A clinical instructor is reviewing the abdominal assessment with a group of students.
She would include which of the following three percussion sounds the nurse would expect to hear? (Select 3 options)
Hyperresonance.
Flatness.
Dullness.
Resonance.
Tympany.
Correct Answer : B,E,C
Choice A rationale
Hyperresonance is a booming sound elicited during percussion, typically heard over hyperinflated lung tissue, such as in emphysema or pneumothorax. In the abdominal assessment, hyperresonance is generally not an expected finding and may indicate gaseous distension.
Choice B rationale
Flatness is a dull, very soft sound with a short duration, usually heard over dense tissues such as bone or muscle. In the abdomen, flatness is not a typical percussion sound and might be elicited over a large tumor or organomegaly.
Choice C rationale
Dullness is a thud-like sound with a medium intensity and duration, typically heard over solid organs such as the liver, spleen, or a distended bladder. In the abdominal assessment, dullness is an expected finding over these organs.
Choice D rationale
Resonance is a hollow sound of moderate duration and low pitch, typically heard over normal lung tissue. Resonance is not an expected percussion sound in the abdominal assessment; tympany and dullness are the predominant sounds.
Choice E rationale
Tympany is a drum-like sound with high pitch and longer duration, commonly heard over air-filled structures such as the stomach and intestines. Tympany is the predominant percussion sound expected over most of the abdomen due to the presence of gas in the gastrointestinal tract.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Explaining the location of food items on the plate using the clock face analogy (e.g., "your meat is at 12 o'clock, your vegetables are at 3 o'clock") provides a consistent and easily understandable spatial reference for a visually impaired patient. This method allows the patient to independently locate and access different food items, promoting autonomy during meals.
Choice B rationale
Encouraging eating one food at a time based on preference does not directly address the challenge of navigating the plate when blind. While respecting preferences is important, it doesn't provide a systematic way for the patient to know where each food item is located.
Choice C rationale
Ordering finger foods might seem helpful, but it limits the variety and nutritional balance of the patient's diet. Not all foods can be easily eaten with fingers, and this approach does not promote independence in eating a regular meal.
Choice D rationale
Feeding the patient completely removes their independence and can be disempowering. The goal is to assist the patient in maintaining as much autonomy as possible, and explaining food placement allows them to eat independently.
Correct Answer is A
Explanation
Choice A rationale
Dried beans, such as lentils, kidney beans, and chickpeas, are excellent sources of plant-based protein. They contain a significant amount of amino acids, which are the building blocks of protein, making them a valuable addition to a vegetarian toddler's diet to support growth and development.
Choice B rationale
Cooked carrots are primarily a source of vitamins, particularly beta-carotene (a precursor to vitamin A), and fiber. They contain minimal amounts of protein and are not the best choice for increasing dietary protein intake in a vegetarian toddler.
Choice C rationale
Sliced bananas are a good source of carbohydrates, potassium, and some vitamins. However, they are low in protein and would not significantly contribute to increasing the dietary protein intake of a vegetarian toddler.
Choice D rationale
Whole wheat bread contains some protein, but it is not as concentrated a source as dried beans. While whole grains are important for fiber and overall nutrition, dried beans offer a higher protein content per serving, making them a better choice for increasing protein intake.
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