The nurse is assessing a client who reports abdominal pain. Which assessment technique will the nurse perform first?
inspection
percussion
palpation
auscultation
The Correct Answer is A
A. Inspection: Inspection is always the first step in any physical examination, including abdominal assessments. It allows the nurse to visually assess the abdomen for distension, asymmetry, discoloration, or other abnormalities.
B. Percussion: Percussion is performed after inspection and auscultation. It helps assess the density of abdominal contents but should not be the first step.
C. Palpation: Palpation is performed last in an abdominal exam to avoid altering bowel sounds and causing discomfort. It should be done after inspection, auscultation, and percussion.
D. Auscultation: Auscultation is typically the second step after inspection to listen for bowel sounds before palpation and percussion, which might alter them.
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Related Questions
Correct Answer is B
Explanation
A. "I will make exercise a part of my daily activities." This is a positive and correct statement. Regular exercise is an important component of a healthy lifestyle and should be encouraged.
B. "I should eat a diet high in fats but low in fiber." This statement is incorrect and indicates a misunderstanding of healthy dietary guidelines. A diet high in fats and low in fiber is not recommended for maintaining health and can lead to various health issues like obesity, heart disease, and digestive problems.
C. "I only have one glass of wine a day with dinner." This statement aligns with moderate alcohol consumption guidelines, which suggest that up to one glass of wine per day for women and two for men can be part of a healthy lifestyle.
D. "I will begin a smoking cessation program this week." This statement reflects a positive health choice. Quitting smoking is one of the most beneficial actions a person can take for their health, reducing risks for many diseases.
Correct Answer is B
Explanation
A. Administer oxygen at 2 L/min: Administering oxygen is important but should be done after positioning the client to improve natural ventilation.
B. Raise the head of the bed: Raising the head of the bed is the first action to take as it facilitates better lung expansion and improves ventilation. This can help increase the oxygen saturation more immediately and effectively.
C. Encourage coughing and deep breathing: Encouraging coughing and deep breathing is also beneficial to help clear secretions and improve lung function, but positioning the client for optimal breathing should be prioritized first.
D. Administer prescribed analgesic medication. Administering analgesics may be necessary for pain management, but it does not directly address the immediate need to improve oxygen saturation.
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