GI/Abdomen Review

A client is complaining of pain in the right upper quadrant and also in the right shoulder. Which organ would the nurse suspect as being involved? A) Gall bladder B) Kidneys C) Stomach D) Pancreas

A) Gall bladder

LUQ inferior to the diaphragm at the left MCL

stomach

A 33-year-old mother of three has visited the clinic seeking a solution to the fact that when she laughs hard or coughs she experiences an involuntary and embarrassing discharge of urine. Which of the following health problems most likely underlies her complaint?

stress incontenence

Mr. Martin is a 72-year-old smoker who comes to you for his hypertension visit. You note that with deep palpation you feel a pulsatile mass which is about 4 centimeters in diameter. What should you do next? A) Obtain abdominal ultrasound B) Reassess by examination in 6 months C) Reassess by examination in 3 months D) Refer to a vascular surgeon

A) Obtain abdominal ultrasound

During the abdominal exam, the nurse supports the client's right knee and ankle, flexing the client's hip and rotating the leg internally and externally. At this point, the client reports pain in the RLQ. This test is positive for which sign? A) Obturator B) Psoas C) Rovsing's D) Murphy's

A) Obturator The obturator sign or Cope's obturator test is an indicator of irritation to the obturator internus muscle. The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession. The patient lies on her/his back with the hip and knee both flexed at ninety degrees. Based on the principle that stretching a pelvic muscle irritated by an inflamed appendix causes pain.

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? A) Positive Rovsing's sign B) Psoas sign C) Obturator sign D) Positive skin hypersensitivity test

A) Positive Rovsing's sign

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? A) The client is more vulnerable to impaired nutrition due to decreased appetite. B) The client will have greater bowel motility than a younger adult. C) The client derives less nutritional value from food because of decreased enzyme production. D) The client's liver will be significantly larger than a younger client.

A) The client is more vulnerable to impaired nutrition due to decreased appetite.

When performing an abdominal examination on a client, which assessment technique should the nurse perform first? A) inspection B) auscultation C) palpation D) percussion

A) inspection

The nurse is percussing a client's abdomen. What predominant sound should the nurse expect to hear over the majority of the abdomen? A) tympany B) dullness C) hyperresonance D) accentuated tympany

A) tympany

The nurse auscultates Mr. Jacob's bowel sounds. What is the normal frequency of bowel sounds? A.5 to 30 times per minute B.1 to 3 times per minute C.30 to 60 times per minute D.Every 5 minutes

A. 5 to 30 times per minute

During the percussion of the abdomen, you note a tympanic area in the LUQ, you would: A.Chart this as a normal finding. B.Chart this as an abnormal finding. C.Refer patient to physician since this may be a mass. D.Follow up with deep palpation.

A.Chart this as a normal finding.

After obtaining health history data, the nurse should perform the abdominal physical assessment steps in which sequence? A.Inspection, auscultation, percussion, palpation B.Inspection, percussion, palpation, and auscultation C.Auscultation, inspection, palpation, percussion D.Inspection, palpation, percussion, and auscultation

A.Inspection, auscultation, percussion, palpation

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? a) It is a splenic rub. b) It is a variant of bowel noise. c) It represents borborymi. d) It is a vascular noise.

a) 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

Some changes that appear on the skin of the abdomen as a result of pregnancy are what? a) Linea nigra b) Striae c) Everted umbilicus d) Hemorrhoids e) Inverted umbilicus

a) Linea nigra b) Striae e) Inverted umbilicus

When inspecting the abdomen, which of the following client positions facilitates correct examination technique? a) Supine with arms at sides or folded across chest b) Trendelenberg with hands over head c) Sitting with hands on hips d) Semi-fowler's with pillows under head and knees

a) Supine with arms at sides or folded across chest

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

a) The gallbladder is deep to the liver and cannot normally be distinguished from the liver clinically.

When reviewing the medications currently taken by a 50-year-old client who is complaining of constipation, teaching is indicated when the nurse notes which medication? A) antacid B) vitamin with iron C) nonsteroidal anti-inflammatory drug D) antidepressant

B) vitamin with iron

Mr. Belland is admitted for a GI workup with a diagnosis of dysphagia. This means: A.Pain when eating B.Difficulty with swallowing C.Frequent belching and regurgitation of food D.Pain with urination

B.Difficulty with swallowing

Sally, age 15, comes to the ER with a complaint of abdominal pain. Palpation reveals rebound tenderness in the RLQ. The nurse may suspect that the problem may be related to the:

appendix

The test for fluid wave is used to identify what?

