Chapter 13: Abdomen and Gastrointestinal System

Which location does a nurse select when palpating a patient's liver? a. A (right lower quadrant) b. B (right upper quadrant) c. C (left upper quadrant) d. D (left lower quadrant)

ANS: B The majority of the liver is located in the right upper quadrant of the abdomen. C is the left upper quadrant. D is the left lower quadrant. REF: p. 256

A patient reports a change in the usual pattern of urination. What question does the nurse ask to determine if incontinence is the reason for these symptoms? a. "Do you have the feeling that you cannot wait to urinate?" b. "Are you urinating a large amount each time you go to the bathroom?" c. "Has the color of your urine changed lately?" d. "Have you noticed any swelling in your ankles at the end of the day?"

ANS: A "Do you have the feeling that you cannot wait to urinate?" is a question that asks about urgency, a symptom of incontinence. Are you urinating a large amount each time you go to the bathroom?" is not a question related to incontinence. Usually patients with incontinence void frequently in small amounts. "Has the color of your urine changed lately?" is a question that is asked when the nurse suspects the patient has gallbladder or liver disease. "Have you noticed any swelling in your ankles at the end of the day?" is a question that relates to patients who have renal or heart disease. REF: p. 249 | p. 250 | p. 253

What instructions does the nurse give a patient before palpating the abdomen? a. Bend the knees. b. Take a deep breath and hold it. c. Take a deep breath and cough. d. Place the hands over the head.

ANS: A Bend the knees to relax the abdominal muscles. Taking a deep breath and hold it is not needed to assess the abdomen. Taking a deep breath and coughing is used to detect bulges in the abdomen, but not used before palpation. Placing the hands over the head is not needed to assess the abdomen. REF: p. 257

A patient tells the nurse, "I've been having pain in my belly for several days that gets worse after eating." Which datum from the symptom analysis is consistent with the nurse's suspicion of peptic ulcer disease? a. Gnawing epigastric pain radiates to the back or shoulder that worsens after eating. b. Sharp midepigastric pain radiates to the jaw. c. Intermittent cramping pain in the left lower quadrant is relieved by defecation. d. Colicky pain is felt near the umbilicus with vomiting and constipation.

ANS: A Gnawing epigastric pain that radiates to the back or shoulder and worsens after eating is a symptom that is consistent with peptic ulcer disease. Sharp midepigastric pain that radiates to the jaw is not a symptom of peptic ulcer disease. Intermittent cramping pain in the left lower quadrant relieved by defecation is a symptom of diverticular disease rather than peptic ulcer disease. Colicky pain felt near the umbilicus with vomiting and constipation is a symptom of an intestinal obstruction rather than peptic ulcer disease. REF: p. 251 | p. 267

The nurse recognizes which clinical finding as expected on palpation of the abdomen? a. Inability to palpate the spleen b. Left kidney rounded at 2 cm below the costal margin c. Slight tenderness of the gallbladder on light palpation d. Bounding pulsation of the aorta over the umbilicus

ANS: A Inability to palpate the spleen is the expected finding on palpating the abdomen. A rounded left kidney at 2 cm below the costal margin is not an expected finding. Kidneys are usually not palpated. Slight tenderness of the gallbladder on light palpation is not an expected finding; the gallbladder is usually not palpable. Bounding pulsation of the aorta over the umbilicus would be an abnormal finding, perhaps indicating an aneurysm. REF: p. 261

A nurse notices abdominal distention when inspecting a patient's abdomen. What action does the nurse take next to gain further objective data? a. Place a measuring tape around the superior iliac crests. b. Assist the patient to turn on to the left side and then the right side. c. Ask the patient to cough while lying supine. d. Use the fingertips to sharply strike one side of the abdomen.

