A nurse is assessing a client's abdomen who reports stomach pain. Which of the following actions should the nurse take first?

Inspect

Palpate

Auscultate

Percuss

Answer and Explanation

The Correct Answer is A

A. Inspection is usually done first to observe any obvious abnormalities, but it is not the immediate action when the client reports pain.

B. Palpation should be done last, as it can cause discomfort or alter the findings of other assessment techniques.

C. Auscultating the abdomen should be done second after inspection. This is recommended because bowel sounds should be assessed before palpation, as palpation may alter the sounds.

D. Percussion can follow auscultation, but it is not the immediate action.

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Correct Answer is B

Explanation

A. Asking "Would it help to discuss your feelings about this hospitalization?" is more closed and may not effectively promote discussion about the client's health history.

B. Asking "What brought you to the hospital?" is an open-ended question that allows the client to provide a comprehensive answer and facilitates a meaningful discussion about their health and hospitalization.

C. "Would you tell me about all of your medical issues?" is too broad and could overwhelm the client. A more specific question would be more effective.

D. "Do you want to talk about your health concerns?" is a yes/no question and may not encourage open communication.

A. Decreased muscle mass B. Reduced chest width C. Thickened vertebral disks D. Increased force of isometric contraction

Correct Answer is A

Explanation

A. Decreased muscle mass is a normal age-related musculoskeletal change. This can lead to reduced strength and mobility in older adults.

B. Chest width typically remains stable, though changes in lung function or posture may occur with aging.

C. Vertebral disks tend to thin and lose hydration with age, not thicken.

D. The force of isometric contraction typically decreases with aging due to muscle weakness and decreased muscle mass.

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A nurse is assessing a client's abdomen who reports stomach pain. Which of the following actions should the nurse take first?

Nursing Test Bank

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