Chapter 23: Assessing Abdomen

The peritoneum is a serous membrane that contains which of the following?

A parietal layer

When palpating the abdomen the nurse finds a large pulsating mass. The nurse would suspect this is what?

Abdominal aortic aneurysm

Which of the following acute abdominal symptoms could be life threatening?

Abdominal pain

A 26-year-old sports store manager comes to the clinic with severe right-sided abdominal pain for 12 hours. He began having a stomach ache yesterday with a decreased appetite, but today the pain seems to be just on the lower right side. He has had some nausea and vomiting but no constipation or diarrhea. His last bowel movement was last night and was normal. He has had no fever or chills. He denies any recent illnesses or injuries. His past medical history is unremarkable. He is engaged. He denies any tobacco or drug use and drinks four to six beers per week. His mother has breast cancer and his father has coronary artery disease. On examination he appears ill and is lying on his right side. His temperature is 38.8° and his heart rate is 170. His bowel sounds are decreased, and he has rebound and involuntary guarding at one third of the way between the anterior superior iliac spine and the umbilicus in the right low

Acute appendicitis

A 22-year-old law student comes to the office complaining of severe abdominal pain radiating to his back. He states it began last night after hours of heavy drinking. He has had abdominal pain and vomiting in the past after drinking but never as bad as this. He cannot keep any food or water down, and these symptoms have been going on for almost 12 hours. He has had no recent illnesses or injuries. His past medical history is unremarkable. He denies smoking or using illegal drugs, but admits to drinking 6 to 10 beers per weekend night. He admits that last night he drank around 14 drinks. Examination shows a young man appearing his stated age in some distress. He is leaning over on the examination table and holding his abdomen with his arms. His blood pressure is 90/60 and his pulse is 120. He is afebrile. His abdominal examination reveals normal bowel sounds, but he is very tender in the left upper quadrant and epigas

Acute pancreatitis

The client has epigastric pain that is poorly localized and radiates to the back. What would be an important diagnosis to assess for?

Acute pancreatitis

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?

An enlarged liver felt during palpation

An emergency department nurse is caring for a teenage client who has severe pain in the umbilical area. Documentation shows that the client exhibits "Rovsing's sign." What medical diagnosis is associated with the assessment finding?

Appendicitis

The nurse identifies the client has a positive Obturator sign. The nurse identifies this is due to what?

Appendicitis

The nurse notes that a client experiencing right lower quadrant abdominal pain when the hip and knee are flexed, and the leg is rotated internally and externally. What should the nurse suspect is occurring with this client?

Appendicitis

The nurse would assess for positive Blumberg sign how?

Applying and releasing pressure to the abdomen

A client presents complaining of nausea, vomiting, and acute abdominal pain. What is the nurse's first action?

Ask the client when the pain began.

The nurse is assessing a client in the emergency department. The client was involved in a motor vehicle accident and is experiencing left upper abdominal pain. The nurse should intervene when another health care provider does which of the following?

Attempts to palpate the spleen

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.

When palpating a client's abdomen, the nurse notes that the liver has a firm edge. What is the likely cause of his abnormal characteristic?

Cirrhosis

A college student presents to the health care clinic with reports of no bowel movement for 4 days, bloating, and generalized abdominal discomfort. She states that she has not been eating and drinking correctly and is stressed because she has a final exam in 2 days. A nurse assesses the abdomen and finds positive bowel sounds in all four quadrants and tenderness in the left lower quadrant with a few small, round, firm masses. The Rovsing's sign and Psoas sign are negative. What nursing diagnosis can the nurse confirm for this client?

Constipation related to decrease in fluid intake

The nurse assess for kidney tenderness at what location?

Costovertebral angle

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

An older client presents with symptoms of pain on urinating. The nurse recognizes that older adults are at increased risk for urinary tract infections for which of the following reasons?

Decreased activity of protective bacteria in the urinary tract

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

The client presents at the clinic with a chief complaint of pain in her upper abdomen. On assessment the nurse notes that the client has recurrent pain, more than two times weekly, in her upper abdomen, and that this recurrent pain started 2 months ago. What term should the nurse use for this type of pain?

Dyspepsia

Mr. Kruger, 84 years old, presents with a smooth lower abdominal mass in the midline, which is minimally tender. There is dullness to percussion up to 6 cm above the symphysis pubis. What does this most likely represent?

Enlarged bladder

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

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

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

Which of the following people need to be vaccinated for hepatitis A and B?

Food-service workers

A nurse is instructing a client who suffers from peptic ulcer disease about the causes of this condition. Which of the following should the nurse mention as a common bacterial cause?

Helicobacter pylori

The nurse has elicited a positive Murphy sign. What does the nurse recognize this indicates?

Inflammation of the gallbladder

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?

Irritable bowel syndrome

Where in the digestive tract is most of the water absorbed?

Large intestine

A nurse is inspecting the abdomen of a young, fit client who has well-defined abdominal muscles. The nurse recognizes the vertical line that appears in the center of the client's abdomen as which of the following?

Linea alba

A client is admitted to a health care facility with new onset of abdominal pain, fatigue, and low back pain. The client relates a 10-year history of high blood pressure. When auscultating the client's abdomen for bowel sounds, what other assessment should the nurse perform at this time?

Listen with the bell of the stethoscope for vascular sounds

Your client describes her stool as soft, light yellow to gray, mushy, greasy, foul-smelling, and usually floats in the toilet. What would you suspect is wrong with your client?

Malabsorption syndrome

A nurse cares for a client with a distended abdomen due to peritonitis. Which parameter should the nurse measure to assess improvement?