ANS: A Placing a measuring tape around the superior iliac crests is the procedure for measuring abdominal girth. Assisting the patient to turn on to the left side and then the right side is unnecessary. The distention will remain in a side-lying position. Having the patient cough is used to assess for bulges rather than distention. Using the fingertips to sharply strike one side of the abdomen is part of the procedure to test for a fluid wave, which is not indicated in this patient. REF: p. 255

On palpation of the left upper quadrant of the abdomen of a female patient, the nurse notes tenderness. This finding may indicate a disorder in which organ? a. Spleen b. Gallbladder c. Sigmoid colon d. Left ovary

ANS: A The spleen is located in the left upper quadrant of the abdomen. The gallbladder is located in the right upper quadrant of the abdomen. The sigmoid colon is located in the left lower quadrant of the abdomen. The left ovary is located in the left lower quadrant of the abdomen. REF: p. 256

Which sound does a nurse expect to hear when percussing a patient's abdomen? a. Tympany over all quadrants b. Resonance over the upper quadrants and tympany in the lower quadrants c. Dull sounds over the upper quadrants and hollow sounds over the lower quadrants d. Dull sounds over the stomach and resonant sounds over the bladder

ANS: A Tympany over all quadrants is a normal finding, which represents the presence of gas. Resonance in the upper quadrants and tympany over the lower quadrants are not normal findings. There would be tympany in the lower quadrants, but also in the upper quadrants. Dull sounds over the lower quadrants and hollow sounds over the upper quadrants are not normal findings. There would be tympany over the lower quadrants, but also in the upper quadrants. Dull sounds over the stomach and resonant sounds over the bladder are not normal findings. REF: p. 259

Alcoholism increases the risk of cancers of the gastrointestinal tract. Which cancer risk is increased in patients with alcoholism? (Select all that apply.) a. Esophageal cancer b. Stomach cancer c. Pancreatic cancer d. Liver cancer e. Colon cancer f. Bladder cancer

ANS: A, B, D, E The risk of esophageal, liver, and colon cancers are increased by heavy intake of alcohol. REF: p. 249 | p. 253

A patient reports having abdominal distention. The nurse notices that the patient's sclerae are yellow. What question is appropriate for the nurse to ask in response to this information? a. "Has there been a change in your usual pattern of urination?" b. "Have you had any nausea or vomiting?" c. "Has there been a change in your bowel habits?" d. "Have you had indigestion or heartburn?"

ANS: B "Have you had any nausea or vomiting?" is an appropriate question because the nurse suspects the patient may have a liver disease based on the abdominal distention and jaundice. The nurse interprets the relationship with data gathered from the history and the observation. "Has there been a change in your usual pattern of urination?" is not a question related to the abdominal distention and jaundice. "Has there been a change in your bowel habits?" is a question that may be related to the abdominal distention, but not the jaundice. "Have you had indigestion or heartburn?" is not a question related to the abdominal distention and jaundice. It applies more to gastric disorders, such as gastroesophageal reflux disease or hiatal hernia. REF: p. 252 | p. 253

What technique does a nurse use when performing deep palpation of a patient's abdomen? a. Places the left hand under the ribs to lift them up b. Asks the patient to breathe slowly through the mouth c. Positions the patient on the right side with knees flexed d. Uses the heel of the hand to depress the abdomen

ANS: B Asking the patient to breathe slowly through the mouth while the nurse uses the pads of the fingers to depress the abdomen is the correct procedure. Placing the left hand under the ribs to lift them up is the technique for palpating the liver. Positioning the patient on the right side with knees flexed is an alternate strategy for palpating the spleen. Using the heel of the hand to depress the abdomen is not a correct technique; the pads of the fingers are used. REF: p. 258

A nurse inspects the abdomen for skin color, surface characteristics, and surface movement. What part of the abdominal assessment does the nurse perform next? a. Light palpation for tenderness and muscle tone b. Ausculation of the bowel sounds in all four quadrants c. Deep palpation for masses or aortic pulsation d. Percussion for tones in all four quadrants

ANS: B Auscultation for bowel sounds occurs before palpating and percussing the abdomen. Palpating lightly for tenderness and muscle tone is performed after auscultation. Palpating deeply for masses or aortic pulsation is performed after light palpation. Percussion for tones is performed after palpation. REF: p. 256

During an assessment for abdominal pain, a patient reports a colicky abdominal pain and pain in the right shoulder that gets worse after eating fried foods. What question does the nurse ask to confirm the suspicion of cholelithiasis? a. "Have you noticed any swelling in your ankles or feet at the end of the day?" b. "Have you noticed a change in the color of your urine or stools?" c. "Have you vomited up any blood in the last 24 hours?" d. "Have you experienced fever, chills, or sweating?"

