Deck 18: Abdomen

Question 1

The recommended sequence of the components of an abdominal examination is inspection followed by

A) palpation, percussion, and auscultation.
B) auscultation, palpation, and percussion.
C) percussion, auscultation, and palpation.
D) auscultation, percussion, and palpation.

Answer 1

auscultation, percussion, and palpation.

Question 2

When performing an abdominal examination, you should

A) visualize the underlying abdominal structures.
B) avoid looking at the patient's face to minimize apprehension.
C) first examine areas of tenderness identified by the patient.
D) proceed quickly without superfluous conversation.

Answer 2

visualize the underlying abdominal structures.

Question 3

Which substance impairs gastric absorption and increases the risk of gastrointestinal bleeding?

A) coffee
B) tobacco
C) caffeinated beverages
D) alcohol

Answer 3

alcohol

Question 4

In which abdominal quadrant is most of the liver located?

A) right upper quadrant
B) right lower quadrant
C) left upper quadrant
D) left lower quadrant

Question 5

A patient reports having vomitus that looks like coffee grounds.You realize this is a description of what?

A) fresh gastrointestinal blood
B) blood that has had time to mix with digestive juices
C) bile
D) fecal matter

Question 6

Parietal pain,which originates in the parietal peritoneum,is described as

A) severe from the onset and precisely localized.
B) dull initially and poorly localized.
C) having a gradual onset and poorly localized.
D) cramping throughout the abdominal area.

Question 7

In which abdominal quadrant is the spleen located?

A) right upper quadrant
B) right lower quadrant
C) left upper quadrant
D) left lower quadrant

Question 8

A female patient has a liver span of 13.5 cm with a liver descent of 4 cm.These findings suggest

A) normal findings.
B) hepatomegaly.
C) ascites.
D) atrophy of the liver.

Question 9

During auscultation of a patient's abdomen,you hear a high-pitched sound that resembles the sound of two pieces of sandpaper being rubbed together.This sound is most likely the result of

A) a bruit caused by turbulent blood flow through a partially obstructed artery.
B) a venous hum caused by blood flow through portal veins obstructed by portal hypertension.
C) a murmur caused by turbulent blood flow from an abdominal aortic aneurysm.
D) a friction rub caused by the rubbing together of inflamed layers of the peritoneum.

Question 10

When auscultating for bowel sounds,you should place your stethoscope on the patient's abdomen holding the

A) bell firmly.
B) diaphragm lightly.
C) bell lightly.
D) diaphragm firmly.

Question 11

Dilated and engorged veins around the umbilicus are known as

A) Cullen's sign.
B) caput medusae.
C) Von Recklinghausen's disease.
D) Sister Mary Joseph's nodule.

Question 12

You note marked,strong abdominal pulsations in the epigastric area when inspecting a patient's abdomen.These most likely indicate

A) normal peristaltic waves.
B) abnormal peristaltic waves.
C) distended abdomen.
D) aortic aneurysm.

Question 13

Normal bowel sounds are heard as

A) continuous, low-pitched rumbling sounds.
B) intermittent, high-pitched tinkling sounds occurring every 10-25 seconds.
C) intermittent, high-pitched gurgling sounds occurring 5-30 times per minute.
D) intermittent, loud gurgling sounds.

Question 14

A patient experiencing referred pain from a disease process in the liver may experience discomfort in the

A) back and left shoulder.
B) right shoulder.
C) right upper quadrant of the abdomen.
D) left upper quadrant of the abdomen.

Question 15

A patient in the late stages of a complete intestinal obstruction resulting from a large cancerous mass is most likely to have

A) absent bowel sounds.
B) borborygmi.
C) hypoactive, or diminished, bowel sounds.
D) hyperactive, or increased, bowel sounds.

Question 16

While auscultating a patient's epigastric region,you hear a blowing sound,which you determine to be

A) normal gastric sounds.
B) a bruit, indicating turbulent blood flow.
C) a thrill, indicating that an aneurysm may be present.
D) normal aortic pulsations.

Question 17

Liver descent is determined by percussing the lower border of the liver at the right midclavicular line first as the patient

A) holds a deep breath and then again after the patient exhales.
B) exhales completely after taking a deep breath and then exhales after a normal breath.
C) breathes normally and then again as the patient breathes deeply.
D) holds a deep breath and then after the patient coughs, inhales deeply, and holds his breath again.

Question 18

The size of the liver correlates directly with

A) lung size.
B) body fat percent.
C) age.
D) body size.

Question 19

Liver span is measured to examine the liver's

A) shrinkage.
B) relocation.
C) enlargement.
D) capacity.

Question 20

A scaphoid abdomen is characterized as a(n)

A) convex symmetrical profile, with maximum height of the abdomen at the umbilicus.
B) convex contour with taut stretching of skin over the abdominal wall.
C) concave symmetrical profile possibly due to flaccid muscles.
D) asymmetrical profile, possibly indicating the presence of a tumor or a bowel obstruction.

