The nurse places the diaphragm of a warmed stethoscope on a client's abdomen to auscultate the bowel sounds. Which finding is considered normal?

Musical intermittent sounds.

Irregular dicks and gurgles.

High pitched tinkling.

Longed prolonged

Answer and Explanation

The Correct Answer is B

A.   Musical sounds or high-pitched, tinkling noises are not typically considered normal bowel sounds. These types of sounds might indicate increased bowel activity or bowel obstruction. They are usually associated with abnormal conditions like bowel obstruction or early signs of a bowel problem.
B.   This description is consistent with normal bowel sounds. Bowel sounds are usually described as clicks and gurgles that occur irregularly. They are typically heard as a mix of low to moderate pitched sounds and are a normal part of the gastrointestinal activity. Normal bowel sounds usually have an irregular pattern and may vary in frequency and intensity.
C.   High-pitched tinkling sounds are not considered normal and could indicate abnormal bowel activity. These sounds are often associated with increased intestinal motility, which can occur in conditions such as bowel obstruction. They suggest that the bowel is more active than normal, which could be a sign of an underlying problem.
D.   Prolonged gurgling sounds can sometimes be heard in cases of increased bowel activity but are not typical of normal bowel sounds. Normal bowel sounds are generally intermittent and irregular rather than prolonged. Prolonged gurgles might suggest issues like increased bowel activity or a bowel condition requiring further investigation.

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Correct Answer is B

Explanation

A. Soft tissue, such as the liver or spleen, typically produces a dull sound on percussion, not a high- pitched musical sound. Soft tissue is more associated with a dullness because it is denser compared to the surrounding air or fluids.
B. Gas in the gastrointestinal tract often produces a musical or high-pitched sound on percussion, known as tympany. This sound occurs because gas is less dense than other abdominal contents and resonates with a high pitch. Tympany is the most common sound heard when percussing over the stomach and intestines.
C. An intestinal mass, depending on its size and location, may produce a dull or a combination of dull and tympanic sounds. However, it is not typically associated with a high-pitched musical sound. Percussion over an intestinal mass would likely be dull rather than musical.
D. A full bladder typically produces a dull sound on percussion, not a musical high-pitched sound. A dull sound indicates the presence of a solid or fluid-filled structure, such as a full bladder.

A. Firm mass palpated at bottom of left rib cage. B. Rebound tenderness with compression over right upper quadrant. C. Tip of spleen palpable when client is asked to forcefully exhale. D. Pain noted when palpating McBurney's point.

Correct Answer is A

Explanation

A. A firm mass at the bottom of the left rib cage could indicate an enlarged spleen. Splenomegaly can result from various conditions such as infections, liver disease, or blood disorders. This finding is considered abnormal and warrants further evaluation.
B. Rebound tenderness in the right upper quadrant is used to assess for peritoneal irritation, often associated with conditions such as appendicitis. This finding is not specific to the spleen but rather indicates potential issues in the right side of the abdomen, and is not directly related to palpation of the spleen.
C. The spleen is normally not palpable in most people. If the tip of the spleen is palpable during deep palpation or when the client is asked to exhale forcefully, it may indicate mild splenomegaly. While this finding might suggest an abnormality, it is less alarming than a firm, consistently palpable mass.
D. McBurney’s point is located in the right lower quadrant and is used to assess for appendicitis. Pain at McBurney’s point is related to appendiceal inflammation and is not specific to the spleen. This finding does not provide information about the spleen but rather about potential appendiceal pathology.

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The nurse places the diaphragm of a warmed stethoscope on a client's abdomen to auscultate the bowel sounds. Which finding is considered normal?

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Naxlex Comprehensive Predictor Exams

While percussing the abdomen of an adult male client, the nurse encounters a musical high-pitched sound. Which does this finding indicate?

Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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