A nurse is planning to collect data about the abdomen of a client who reports "stomach pain". Which of the following actions should the nurse take first?

Percuss

Auscultate.

Palpate.

Inspect

Answer and Explanation

The Correct Answer is D

A. Percuss:
Percussion involves tapping the abdomen with the fingers to assess for areas of dullness or resonance. Dullness might indicate organ enlargement or mass, while resonance is the typical sound over air-filled structures. This step helps identify the borders and size of organs.

B. Auscultate:
Auscultation involves listening to the abdomen using a stethoscope. The nurse listens for bowel sounds, which are the noises made by the movement of the intestines. Absence or abnormal bowel sounds can indicate intestinal obstruction or other gastrointestinal issues.

C. Palpate:
Palpation involves gently pressing the abdomen to assess for tenderness, masses, or areas of discomfort. This step helps identify areas of pain or tenderness, guarding, or rigidity, which might indicate inflammation, infection, or other abdominal issues.

D. Inspect:
Inspection involves visually assessing the abdomen for any visible abnormalities such as scars, distention, pulsations, or visible masses. It's the first step in the abdominal assessment process as it provides initial information about the overall condition of the abdomen before physical contact.

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Correct Answer is D

Explanation

A. Docusate:
Docusate is a stool softener used to prevent constipation and straining during bowel movements. It is not typically used as a treatment for acute exacerbation of ulcerative colitis.

B. A bowel cathartic medication:
Bowel cathartic medications are laxatives that promote bowel movements. They are generally not used to treat acute exacerbation of ulcerative colitis and can sometimes worsen symptoms in individuals with inflammatory bowel disease.

C. Aspirin:
Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can worsen symptoms of inflammatory bowel disease and is generally avoided in individuals with ulcerative colitis.

D. A corticosteroid medication:
This is the correct answer. Corticosteroids, such as prednisone, are often used to reduce inflammation in the colon during acute exacerbations of ulcerative colitis. They help in managing the symptoms and promoting healing of the inflamed intestinal lining.

A. Diabetes mellitus B. Hepatitis A C. Cirrhosis D. Cholecystitis

Correct Answer is C

Explanation

A. Diabetes mellitus
Diabetes mellitus can cause easy bruising and slow wound healing, but it is not typically associated with frequent nosebleeds.

B. Hepatitis A
Hepatitis A primarily affects the liver and does not cause frequent bruising and nosebleeds.

C. Cirrhosis
Cirrhosis, which is scarring of the liver tissue due to long-term liver damage, can lead to impaired liver function. One consequence of cirrhosis is decreased production of clotting factors, which can result in easy bruising. Additionally, the enlarged spleen in cirrhosis can lead to thrombocytopenia (low platelet count), contributing to bleeding tendencies, including nosebleeds. Cirrhosis is the most likely condition given the symptoms described.

D. Cholecystitis
Cholecystitis is inflammation of the gallbladder and is not directly associated with frequent bruising and nosebleeds.

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A nurse is planning to collect data about the abdomen of a client who reports "stomach pain". Which of the following actions should the nurse take first?

Nursing Test Bank

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