ANS: B Gallstones can obstruct the flow of bile to the gastrointestinal tract making urine darker and stools lighter in color. The question "Have you noticed any swelling in your ankles or feet at the end of the day?" is related to fluid retention, which may be asked if the patient has renal or heart failure. The question "Have you vomited up any blood in the last 24 hours?" applies if the patient has peptic ulcer disease or esophageal varices. The question "Have you experienced fever, chills, or sweating?" applies if the patient has gastroenteritis or a urinary tract infection. REF: p. 251 | p. 268

A patient reports having abdominal distention. The nurse observes that the patient's sclerae are yellow. Which abnormal finding does the nurse anticipate on examination of this patient's abdomen? a. Decreased bowel sounds in all quadrants b. Glistening or taut skin of the abdomen c. Bulge in the abdomen when coughing d. Bruit around the umbilicus

ANS: B Glistening or taut skin of the abdomen is consistent with ascites that appear as abdominal distention. Jaundice and ascites suggest liver disease. There would also be an increase in abdominal girth. Decreased bowel sounds in all quadrants may be present if the abdominal distention was from an intestinal obstruction, but the observation of jaundice suggests liver disease, which does not decrease bowel sounds. A bulge in the abdomen when coughing is a finding associated with abdominal or incisional hernias. Bruit around the umbilicus is a finding associated with an abdominal aortic aneurysm. REF: p. 255

How does the nurse accurately assess bowel sounds? a. Press the diaphragm of the stethoscope firmly against the abdomen in each quadrant. b. Hold the diaphragm of the stethoscope lightly against the abdomen in each quadrant. c. Press the bell of the stethoscope firmly against the abdomen in each quadrant. d. Hold the bell of the stethoscope lightly against the abdomen in each quadrant.

ANS: B Holding the diaphragm lightly against the abdomen in each quadrant is the correct technique for listening to bowel sounds. Pressing the diaphragm of the stethoscope firmly against the abdomen in each quadrant is not the correct technique for listening to bowel sounds. The bell is used to listen to vascular sounds of the abdomen, which are normally not heard. The bell is used to listen to vascular sounds of the abdomen, which are normally not heard. REF: p. 256

Which assessment technique is the nurse performing in the figure below? a. Direct percussion b. Indirect percussion c. Light palpation d. Deep palpation

ANS: B Indirect percussion is the technique shown. Direct percussion is performed with one hand. Light palpation is performed using the pads of the fingers depressing the tissue 1 to 2 cm, usually on the abdomen. Deep palpation is performed using the pads of the fingers depressing the tissue 4 to 6 cm, usually on the abdomen. REF: p. 259

When inspecting a patient's abdomen, the nurse notes which finding as abnormal? a. Protruding abdomen with skin that is lighter in color than the arms and legs b. Marked, widely lateral pulsating mass to the left of the midline c. Faint, fine vascular network d. Small shadows created by changes in contour

ANS: B Marked wide, bounding, laterally pulsating mass to the left of the midline is an abnormal finding that may indicate an abdominal aortic aneurysm. Obesity may cause a protruding abdomen and although obesity is not an indicator of health, it does not necessarily indicate a disease is present. A faint, fine vascular network is a normal finding. If the vessels were engorged, it would be an abnormal finding. Small shadows created by changes in contour are a normal finding and they are seen by using a light source to inspect the contour. REF: p. 258

When assessing the abdomen of a patient who has fluid in the peritoneal cavity, the nurse expects what change to occur when the patient turns from supine to the left side? a. Movement of the tympanic tones from lateral in the supine position to closer to midline when lying on the left side b. Movement of the dull tones from lateral in the supine position to closer to midline when lying on the left side c. Change in bowel sounds from hypoactive in the supine position to hyperactive when lying on the left side d. Change in bowel sounds from hyperactive in the supine position to hypoactive when lying on the left side