Measure abdominal girth

Where is the linea alba located?

Middle of the ventral abdominal wall

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?

Murphy's

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

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?

Obturator

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

A client complains of abdominal pain that is worsened with alcohol ingestion. The nurse should suspect which of the following as the underlying cause?

Pancreatitis

A nurse assesses a client with a distended abdomen. Which action by the nurse demonstrates the correct way to assess the client for ascites?

Percuss the flanks from bed upward toward the umbilicus

When assessing the abdomen, the nurse auscultates before percussing because:

Percussion may alter the frequency of bowel sounds.

How should the nurse perform blunt percussion over the liver?

Place right hand on mid of the rib cage; strike it with ulnar side of left fist

A nurse is attempting to palpate the abdomen of a 6-year-old girl, but the girl is so ticklish that the nurse cannot proceed. Which of the following should the nurse do?

Place the client's hand under the nurse's hand for a few moments

What precaution should the nurse take when measuring a client's abdominal girth to screen for cardiovascular risk factors?

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

The nurse understands that the liver does what?

Produces clotting factors

The client would complain of pain in what quadrant if experiencing appendicitis?

RLQ

The nurse correctly identifies the gallbladder is located where?

RUQ

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?

Referred pain

Diagnostic tests completed validate that a client has an obstruction of the ascending and transverse colon. Where should the nurse assess for bowel sounds around the obstruction?

Right upper quadrant

During the abdominal examination, a nurse performs deep palpation in the left lower quadrant. At this point, the client reports pain. This test is positive for which sign?

Rovsing's

A nurse performs light palpation of the abdomen and feels a prominent, nontender, pulsating mass above the umbilicus that measures approximately 6 cm. What is an appropriate action by the nurse?

Stop the palpation and notify the health care provider

The nurse is assessing a client with a bladder disorder. Where would the nurse expect the pain to be?

Suprapubic

The nurse auscultates hyperactive bowel sounds in the ascending colon and absent bowel sounds in the descending colon. What is the nurse's best action?

Tell the client not to eat or drink anything.

Which of the following statements provides the most accurate guide to the assessment of the gallbladder?

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

A young client presents with a left-sided mass in her abdomen. It is present in the left upper quadrant. Which of the following would support that this represents an enlarged kidney rather than her spleen?

The presence of normal tympany over this area

The nurse is assessing the abdomen of a client. While percussing the abdomen, what normal sound does the nurse expect to hear?

Tympany

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

The abdominal contents are enclosed externally by the abdominal wall musculature—three layers of muscle extending from the back, around the flanks, to the front. The outer muscle layer is the external

abdominal oblique.

For a client who is deemed to be an average risk for colorectal cancer, the nurse should review which screening test(s) according to recommendations from the American Cancer Society (2018)? Select all that apply.

all of the above

The nurse is performing an abdominal assessment for a client. What step(s) should the nurse take during the assessment? Select all that apply.

all of the above

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

ask the client to empty his bladder.

During the health history, a client who has abdominal pain reports having occasional nausea and diarrhea. In which section of the health history should the nurse document this finding?

associated manifestations

The nurse plans to assess an adult client's kidneys for tenderness. The nurse should assess the area at the

costovertebral angle.

The pancreas of an adult client is located

deep in the upper abdomen and is not normally palpable.

The nurse is assessing the abdomen of an adult client and observes a purple discoloration at the flanks. The nurse should refer the client to a physician for possible

internal bleeding.

While auscultating rushes of high-pitched bowel sounds a client complains of abdominal pain. What should the nurse suspect is occurring with this client?

intestinal obstruction

While assessing the abdominal sounds of an adult client, the nurse hears high-pitched tinkling sounds throughout the distended abdomen. The nurse should refer the client to a health care provider for possible

intestinal obstruction.

he sigmoid colon is located in this area of the abdomen: the

left lower quadrant.

To palpate the spleen of an adult client, the nurse should begin the abdominal assessment of the client at the

left upper quadrant.

A nurse assesses a client who reports abdominal pain. Which technique should the nurse use during the physical examination to detect tenderness?

light palpation

While assessing an adult client's abdomen, the nurse observes that the client's umbilicus is deviated to the left. The nurse should refer the client to a physician for possible

masses.

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

palpate deeply while quickly releasing pressure.

The nurse is assessing the bowel sounds of an adult client. After listening to each quadrant, the nurse determines that bowel sounds are not present. The nurse should refer the client to a physician for possible

paralytic ileus.

A nurse is assessing an older adult client admitted to the hospital with acute diverticulitis. No bowel sounds are heard for 5 minutes and the abdomen is firm and rigid. What complication would the nurse suspect?

peritonitis

To palpate the spleen of an adult client, the nurse should

place the right hand below the left costal margin.

To assess an adult client for possible appendicitis and a positive psoas sign, the nurse should

raise the client's right leg from the hip.

The colon originates in this abdominal area: the

right lower quadrant

When palpating the abdomen, the nurse may be able to feel the lower edge of the liver in which quadrant?

right upper

To percuss the liver of an adult client, the nurse should begin the abdominal assessment at the client's

right upper quadrant.

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

use the diaphragm of the stethoscope.

A nurse is assessing a client with a history of alcohol abuse. The client reports right upper quadrant pain. Which type of pain is the client experiencing?

visceral

A nurse observes silvery, white 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 regard to this finding?

"Have you been pregnant?"

A client reports that he has been experiencing diarrhea for the past week. What question by the nurse will assist in determining whether this client is truly experiencing an alteration in bowel pattern?

"How many times a day are you having a bowel movement?"