A home health nurse is teaching a client about home safety. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.)

Choice A reason:
Increased night-time sleeping is the appropriate finding. As individuals age, it is common for their sleep patterns to change. Older adults often experience changes in their sleep duration, including increased night-time sleeping and daytime napping. This can be attributed to changes in circadian rhythm and other factors.
Choice B reason:
A heightened sense of pain is incorrect. Older adults may experience a decreased sensitivity to pain, known as hypoalgesia, due to changes in the nervous system.
Choice C reason:
Decreased sense of balance is incorrect. While changes in balance can occur with aging, they are not universal. Many older adults maintain good balance through exercise and other strategies.
Choice D reason:
Night-time urinary incontinence is incorrect. While some older adults may experience night-time urinary incontinence, it is not a universally expected finding and can be influenced by various factors, including overall health and lifestyle.

Choice A reason:
Palpation can help assess for tenderness, rigidity, or masses in the abdomen, which might indicate infection, bleeding, or other complications. However, palpation could potentially worsen a condition such as an evisceration or dehiscence, or cause additional pain. Therefore, palpation should be done only after the visual inspection and with great caution in the presence of severe pain.
Choice B reason:
Percussion is useful for assessing the presence of gas, fluid, or solid masses in the abdomen. Resonance might indicate normal air-filled intestines, while dullness could suggest fluid or mass. However, percussion is not the first action in an acute setting of sudden severe pain because it does not provide immediate information that could be life-saving. It is a later step in the physical examination.
Choice C reason:
Visual inspection is the first step because it can quickly reveal critical signs such as swelling, distention, redness, or evidence of wound complications like dehiscence or evisceration. Identifying these signs early allows for rapid intervention, which could be life-saving. This is why exposing and inspecting the abdomen is the priority in the context of sudden severe pain following surgery.
Choice D reason:
Listening for bowel sounds can provide information about the function of the gastrointestinal system. Absence of bowel sounds might suggest a paralytic ileus, while hyperactive sounds could indicate a bowel obstruction. However, in the context of sudden, severe abdominal pain postoperatively, auscultation is not the first priority.