ANS: B Movement of the dull tones from lateral in the supine position to closer to midline when lying on the left side is the expected change when assessing for shifting dullness. Movement of the tympanic tones from lateral in the supine position to closer to midline when lying on the left side is incorrect because the tone will be dull, rather than tympanic, due to the fluid. A change in bowel sounds from hypoactive in the supine position to hyperactive when lying on the left side is incorrect because bowel sounds would not be affected by the fluid. A change in bowel sounds shifting from hyperactive in the supine position to hypoactive when lying on the left side is incorrect because bowel sounds would not be affected by the fluid. REF: p. 265

In assessing a patient with renal disease, the nurse palpates edema in both ankles and feet. Based on this finding, what question does the nurse ask the patient? a. "Have you had any pain in your abdomen?" b. "Have you had an unexpected weight gain?" c. "Have you noticed a change in the color of your skin?" d. "Have you had any nausea or vomiting?"

ANS: B The question "Have you had an unexpected weight gain?" relating to weight gain and edema suggests fluid retention that occurs with renal or heart disease, particularly renal failure. The question "Have you had any pain in your abdomen?" does not relate to renal disease. The pain experienced with renal disease is usually flank pain over the costovertebral angle. The question "Have you noticed a change in the color of your skin?" does not relate to renal disease. It might relate to liver or gallbladder disease if the change in skin color was yellow, indicating jaundice. The question "Have you had any nausea or vomiting?" usually relates to disorders within the gastrointestinal tract itself and not renal disease. REF: p. 253

A nurse suspects appendicitis in a patient with abdominal pain. Which findings are suggestive of appendicitis? (Select all that apply.) a. Pain radiating to the right shoulder b. Pain around the umbilicus c. Pain relieved by lying still d. Right lower quadrant pain e. Increased peristalsis

ANS: B, C, D Options B, C, and D are all descriptions of pain related to appendicitis. Pain radiating to the right shoulder is associated with gallbladder disease. Increased peristalsis can be associated with gastroenteritis or diarrhea. REF: p. 251

A patient reports having abdominal distention and having vomited several times yesterday and today. What question is appropriate for the nurse to ask in response to this information? a. "Has there been a change in your usual pattern of urination?" b. "Did you have heartburn before the vomiting?" c. "What did the vomitus look like?" d. "Have you noticed a change in the color of your urine or stools?"

ANS: C "What did the vomitus look like?" is an appropriate question because the characteristics of the vomitus may help determine its cause. Acute gastritis leads to vomiting of stomach contents, obstruction of the bile duct results in greenish-yellow vomitus, and an intestinal obstruction may cause a fecal odor to the vomitus. "Has there been a change in your usual pattern of urination?" is not a question related to abdominal distention and vomiting. Have you noticed a change in the color of your urine or stools?" is not a question related to abdominal distention and vomiting. It is related to elevated bilirubin from liver or gallbladder disease and is accompanied by jaundice. Option D is not a question related to the abdominal distention and vomiting. Heartburn applies more to gastric disorders, such as gastroesophageal reflux disease or hiatal hernia. REF: p. 252

A 75-year-old male patient asks how to reduce his risk of esophageal cancer. What is the nurse's most appropriate response? a. "Don't worry about it, esophageal cancers have a low incidence in men." b. "You should not be concerned about esophageal cancer at your age." c. "You should consider limiting your alcohol intake to two drinks per day." d. "Increasing the fiber and protein in your diet can help you lower your risk."

ANS: C "You should consider limiting your alcohol intake to two drinks per day. Long-term alcohol intake increases your risk for esophageal cancer." Men have a rate three times that of women. The risk increases with age, with the peak between 70 and 80 years. Although fiber and protein are important for the diet, their intake does not affect the risk of esophageal cancer. REF: p. 249

When palpating the abdomen to determine a floating mass, a nurse presses on the abdomen at a 90-degree angle with the fingertips. Which finding indicates a mass? a. An increase in abdominal girth. b. A complaint from the patient of a dull pain in the flank area. c. A freely movable mass will float upward and touch the fingertips. d. Fluid in the abdomen will shift upward and touch the fingertips.

