The nurse understands, when performing an abdominal assessment, which order is correct:

Percussion, inspection, palpation, and auscultation

Inspection, auscultation, palpation, and percussion

Inspection, palpation, auscultation, and percussion

Palpation, auscultation, inspection, and percussion

Answer and Explanation

The Correct Answer is B

A. Percussion, inspection, palpation, and auscultation: Beginning with percussion before visually inspecting the abdomen disrupts the standard flow of assessment; inspection is normally the first step to note contour, scars, or distension.

B. Inspection, auscultation, palpation, and percussion: Starting with inspection then auscultation follows recommended practice (listen before you manipulate); percussion and palpation are then listed, but most textbook guidance places percussion before palpation to avoid altering bowel sounds.

C. Inspection, palpation, auscultation, and percussion: Palpation before auscultation can change bowel sounds and is generally avoided because palpation may introduce or alter bowel noises.

D. Palpation, auscultation, inspection, and percussion: Palpation first can disturb findings and inspection should come before hands-on techniques; this sequence does not follow standard abdominal assessment order.

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Correct Answer is B

Explanation

A. Cutaneous pain: Cutaneous pain originates from the skin and is superficial; while it may be described as burning, this scenario after amputation more commonly reflects a nerve-origin phenomenon.

B. Neuropathic pain: Burning, shooting, or electric-like sensations after nerve injury or amputation (including phantom limb pain) are characteristic of neuropathic pain caused by peripheral/central nervous system changes.

C. Visceral pain: Visceral pain arises from internal organs and is usually dull, poorly localized, and not described as a localized burning on a limb after amputation.

D. Somatic pain: Somatic pain comes from muscles, bones, joints, or connective tissue and is usually localized aching or throbbing; phantom/burning sensations after amputation are classically neuropathic.

A. Heart rate of 77 B. Urine output of 300 ml in 24-hour C. Temperature of 99.2 oral D. Pain rating 3 on 1-10 pain scale

Correct Answer is B

Explanation

A. Heart rate of 77: A heart rate of 77 bpm is within normal resting range for many adults and would not typically demand immediate intervention.

B. Urine output of 300 ml in 24-hour: 300 ml in 24 hours is markedly low (oliguria); inadequate urine output may indicate hypovolemia, renal impairment, or obstruction and requires immediate assessment and intervention.

C. Temperature of 99.2 oral: 99.2°F is a low-grade elevation and can be common after surgery; it is not usually an immediate emergency at 24 hours post-op.

D. Pain rating 3 on 1–10 pain scale: A pain score of 3 is mild/moderate and typically managed with routine analgesia and reassessment rather than immediate urgent action.

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The nurse understands, when performing an abdominal assessment, which order is correct:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client experienced a left above-the-knee amputation (AKA) due to a motorcycle accident one week prior. The client called the nurse, stating feeling burning pain on the surface of his left lower leg. The nurse understands the client is experiencing which of the following:

Correct Answer is B

Explanation

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Correct Answer is B

Explanation

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