Question 21

A client is diagnosed with hepatitis A and asks the nurse how to avoid infecting other family members.The nurse's response would be based on the understanding that the spread of hepatitis A is primarily

A) from person to person through fecal contamination or contaminated food and water.
B) sexual contact with an infected person who does not show symptoms of the disease.
C) by contaminated needles from a person who has some form of hepatitis.
D) through blood transfusions of improperly prepared blood.

Question 22

Which of the following accurately describes a distinguishing feature that will assist you in determining whether you are palpating an enlarged right kidney or an enlarged liver?

A) The edge of the liver is sharper, and the pole of the kidney is more rounded.
B) The edge of the liver can be "captured," whereas an enlarged kidney cannot.
C) Dullness to percussion is heard over the liver, whereas resonance is heard over the right kidney.
D) A palpable notch on the medial edge of the organ favors the kidney.

Question 23

When examining a patient's right lower quadrant for cutaneous hypersensitivity,you elicit a painful response as you

A) gently touch his skin with a cotton-tipped applicator.
B) lift a fold of skin away from the underlying muscle.
C) place a warm washcloth on his abdomen.
D) flex his left leg.

Question 24

Muscle guarding,or tensing of the rectus muscles,during expiration indicates

A) the patient may be anxious.
B) bulging of the aorta.
C) possible pyelonephritis.
D) possible peritonitis.

Question 25

A 44-year-old patient is concerned about colorectal cancer because of a change in bowel habits.Which of the following is a risk factor for colorectal cancer?

A) vegetarian diet
B) alcohol intake of one beer every night
C) body mass index of 32
D) marathon runner

Question 26

As you perform the iliopsoas muscle test on a patient with acute abdominal pain,the patient complains of pain in the right lower quadrant as you place your left hand over his right thigh and

A) press upward with your right hand under his thigh as he raises his leg.
B) gently jab his abdomen with a pin.
C) press downward on his right thigh as he raises his leg, flexing at the hip.
D) flex his leg at the hip and knee with your right hand under his lower leg.

Question 27

You should be particularly careful when performing deep palpation of the abdomen in patients with suspected

A) cancer of the bowel to prevent metastasis.
B) ascites to prevent fluid shifting and electrolyte loss.
C) enlarged spleen to prevent rupture.
D) fecal impaction or severe diarrhea to prevent pain.

Question 28

A positive Murphy's sign suggests which of the following disorders?

A) hepatitis
B) appendicitis
C) peritonitis
D) cholecystitis

Question 29

When palpating the liver's edge using the hook method,you find an enlarged,hard liver with irregular borders and nodules.These findings suggest what pathology?

A) cirrhosis
B) liver malignancy
C) hepatitis
D) ascites

Question 30

A patient's chief complaint is an initial incident of vomiting followed by the onset of abdominal pain that has lasted more than 3 hours.To examine the patient's abdominal pain,you apply firm pressure to his abdomen for 4 seconds with your hand at a 90° angle and your fingers extended.After you release the pressure,the patient complains of pain at the pressure site,indicating

A) referred rebound tenderness.
B) localized pain.
C) direct rebound tenderness.
D) positive Cullen's sign.

Question 31

Your patient,a 62-year-old white male whose chief complaint is abdominal discomfort,is jaundiced and has an enlarged abdomen.The patient denies any tenderness after you perform fist percussion over his liver.This finding most likely indicates

A) a normal finding.
B) hepatitis.
C) insensitivity to pain associated with a grossly enlarged liver.
D) obstructed bile ducts.

Question 32

As you perform the obturator muscle test on a patient with acute abdominal pain,the patient complains of pain.Typically,irritation of the obturator internus muscle causes pain

A) in the right lower quadrant.
B) throughout the perineum.
C) at McBurney's point.
D) in the hypogastric area.

Question 33

During an inspection of the abdomen,which of the abdominal findings should the nurse report as abnormal?

A) strong abdominal pulsations
B) bilateral symmetrical abdomen
C) flat abdominal contour
D) depressed umbilicus beneath the abdominal surface

Question 34

Splenic enlargement is indicated when the area of dullness on percussion is over

A) 3 cm.
B) 5 cm.
C) 6 cm.
D) 8 cm.

Question 35

The nurse is evaluating the pain complaints of four clients.Which client does the nurse report to the primary care provider as indicative of peptic ulcer disease?

A) right upper quadrant (RUQ) pain radiating to the right shoulder
B) low, colicky abdominal pain
C) a gnawing epigastric pain relieved by food
D) left upper quadrant (LUQ) pain that radiates to the back

Question 36

The palpation technique of ballottement is employed to

A) examine the amount of fluid in the abdominal cavity.
B) locate an organ or mass by displacing the fluid in the abdominal cavity.
C) determine the source of fluid in the abdominal cavity.
D) displace the fluid in the abdomen to prevent pressure on enlarged organs.

Question 37

Palpation of the abdominal aorta reveals an aorta width of 5 cm and lateral pulsation.This finding suggests a(n)

A) normal finding.
B) ruptured aorta.
C) abdominal aortic aneurysm.
D) coarctation of the aorta.