ANS: C A freely movable mass floating upward and touching the fingertips is the expected finding (ballottement). An increase in abdominal girth does not occur as a result of ballottement. A complaint from the patient of a dull pain in the flank area is not an expected finding. Fluid in the abdomen shifting upward and touching the fingertips does not occur; it is the mass on the abdomen that shifts upward. REF: p. 265

Which techniques does a nurse use to palpate a patient's right kidney? a. Asks the patient to take a deep breath, elevates the patient's eleventh and twelfth ribs with the left hand, and deeply palpates for the right kidney with the right hand. b. Asks the patient to exhale, elevates the patient's eleventh and twelfth ribs with the left hand, and deeply palpates for the right kidney with the right hand. c. Asks the patient to take a deep breath, elevates the patient's right flank with the left hand, and deeply palpates for the right kidney with the right hand. d. Asks the patient to exhale, elevates the patient's right flank with the left hand, and deeply palpates for the right kidney with the right hand.

ANS: C Asking the patient to take a deep breath, elevating the patient's right flank with the left hand, and deeply palpating for the right kidney with the right hand is the correct technique. Asking the patient to take a deep breath, elevating the patient's eleventh and twelfth ribs with the left hand, and deeply palpating for the right kidney with the right hand is incorrect because the flank is elevated rather than the ribs. Asking the patient to exhale, elevating the patient's eleventh and twelfth ribs with the left hand, and deeply palpating for the right kidney with the right hand is incorrect because the flank is elevated rather than the ribs and the patient is asked to inhale rather than exhale. Asking the patient to exhale, elevating the patient's right flank with the left hand, and deeply palpating for the right kidney with the right hand is incorrect because the patient is asked to inhale rather than exhale. REF: p. 263

On inspection of a female patient's abdomen, the nurse asks the patient to raise her head without using her arms and notes a midline bulge. What is the appropriate response of the nurse at this time? a. Ask the patient to hold her breath to see if the bulge reappears. b. Auscultate the patient's abdomen for hypoactive bowel sounds. c. Document this as a normal finding and continue the examination. d. Perform light palpation of the abdomen.

ANS: C Document this as a normal finding and continue the examination. This is a normal finding on a patient. Ask the patient to cough; not holding her breath would cause the bulge to appear. A bulge that appears with coughing is an abnormal finding revealed by the increase in intrathoracic pressure during the cough. This would occur with a hernia. The abdomen should not bulge when the client raises their head. It would bulge when the patient coughs, laughs, or strains causing an increase in intra-abdominal pressure. Auscultating the patient's abdomen for hypoactive bowel sounds is not indicated because the bulge is a normal finding. Performing light palpation of the abdomen revealing a bulge indicates a hernia, a mass protruding through the abdominal muscular wall. REF: p. 255

To correctly percuss the abdomen, a nurse places the distal aspect of the middle finger of the nondominant hand against the skin of the abdomen, and the other fingers are spread apart and slightly lifted off the skin. How does the nurse use the fingers of the dominant hand? a. The pad of the middle finger strikes the distal interphalangeal joint of the middle finger touching the skin of the abdomen. b. The tip of the middle finger strikes the nail of the middle finger touching the skin of the abdomen. c. The tip of the middle finger strikes the distal interphalangeal joint of the middle finger touching the skin of the abdomen. d. The pads of the index and middle fingers strike the nail of the middle finger touching the skin of the abdomen.

ANS: C Option C is the correct technique. The description in Option A is incorrect because the tip of the finger is used rather than the pad. The description in option B is incorrect because the distal joint is struck rather than the nail. The description in option D is incorrect because the tip of the middle finger strikes the distal joint. REF: p. 258

A patient reports intermittent cramping abdominal pain that is relieved by having a bowel movement. The patient complains of having the pain at this time, which is why she is seeking care. Which abnormal finding does the nurse anticipate finding on examination of this patient's abdomen? a. Decreased bowel sounds b. Bulge in the abdomen when coughing c. Palpable mass in the left lower quadrant d. Bruit around the umbilicus