ascites

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? a) Inflammatory bowel disease b) Colon cancer c) Irritable bowel syndrome d) Cholecystitis

c) Irritable bowel syndrome

What precaution should the nurse take when measuring a client's abdominal girth to screen for cardiovascular risk factors? a) Ask the client to be seated and relaxed when taking the measurement b) Inform the client that the pen mark on the abdomen should not be washed off c) Place the tape measure behind the client and measure at the umbilicus d) Ensure that the client has had a full meal before measuring the abdomen

c) Place the tape measure behind the client and measure at the umbilicus

A nurse is assessing a male client's abdomen. Which of the following would lead the nurse to suspect a problem? a) Symmetric appearance b) No bulging with head raising c) Visible peristaltic waves d) Abdominal respiratory movements

c) Visible peristaltic waves Peristaltic waves are typically only present in very thin people.

Which of the following acute abdominal symptoms could be life threatening? a) Indigestion b) Striae c) Kidney stones d) Abdominal pain

d) Abdominal pain

A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should the nurse measure to assess improvement? a) Palpate the abdomen b) Perform percussion for tympany c) Auscultate for bowel sounds d) Measure abdominal girth

d) Measure abdominal girth

Which of the following is consistent with obturator sign? a) Pain with extension of the right thigh while the client is on the left side or while pressing the knee against the examiner's hand with thigh flexion b) Pain in the right upper quadrant that stops inhalation c) Pain distant from site used to check rebound tenderness d) Right hypogastric pain with the right hip and knee flexed, and the hip internally rotated

d) Right hypogastric pain with the right hip and knee flexed, and the hip internally rotated

The nurse is admitting a new patient to the floor and asks if the patient has any dizziness. Why does the nurse do this? a) To check for an absorption problem b) To assess for pancreatic problems c) To assess for heart problems d) To check for possible dehydration

d) To check for possible dehydration

LUQ inferior to the diaphragm at the left MAL

spleen

The ______ functions primarily to filter the blood of cellular debris, to digest microorganisms, and to return the breakdown products to the liver.

spleen

True or False? Rovsing's sign is a test of referred rebound tenderness in appendicitis.

t

The nurse percussess Linda's liver dimensions. The span is 8 cm at the right midclavicular line and 4 cm at the midsternal line. These are expected dimensions for a healthy young adult. t or f

true

The nurse assesses a client with lower abdominal pain who reports localized tenderness in the right lower quadrant with right flank pain. Which assessment should the nurse conduct next?

Palpate the right lower quadrant for rebound tenderness. Localized tenderness anywhere in the right lower quadrant, even in the right flank, suggests appendicitis. The nurse should follow this finding with an assessment of rebound tenderness. This will assist the nurse in determining if the client is guarding and develops muscle rigidity—two additional features of appendicitis.

Murphy's sign is used to assess for what?

acute cholecystitis

The nurse would assess for positive Blumberg sign how?

Applying and releasing pressure to the abdomen Pain upon releasing pressure indicates parietal inflammation associated with appendicitis

The nurse is preparing to assess the size of the aorta. The nurse would palpate at which location? A) Midline at the umbilicus B) Deep epigastrium to the left of midline C) Slightly above the suprapubic area D) Between the umbilicus and the symphysis pubis

B) Deep epigastrium to the left of midline

Josh is a 14-year-old boy who presents with a sore throat. On examination, you notice dullness in the last intercostal space in the anterior axillary line on his left side with a deep breath. What does this indicate? A) His spleen is definitely enlarged and further workup is warranted. B) His spleen is possibly enlarged and close attention should be paid to further examination. C) His spleen is possibly enlarged and further workup is warranted. D) His spleen is definitely normal.

B) His spleen is possibly enlarged and close attention should be paid to further examination. This scenario is not uncommon in infectious mononucleosis. The presence of dullness with inspiration should definitely increase your attention to further examination of the spleen, although dullness can occur in normal patients too

A nurse observes tenderness over the costovertebral angle on the right side. The nurse recognizes this as an abnormal finding for which organ? A) gallbladder B) kidney C) liver D) spleen

B) Kidney

Which of the following would a nurse suspect if dullness is percussed at the last interspace at the anterior axillary line on deep inspiration? A) Hepatomegaly B) Splenomegaly C) Abdominal mass D) Intestinal air

B) Splenomegaly

A client complains of a burning sensation of in the esophagus after eating. Which associated condition should the nurse most suspect? A) gastric ulcer B) acid reflux C) pancreatic cancer D) acute pancreatitis

B) acid reflux

Which change in auscultation of bowel sounds should the nurse recognize as diagnostic of an intestinal obstruction? A) increase in the frequency of the gurgles B) an increase in the pitch C) a soft click every 5-15 seconds D) no sound heard in 1 minute

B) an increase in the pitch

Jim is a 60-year-old man who presents with vomiting. He denies any blood in his emesis, which has been present for 2 days. He does note a dark granular substance resembling the coffee left in the filter after brewing. What should the nurse suspect? A) bleeding from diverticulum B) bleeding from peptic ulcer C) bleeding from colon cancer D) bleeding from cholecystitis

B) bleeding from Peptic ulcer (When blood is exposed to the environment of the stomach, it often resembles "coffee grounds.)

