A nurse is performing an abdominal assessment as part of a client’s comprehensive physical examination. Which of the following is the final step the nurse should perform?

Choice A reason: Giving 2 ounces of water before newborn genetic screening is unnecessary and inappropriate, as the test involves a heel stick blood sample, not oral intake. Water may disrupt feeding or hydration balance in newborns, making this statement incorrect and irrelevant.
Choice B reason: Newborn genetic screening is typically a one-time test shortly after birth, not repeated at 2 months unless specific conditions warrant follow-up. Routine repetition is not standard, making this statement inaccurate for general teaching about the screening process.
Choice C reason: Blood for newborn genetic screening is collected via a heel stick, not the inner elbow, to minimize discomfort and obtain sufficient capillary blood. Drawing from the elbow is incorrect and impractical for newborns, making this statement inaccurate.
Choice D reason: Performing genetic screening after 24 hours ensures accurate detection of metabolic disorders, as newborns need time to metabolize nutrients. This timing aligns with national guidelines (e.g., AAP), making it essential and correct information for parents about the screening process.

Choice A reason: Percussion precedes palpation to assess abdominal resonance and organ size without altering bowel motility. Performing it last risks inaccurate findings, as palpation may stimulate peristalsis, changing resonance patterns. This sequence ensures reliable detection of abnormalities like organomegaly or fluid accumulation in the abdomen.
Choice B reason: Auscultation is done before palpation to capture natural bowel sounds. Manipulation during palpation can alter peristalsis, affecting auscultatory findings. Early auscultation ensures accurate detection of hypoactive or hyperactive bowel sounds, critical for diagnosing conditions like ileus or obstruction in abdominal assessments.
Choice C reason: Palpation is the final step, following inspection, auscultation, and percussion, to assess for tenderness or masses. This sequence prevents manipulation from altering earlier findings, ensuring accurate identification of abdominal abnormalities like peritonitis or organ enlargement, critical for a comprehensive physical examination.
Choice D reason: Inspection is the first step, providing a visual baseline of abdominal appearance, such as distension or scars. Performing it last misses initial cues guiding subsequent steps. Early inspection ensures no manipulation affects visual assessment, vital for identifying external signs of underlying abdominal pathology.