ANS: C Palpable mass in the left lower quadrant is expected when interpreted with other data—age of the patient, intermittent cramping abdominal pain relieved by a bowel movement—as consistent with diverticular disease. Decreased bowel sounds are not expected if the patient is having bowel movements. Bulge in the abdomen when coughing is a finding associated with abdominal or incisional hernias. Bruit around the umbilicus is a finding associated with an abdominal aortic aneurysm. REF: p. 251

The nurse observes a patient rocking back and forth on the examination table in pain. Based on the patient's history, the nurse suspects kidney stones. What additional examination technique does the nurse perform to confirm this suspicion? a. Palpating the flank area for rebound tenderness b. Percussing the bladder for fullness c. Percussing the costal vertebral margins for tenderness d. Palpating McBurney point for tenderness

ANS: C Percussing the costal vertebral margins for tenderness is the appropriate technique to detect kidney stones. The nurse recognizes the relationship between the history and the observation with further assessment techniques needed to confirm kidney stones. Palpating the flank area for rebound tenderness is the correct location (flank area), but rebound tenderness is performed on the abdomen to detect peritoneal inflammation. Percussing the bladder for fullness would provide data about bladder distention, but is not a technique to detect for kidney stones. Palpating McBurney point for tenderness is a technique to detect appendicitis. REF: p. 264

When assessing an adult's liver, the nurse percusses the lower border and finds it to be 5 cm below the costal margin. What is the nurse's appropriate action at this time? a. Document this as an expected finding for this adult. b. Palpate the gallbladder for tenderness. c. Percuss downward beginning in the right midclavicular line. d. Use the hooking technique to palpate the lower border of the liver.

ANS: C Percussing the upper border of the liver is the correct technique to use when an enlarged liver is found (as indicated by the liver being percussed 5 cm below the costal margin) to determine the liver span. Documenting this as a normal finding for an adult patient is incorrect because this finding indicates an enlarged liver. Palpating the gallbladder for tenderness is not indicated for an enlarged liver. Using the hooking technique to palpate the lower border of the liver is not needed because the liver is enlarged. REF: p. 259 | p. 260

When auscultating a patient's abdomen using the bell of the stethoscope, the nurse hears soft, low-pitched murmurs over the right and left upper midline. What do these sounds indicate? a. Expected peristalsis b. Femoral artery stenosis c. Renal artery stenosis d. Hyperactive bowel sounds

ANS: C Renal artery stenosis is a vascular sound heard with the bell and located in the upper abdomen. Expected peristalsis would be heard using the diaphragm of the stethoscope and would be a gurgling sound. Femoral artery stenosis is a vascular sound heard with the bell, but located in the lower abdomen. Hyperactive bowel sounds would be heard using the diaphragm and would be present in all quadrants. REF: p. 257

Put in correct order the steps used to palpate the liver. a. Place your right hand parallel to the right costal margin. b. Ask the patient to take a deep breath and hold it. c. Lift up the eleventh and twelfth ribs with the left hand. d. Press your right hand down and under the coastal margin. e. Assess the border and contour of the liver.

ANS: C, A, B, D, E REF: p. 259 | p. 260

A patient reports having frequent heartburn. Which question does the nurse ask in response to this information? a. "Has your abdomen been distended when you feel the heartburn?" b. "What have you eaten in the last 24 hours?" c. "Is there a history of heart disease in your family?" d. "How long after eating do you have heartburn?"

ANS: D Asking "How long after eating do you have heartburn?" can aid in determining if the patient has gastroesophageal reflux disease or a hiatal hernia. Both are common disorders that cause indigestion a few hours after meals. The question "Has your abdomen been distended when you feel the heartburn?" is not related to the heartburn. Distention usually is related to intestinal obstruction or liver disease. The question "What have you eaten in the last 24 hours?" relates more to gastroenteritis. Indigestion is usually caused by food eaten in the last meal rather than in the last 24 hours. The question "Is there a history of heart disease in your family?" points to myocardial ischemia. Although heartburn may be a symptom of myocardial ischemia, asking the patient about the family history is not relevant in this case. REF: p. 267

Using deep palpation of a patient's epigastrium, a nurse feels a rhythmic pulsation of the aorta. Based on this finding, what is the nurse's most appropriate response? a. Auscultate this area using the bell of the stethoscope. b. Percuss the area for tones. c. Ask the patient if there is pain in this area. d. Document this as a normal finding.