Question 38

During an examination of the abdomen the nurse should

A) position the patient in the supine position with the bed flat and knees straight.
B) listen in all four quadrants for 1 minute for bowel sounds.
C) use the following order of technique: inspection, auscultation, percussion, palpation.
D) describe bowel sounds as absent if no sound is heard in the LRQ after 2 minutes.

Question 39

Which of the following is not an appropriate action to take when palpating a patient's abdomen?

A) Palpate painful or tender areas last.
B) Instruct the patient to hold her breath throughout the examination.
C) Palpate using gentle pressure initially and gradually increasing it.
D) Allow the ticklish patient to perform self-palpation with your hand over the patient's hand.

Question 40

To examine a patient for Murphy's sign,palpate below the liver margin at the lateral border of the rectus muscle and then ask the patient to take a deep breath.Murphy's sign is present when the patient

A) complains of pain with palpation.
B) complains of pain in the right lower quadrant.
C) adducts the leg.
D) complains of pain in the left shoulder.

Question 41

Enlarged,palpable kidneys can be caused by which of the following? Select all that apply.

A) Pyelonephritis
B) Hydronephrosis
C) Neoplasms
D) Cirrhosis
E) Polycystic kidney disease
F) Congestive heart failure

Question 42

The most commonly used abdominal examination approach is the ____________________ technique.

Question 43

The spleen,gallbladder,stomach,liver,bile duct,small intestine,and large intestine are considered the ____________________ organs.

Question 44

A nursing instructor quizzes the students on the anatomical structures located in the abdomen.One question was to identify the structures in the right lower quadrants of the abdomen.Which responses by the students would indicate that further study is needed? Select all that apply.

A) Cecum
B) Spleen
C) Appendix
D) Duodenum
E) Stomach
F) Sigmoid colon

Question 45

Which of the following is cause for concern when palpating the inguinal lymph nodes?

A) small, movable nodes
B) a 0.75 cm palpable node
C) nonmovable nodes
D) nontender nodes

Question 46

The examination of a patient reveals a positive Rovsing's sign,which is abdominal pain felt in the right lower quadrant as you pressed deeply and evenly for 5 seconds

A) in her left lower quadrant (LLQ).
B) in her right lower quadrant (RLQ).
C) directly over her ileocecal valve.
D) in her umbilical area.

Question 47

Costovertebral angle tenderness can occur in ____________________.

Question 48

A 62-year-old white male whose chief complaint is abdominal discomfort,is admitted to your unit.The patient is jaundiced and has an enlarged abdomen.To further evaluate for ascites,you ask the patient to kneel and assume the knee-chest position for several minutes.You then percuss his abdomen.Which of the following confirms the presence of ascites in the patient's abdomen?

A) increased tympany over the abdomen
B) dullness over the umbilical area
C) increased dullness in the flanks
D) increased dullness in the right upper quadrant over the liver

Question 49

____________________ bowel sounds indicate decreased motility.

Question 50

Which of the following are risk factors for the Hepatitis A Virus (HAV)? Select all that apply.

A) Perinatal transmission
B) Overcrowded living quarters
C) Men who have sex with men
D) Having multiple sexual partners
E) Food and water contamination
F) Ingestion of shell fish from contaminated areas

Question 51

Risk factors for esophageal cancer include which of the following? Select all that apply.

A) Obesity
B) Alcohol use
C) Female gender
D) Tobacco use
E) Cancer of the lung, mouth, or throat
F) Diet high in vegetables and fruits

Question 52

A 62-year-old white male whose chief complaint is abdominal discomfort is admitted to your unit.The patient is jaundiced and has an enlarged abdomen.Upon percussing the patient's abdomen,you determine that ascites is present on the basis of which finding?

A) hyperresonance to percussion in the left lower quadrant
B) change from tympany to resonance as you percuss each quadrant of the abdomen
C) dullness detected in the right upper quadrant
D) shift in location of the areas of dullness as he turns from side to side

Question 53

A female patient reports an increase of involuntary loss of urine with sneezing and coughing.Her past medical history reveals uterine cancer,an abdominal hysterectomy,and radiation therapy.What type of incontinence is she most likely experiencing?

A) stress incontinence
B) urge incontinence
C) overflow incontinence
D) functional incontinence

Question 54

You are assigned to a 45-year-old Caucasian female client who was admitted for possible bladder cancer.The patient's history revealed that she is married with three children,aged 2,5,and 9.She has worked as a hair dresser in order to supplement the family income for the past 8 years.The patient denies tobacco or alcohol use,but states that there is a family history of alcoholism,drug dependence,bladder cancer,heart disease,and diabetes.Which of the following pieces of data regarding the patient,places her at risk for bladder cancer? Select all that apply.

A) Age
B) Gender
C) Ethnicity
D) Marital status
E) Type of occupation
F) Family history of bladder cancer

Question 55

The nurse teaches the female patient who has frequent UTIs that she should

A) take tub baths with bubble bath.
B) take prophylactic sulfonamides for the rest of her life.
C) urinate after sexual intercourse.
D) restrict fluid intake to prevent the need for frequent voiding.