A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates the correct way to assess the client for ascites? A) inspect the abdominal skin for vascularity B) percuss the flanks from the bed upward toward the umbilicus C) palpate the abdomen lightly for areas of tenderness D) auscultate for bowel sounds in all 4 quadrants

B) percuss the flanks from the bed upward toward umbilicus

A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis? A) Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses. B) Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding. C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding. D) Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.

C) Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.

The nurse is percussing a client's' liver and is assessing liver descent. The nurse would have the client do which of the following? A) Cough forcefully B) Hold his or her breath C) Breathe deeply D) Perform the Valsalva maneuver

C) Breathe deeply

A nurse suspects intra-abdominal bleeding in a client who was involved in a motor vehicle accident 3 days ago. Which finding would the nurse most likely have noted? A) Tenderness on palpation B) Diastasis recti C) Cullen's sign D) Tympany on percussion

C) Cullen's sign Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. It is named for gynecologist Thomas Stephen Cullen (1869-1953), who first described the sign in ruptured ectopic pregnancy in 1916.

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? A) Right upper quadrant B) Left upper quadrant C) Right lower quadrant D) Left lower quadrant

C) Right lower quadrant

When inspecting a client's abdominal contour, the nurse observes the abdomen to be sunken with the lower edges of the ribs visible. The nurse documents this as which of the following? A) Flat B) Rounded C) Scaphoid D) Protuberant

C) Scaphoid

A young patient presents with a left-sided mass in her abdomen. You confirm that it is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen? A) A palpable "notch" along its edge B) The inability to push your fingers between the mass and the costal margin C) The presence of normal tympany over this area D) The ability to push your fingers medial and deep to the mass

C) The presence of normal tympany over this area A left upper quadrant mass is more likely to be a kidney if there is no palpable "notch," you can push your fingers between the mass and the costal margin, there is normal tympany over this area, and you cannot push your fingers medial and deep to the mass. These findings are very difficult to appreciate in an obese patient

Which action by the nurse will facilitate relaxation of the abdominal muscles during examination of the abdomen? A) provide privacy to the client and instruct them to relax B) raise the client's arms or fold them behind the head C) flex the client's legs by placing a pillow under the knees D) avoid the use of a pillow behind the head during examination

C) flex the client's legs by placing a pillow under the knees

A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should the nurse measure to assess improvement? A) auscultate for bowel sounds B) perform percussion for tympany C) measure abdominal girth D) palpate the abdomen

C) measure abdominal girth

A scaphoid abdomen is characterized as a: A.Convex contour with taut stretching of skin over the abdominal wall B.Convex symmetrical profile, with minimum height of the abdomen at the umbilicus C.Concave symmetrical profile. D.Asymmetrical profile, possibly indicating the presence of a tumor or a bowel obstruction

C. Concave symmetrical profile.

Proper client positioning for inspection of the abdomen is: A.Lying flat B.Side lying C. Supine with small pillows under head and knees D.High Fowler's suported by pillows

C. Supine with small pillows under head and knees

A young adult male who comes to the emergency department complaining of abdominal pain for the past 3 days is suspected having a ruptured appendix. The nurse auscultates the client's bowel sounds, noting them to be which of the following? A) Normoactive B) Hyperactive C) Hypoactive D) Absent

D) Absent

During deep palpation of the abdomen, the nurse identifies a soft, nontender, solid mass extending 2 to 3 cm below the right costal margin. Which of the following would be most appropriate? A) Refer the client for medical follow-up. B) Evaluate further for a problem with the spleen. C) Assess urinary output. D) Document the position of the liver.

D) Document the position of the liver.

Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent? A) Sigmoid mass B) Tumor in the abdominal wall C) Hernia D) Enlarged bladder

D) Enlarged bladder It is possible that this represents a sigmoid colon mass, but this is less likely than an enlarged bladder. Prostatic hypertrophy is very common in this age group and can frequently cause partial urinary obstruction with bladder enlargement. If the mass resolves with catheterization, this is a likely cause. Other forms of urinary obstruction such as neurogenic bladder, urethral stricture, and side effects of drugs can also be contributing to the problem. A hernia would most likely not be dull to percussion. Midline abdominal wall tumors of this size would be unusual but could be discerned by having the patient tense his abdominal muscles.