ANS: D Document this as a normal finding. The aorta is often palpable at the epigastrium. Auscultating this area using the bell of the stethoscope is not necessary because this is a normal finding. Vascular sounds are usually not heard. Percussing the area for tones is not necessary because this is a normal finding. Asking the patient if there is pain in this area is not necessary because this is a normal finding. REF: p. 258

A nurse expects which finding when assessing the abdomen of a patient who has been unable to void for 12 hours? a. Absent bowel sounds b. Hyperactive bowel sounds c. Tympanic tones over the lower abdomen d. Dull tones over the suprapubic area

ANS: D Dull tones over the suprapubic area would be found. The urine in the bladder would create a dull sound when the bladder is percussed similar to the sounds when an abdominal mass is present. Absent bowel sounds is incorrect because the bowel sounds would not be affected by a full bladder. Hyperactive bowel sounds is incorrect because the bowel sounds would not be affected by a full bladder. Tympanic tones over the lower abdomen is incorrect because tympany sound is created by gas in the abdomen. REF: p. 259

The patient reports right lower quadrant (RLQ) pain that is worse with coughing. Based on the patient's history, the nurse suspects appendicitis. What additional examination technique does the nurse perform to confirm this suspicion? a. Placing the hand over the lower right thigh and asking the patient to flex the knee while pushing down on the knee to resist it and noting if the patient complains of pain b. Palpating deeply a point of the abdomen, located halfway between the umbilicus and the left anterior iliac crest c. Asking the patient to flex the right hip and knee to 90 degrees, then abducting the leg and noting if the patient complains of pain d. Pressing down in an area away from the RLQ at a 90-degree angle to the abdomen, then releasing the fingers quickly and noting any complaint of pain

ANS: D Option D describes rebound tenderness, which is performed to detect peritoneal inflammation. Option A is an incorrect description of the iliopsoas muscle test. Option B is an incorrect description of the testing for McBurney point. McBurney point is located to the right of the umbilicus. Option C is an incorrect description of the obturator muscle test. REF: p. 251 | p. 265

Which patient has the lowest risk for colon cancer? a. Patient A is 50 years old, is obese, and has type 2 diabetes mellitus. b. Patient B is 60 years old, has alcoholism, and smokes a pack of cigarettes daily. c. Patient C is 55 years old, has ulcerative colitis, and inflammatory bowel disease. d. Patient D is 45 years old and has diverticulosis.

ANS: D Patient D has the lowest risk of colon cancer. Ninety percent of colon cancers occur in adults older than 50 years of age. Although this patient does have a disorder of the colon, it is not linked to an increased risk of colon cancer. Patient A has three risk factors for colon cancer. Patient B has three risk factors for colon cancer. Patient C has two risk factors for colon cancer. REF: p. 249

When inspecting a patient's abdomen, which finding does the nurse note as normal? a. Engorgement of veins around the umbilicus b. Sudden bulge at the umbilicus when coughing c. Visible peristalsis in all quadrants d. Silver-white striae extending from the umbilicus

ANS: D Silver-white striae extending from the umbilicus is a normal finding, particularly in women who have been pregnant or in any adult who has lost weight after having an obese abdomen. Engorgement of veins around the umbilicus is an abnormal finding. Sudden bulge at the umbilicus when coughing is an abnormal finding and may indicate a hernia. Visible peristalsis in all quadrants is an abnormal finding. REF: p. 255

What sound does a nurse expect to hear when using the bell of the stethoscope over the epigastric area of the abdomen of a healthy patient? a. Bowel sounds b. Venous hum c. Soft, low-pitched murmur d. No sounds

ANS: D The bell is used to listen for vascular sounds and normally no vascular sounds are heard in the abdomen. Bowel sounds are heard with the diaphragm of the stethoscope. Venous hum is not a normal finding. Soft, low-pitched murmur is not a normal finding. REF: p. 257