The nurse completes percussion of the abdomen on an adult client. Which finding is considered normal?
Absolute dullness.
Absent sounds.
Pain.
Musical and drum like.
The Correct Answer is D
A. Absolute dullness: This typically indicates fluid or a mass in the abdomen and is not a normal finding.
B. Absent sounds: Complete absence of bowel sounds can be a sign of an obstruction or ileus.
C. Pain: Pain during percussion suggests inflammation or irritation in the underlying organs.
D. Musical and drum like sounds: These are normal bowel sounds produced by gas and fluid movement within the intestines.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Takes a first step alone: This is typically achieved closer to 12 months.
B. Sits alone unsupported: Some 8-month-olds might achieve this, but pulling to sit is a more consistent milestone at this age.
C. Can feed self finger food: While some babies might explore finger foods at 8 months, independent feeding is usually a skill developed later.
D. Pulls self to sitting position: This demonstrates developing upper body strength and coordination, commonly seen around 8-9 months.
Correct Answer is D
Explanation
A. Triceps skin fold and mid-arm circumference. These measurements can provide some indication of nutritional status, but they may not be as reliable in older adults due to changes in body composition and skin elasticity.
B. Twenty-four-hour food recall, preferences, and allergies. While dietary information is important, it may not accurately reflect the client's current nutritional status.
C. Weight loss history and body surface area (BSA). While weight loss history is relevant, BSA is not typically used to assess nutritional status.
D. Body mass index (BMI) and serum albumin level. BMI is a commonly used indicator of nutritional status, and serum albumin level reflects protein status, which is important for assessing malnutrition.
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