The nurse demonstrates the correct technique for assessing the psoas sign by which action? A) Applying deep palpation pressure to the client's right lower quadrant, then suddenly releasing B) Tapping fingerpads over the client's abdominal wall, feeling for a floating mass C) Flexing the client's right hip and knee, rotating the hip internally and externally D) Flexing the client's right hip, applying downward pressure on the right thigh

D) Flexing the client's right hip, applying downward pressure on the right thigh

A nurse is preparing to palpate a client's spleen. Which position would the nurse use to facilitate palpation? A) Sitting B) Lying prone C) Left side-lying D) Right side-lying

D) Right side-lying

Which of the following would be most appropriate if a nurse palpates the abdomen and feels a prominent, nontender, pulsating 6-cm mass above the umbilicus? A) Refer the client to an oncologist. B) Provide a dietician consult for the client. C) Counsel the client regarding hernia repair. D) Stop palpating and get medical assistance.

D) Stop palpating and get medical assistance

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

D) Tympany which changes location with patient 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 that dullness when supine would argue against this. Likewise, because fluid gathers in dependent areas, the flanks should ordinarily be dull with ascites. Tympany which changes location with patient position ("shifting dullness") would support the presence of ascites. A fluid wave and edema would support this diagnosis as well.

A nurse inspects a client's abdomen and notices a large bulge is present in the RLQ. How should the nurse further assess this finding using inspection? A) have the client cough forcefully a few times B) percuss to determine if the mass is fluid filled C) palpate to measure the diameter of the mass D) ask the client to raise the head off the bed

D) ask the client to raise the head off the bed

A nurse is attempting to palpate the abdomen of a 6-year-old female, but the girl is so ticklish that the nurse cannot proceed. Which of the following should the nurse do? A) adjust the bed level B) hold the nurse's hand under warm water just before the exam C) drape the client's genital area when the client is not being examined D) place the client's hand under the nurse's hand for a few moments

D) place the client's hand under the nurse's hand for a few moments

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

D) 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.

A positive Murphy's sign indicates: A.Appendicitis B.Peritonitis C.Hepatitis D.Cholecystitis

D. Cholecystitis

When auscultating for bowel sounds, you should place your stethoscope on the patient's abdomen holding: A.The diaphragm firmly. B.The bell firmly. C.The bell lightly. D.The diaphragm lightly.

D.The diaphragm lightly.

In which abdominal quadrant is the spleen located?

LUQ

auscultating before percussion bc?

Percussion may alter the frequency of bowel sounds.

How do you perform Murphy's test, what is a positive Murphy's sign and what does it indicate?

Press down under the liver border at the R. costal angle. Ask the pt. to inhale deeply. Accentuated sharp pain causes the pt. to hold breath (inspiratory arrest)=+ Murphy's (acute cholecystitis)

Which quadrant is most of the liver located?

RUQ

position for assessing abdomen

Supine with arms at sides or folded across chest

Muscle pain elicited with right leg elevation while supine; associated with appendicitis

psoas sign

Pain in RLQ when pressure is released in LLQ suggesting peritoneal irritation or appendicitis

rebound tenderness

Abdominal pain can be described as visceral, parietal, or _______ pain.

referred

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? a) "It takes about 3-5 days after surgery for the bowel sounds to return completely" b) "You need to call the health care provider immediately for orders" c) "Did you listen for five (5) minutes in all four (4) quadrants of the abdomen?" d) "The nasogastric tube is preventing you from hearing the bowel sounds correctly"

a) "It takes about 3-5 days after surgery for the bowel sounds to return completely"

The nurse is assessing a patient and notes dullness to percussion in the lowest point of the abdomen. When rolling the patient to the left, the nurse notes that there is now dullness on the left side. This indicates ascites, which can be caused by a) Cirrhosis and nephrosis b) CHF and pyelonephritis c) CHF and CAD d) Metastatic neoplasms and CAD

a) Cirrhosis and nephrosis

When assessing risk of colon cancer, which of the following health-history components should the nurse prioritize?

fam hx, dietary habits

Small organ in right hypochondriac and right epigastric areas

gallbladder

A positive obturator sign can suggest what?

inflammation of the appendix; however, this test has low sensitivity The obturator sign or Cope's obturator test is an indicator of irritation to the obturator internus muscle. The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession. The patient lies on her/his back with the hip and knee both flexed at ninety degrees.

Extends from RUQ to just left MSL inferior to diaphragm

liver

Sharp abdominal pain halting inspiration elcited when palpating liver; associated with cholecystitis

murphy's sign

Extends from LUQ at widest portion and tails to the left axillary area

pancreas