The physician comments that the client has abdominal borborygmi. The nurse recognizes that which of the following is the best description of borborygmi?

A peritoneal friction rub

Loud continual humming bowel sounds

Hypoactive bowel sounds

Loud gurgling bowel sounds

Answer and Explanation

The Correct Answer is D

Choice A rationale: A peritoneal friction rub is a grating sound caused by the movement of inflamed peritoneal surfaces and is not associated with bowel sounds.

Choice B rationale: Loud continual humming bowel sounds do not accurately describe borborygmi and are not a common term used to describe bowel sounds.

Choice C rationale: Hypoactive bowel sounds indicate decreased bowel motility and are not associated with borborygmi.

Choice D rationale: Borborygmi refers to loud, gurgling bowel sounds that are audible without the use of a stethoscope. It is a normal sound associated with the movement of gas and fluid through the intestines.

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Correct Answer is B

Explanation

Choice A rationale: The Glasgow Coma Scale is used to assess the level of consciousness, not specific weakness in the extremities.

Choice B rationale: A complete neurological examination is appropriate to assess the client's weakness in the left arm and leg. This examination includes evaluating motor function, sensory function, coordination, reflexes, and cranial nerve function.

Choice C rationale: A muscular examination may focus on specific muscle groups but may not provide a comprehensive assessment of neurological function.

Choice D rationale: A neurologic recheck examination is not a standardized term and may not cover all aspects of a complete neurological assessment.

A. Tell the adolescent, everything will be fine and there’s nothing to worry about. B. Complete an assessment and notify the emergency department physician immediately. B. Perform a focused assessment and document. C. Document pain assessment as normal

Correct Answer is B

Explanation

Choice A rationale: Telling the adolescent that everything will be fine without a thorough assessment may delay necessary interventions.
Choice B rationale: Excruciating pain in the testicle requires immediate attention since it could be an indication of testicular torsion. The nurse should complete an assessment and notify the emergency department physician promptly.
Choice C rationale: While documentation is important, the priority is to address the immediate needs of the adolescent in severe pain.
Choice D rationale: Documenting pain assessment as normal is not appropriate when the client is experiencing excruciating pain.

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The physician comments that the client has abdominal borborygmi. The nurse recognizes that which of the following is the best description of borborygmi?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client comes to the clinic and reports having weakness in the left arm and leg for the past week. The nurse should perform which type of neurological exam?

Correct Answer is B

Explanation

An adolescent male is brought to the emergency department with complaints of excruciating pain in his left testicle. Which of the following should be the priority action by the nurse?

Correct Answer is B

Explanation

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