent care clinic with intense left flank and lower left quadrant pain. A patient response to a history of present illness questions that further supports a tentative diagnosis of renal calculi is which of the following? a. "My urine has been a bright yellow." b. "I have had fever and chills for 2 days." c. "I also have a headache and neck ache." d. "My left testicle and shoulder hurt as well."

ANS: D Renal calculi present with hematuria, intermittent flank pain that radiates to the groin and genitals, and a positive Kehr sign (pain radiating to the left shoulder). REF: p. 409

The appendix is an extension of the: a. stomach. b. pancreas. c. small intestine. d. large intestine.

ANS: D The appendix is a blind-ended tube connected to the cecum, the site of the beginning of the large intestine, located in the right lower quadrant of the abdomen. It develops embryologically from the cecum REF: p. 372

When palpating the abdomen, you should note whether the liver is enlarged in the: a. left lower quadrant. b. midepigastric region. c. periumbilical area. d. right upper quadrant.

ANS: D The liver is located in the right upper quadrant of the abdomen REF: p. 372

When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? a. Arterial bruit b. Gastric rumbling c. Renal hyperresonance d. Venous hum

ANS: D Venous hum is associated with blood flow in the venous collaterals, as found in portal hypertension. Aortic bruit occurs during systole, whereas a venous hum is a continuous sound and softer than a bruit. REF: p. 381

Your patient returns to the office with multiple complaints regarding her abdomen. Which of the following are objective findings? (Select all that apply.) a. Nausea b. dullness on percussion c. rebound tenderness d. Vomiting e. Diarrhea f. burning pain in epigastrium

ANS:B, C,E, F Nausea, vomiting and diarrhea, and burning pain in epigastrium are subjective signs. Dullness on percussion and rebound tenderness are objective findings. REF: p. 409

Which intervention should the nurse do first in assessing the abdomen? Perform light palpation. Auscultate before palpation. Ask the patient to empty the bladder. Observe for scars from previous surgeries

Ask the patient to empty the bladder. The nurse should first ask the patient to empty the bladder because a full bladder will interfere with the assessment findings. Observing for scars and performing auscultation before light palpation are done after the patient is prepared for the assessment.

How does a nurse assess for pain related to peritonitis? Assess for rebound tenderness. Assess for the presence of a fluid wave. Perform light palpation in the four quadrants. Perform indirect percussion in the costovertebral angle.

Assess for rebound tenderness. Rebound tenderness is a sign of peritonitis, acute inflammation of the peritoneum. The nurse pushes slowly and deeply on a site away from the area of pain. Upon quick release, the patient has pain over the area of tenderness. Light palpation or indirect percussion of the costovertebral angle is not specific to peritonitis. Ascites is not associated with peritonitis.

What is the purpose of the liver scratch test? Assess for the presence of bruit Determine whether the patient has ascites Differentiate between cirrhosis and hepatitis Determine liver span when abdomen is distended

Determine liver span when abdomen is distended The liver scratch test is used to define liver borders in a patient with abdominal distention. Changes in sound while scratching the abdomen are heard with the stethoscope over the liver. The scratch test is not used to identify bruit or ascites or differentiate types of liver disease.

Which type of incontinence is caused by dementia in patients? Urge Stress Overflow Functional

Functional Functional incontinence occurs in persons with dementia because decreased mental capacity limits the ability to attend to the urge to void. The urge type is the uncontrollable constant need to urinate. Stress type is small volume incontinence that occurs with coughing or sneezing. Overflow type is dribbling in small amounts while the bladder remains full and overdistended.

Which condition is associated with episodes of bloating, abdominal pain, and constipation alternating with diarrhea? Diverticulitis Ulcerative colitis Colorectal cancer Inflammatory bowel disease

Inflammatory bowel disease Inflammatory bowel disease is a chronic condition with episodes of constipation and diarrhea. Diverticulitis is a condition in which outpouchings of the colon become inflamed and cause pain. Ulcerative colitis is a condition of chronic inflammation of the colon resulting in frequent bloody diarrhea. Colorectal cancer is a malignant condition causing bleeding and eventually obstruction if treated.

The nurse observes a bluish discoloration around the umbilicus in a patient (Cullen sign). What is this sign associated with? Appendicitis Umbilical hernia Liver enlargement Intraabdominal bleeding

Intraabdominal bleeding A bluish discoloration around the umbilicus is a sign of bleeding within the abdomen. An umbilical hernia causes a bulge at the umbilicus. Liver enlargement is detected by percussing the borders of the liver. Rebound tenderness in the right lower quadrant is associated with appendicitis.

An infant develops severe abdominal pain, keeps his legs pulled to his abdomen, and has light red mucous stools. What condition do these symptoms suggest? Pyloric stenosis Intussusception Nephroblastoma Hirschsprung disease

Intussusception The clinical picture suggests intussusception, a condition in which a segment of bowel telescopes into another causing obstruction. Pyloric stenosis is hypertrophy of the pyloric sphincter causing projectile vomiting in the neonate. Nephroblastoma is a malignancy of the kidney causing an abdominal mass in children 2 to 3 years old. Hirschsprung disease is a congenital absence of innervation of the colon causing constipation and requiring surgery.

The nurse assesses hypoactive and absent bowel sounds in the four quadrants of the abdomen in a female patient. Which finding from the patient history is likely the cause? (Select all that apply.) Has stress incontinence Takes diuretic medication daily History of essential hypertension Abdominal hysterectomy 3 years ago Takes narcotic analgesics for recent shoulder injury

Takes diuretic medication daily Takes narcotic analgesics for recent shoulder injury Taking a diuretic predisposes the patient to hypokalemia, a cause of decreased peristalsis. Taking narcotics also decreases peristaltic activity. The history of stress incontinence, essential hypertension, and past abdominal hysterectomy are not significant to decreased peristalsis.

Which method should the nurse use to determine if a patient has ascites? (Select all that apply.) Perform the iliopsoas muscle test. Observe a bulge at the umbilicus. Test for a fluid wave in the abdomen. Test for shifting dullness in the abdomen. Perform light palpation for right upper quadrant tenderness.

Test for a fluid wave in the abdomen. Test for shifting dullness in the abdomen. The nurse notes a fluid wave by striking the side of the abdomen with the patient supine and feeling the fluid wave impulse on the opposite side. Shifting dullness is detected by percussing dullness with the patient supine and noting a shift in the dullness when the patient turns on his side. The iliopsoas muscle test is used to assess pain related to appendicitis. A bulge at the umbilicus may be present with ascites but is actually caused by a hernia. Tenderness in the right upper quadrant may be associated with cholelithiasis.

Under which circumstance is it appropriate to use direct or indirect percussion with a closed fist during assessment? To locate the border of the spleen To test for tenderness of the kidney To determine the lower border of the liver To locate areas of tympany in the abdominal cavity

To test for tenderness of the kidney Direct or indirect percussion with a closed fist is used to elicit areas of tenderness of the kidney. Tenderness is noted in the costovertebral angle. A spleen that is palpable in the left upper quadrant is usually enlarged. Percussing with fingers is the technique used to detect the lower border of the liver and areas of tympany in the abdomen.